Transcript WHO

- Established by the National Institute on Drug
Abuse (NIDA) in 1976.
-The Community Epidemiology Work Group
(CEWG) is a network composed of researchers
from major metropolitan areas of the United States
and selected foreign countries.
- They meet twice a year to discuss the current
epidemiology of drug abuse.
• The primary mission of the Work Group is to
provide ongoing community-level
surveillance of drug abuse through analysis of
quantitative and qualitative research data.
-
Through this program the CEWG
provides current descriptive and
analytical information regarding the
nature and patterns of drug abuse,
emerging trends, characteristics of
vulnerable populations and social and
health consequences.
SOURCES
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Drug abuse treatment admissions and discharges
Drug-related deaths
Drug-exposed newborns
Emergency room drug abuse episodes
Public health data
AIDS cases associated with injection drug use
Drug-related arrests
Price and purity levels (of illicit drugs)
Survey findings
Ethnographic research data
• Drug use in
• Introduction:
# area description
#data source and time period
• Drug Abuse trends:
#intro
# cocaine and crack
# heroin and other opiates
# marijuana # stimulant # depressant
# hallucinogens
• AIDS among injecting drug users
By comparing and assessing data
from different sources
concurrently , members are trying
to obtain a more comprehensive
view of drug abuse patterns and
trends within the US
BUT……
…CEWG has been (and still is)
quite criticized for not being
“scientific” enough…. 
• Interpretation of indicator
data, therefore, requires an
understanding of the
weaknesses and the strengths
of each data source and
variables within each database.
#Diversity of the sources : partial, imprecise
“unknown”, changing from year to year for
the same kind of information…
#Diversity within the agencies: Public
Health Services. Private institution.
Community based Services. University…
#Diversity within the people in terms of
interest, motivation, time available,
previous training, access to information,
support,…
# “Timing issues”: no real synchronization
between the information (dependent of the
availability, the sources…) information
often outdated.
# PEOPLE !: committed +++.
Knowledgeable. “Bonded together”.
Often very involved within the (their) community.
Extensive familiarity within the field of addiction.
Generosity in the distribution of the information.
#Diversity of the sources
#Diversity within the agencies
#Diversity within the people
#“Timing issues”: flexibility, rapidity in the exchange
and transmission of the information.
CEWG members, through systematic
analysis of indicator data and
supplementary information from local
field studies, identify and track
increases and decreases in the
availability and use of illicit drugs;
The CEWG serve as an early warning
system by identifying the emergence of
drugs and drug use patterns (as in the
use of crack);
• the CEWG substantiates the fact that
indicator data from multiple sources can
provide the basis for decisive action (as in
the case of methaqualone)
• through CEWG reports, it is possible to track
the spread of drug use patterns from one
area to another.
• the CEWG not only identifies changes in the
use patterns of particular drugs but also the
way they are used (as in the case of blunts).
• the CEWG identifies 'vulnerable populations'
(such as use of crack among African
American in inner city neighborhoods).
• Atlanta,A/Baltimore,M/Boston,MA/Chicago,IL/
• Denver, CO/Detroit, MI/Honolulu, HI/
• Los Angeles,CA/Miami, FL/
• Minneapolis/St.Paul,MN/
Newark, NJ/
• New Orleans,LA/
• Philadelphia, PA
• New York, NY
Phoenix, AZ
• Seattle, WA San Diego, CA
San Francisco,CA
• St. Louis, MO Texas (Statewide) Washington D.C.
COCAINE
• Indicators remain elevated in most area
• ED Mention increase in Los Angeles/San
Diego/Phoenix/Denver/Miami.
• Decline reported in 18 of the 21 CEWG area.
• Downward particularly in areas where the abuse
has been most concentrated.
• Cocaine ranks first in DAWN ME drug-related
deaths in 9 sites: Miami (78% of deaths) Atlanta (97%)
Chicago (58%) New York (52%) Dallas(48%) Cleveland
(45%)Washington DC(44%) Detroit (40%) St.Louis(30%)
• The aging-out of the crack abuser seems to be a
major factor in this decline
• Atlanta: crack use is moving to rural area outside
the city.
• Cocaine is emerging as a significant problem
along the Texas-Mexico border (ADAM and
school survey data)
• Methamphetamine indicators, which
appeared to be trending downward from
1997 through the first half of 1999,
showed signs of increasing again during
the last half of 1999.
• Predominantly White
• The next racial/ethnic group is persons of
Mexican origin
• In Los Angeles:
- MA in Hispanic populations continues
to grow as a primary drug
-Females make up 47% of
MA/amphetamine admission
WEST
Coast has the highest
rate:
#On the basis of several indicators,
Hawaii can probably lay claim to
being the crystal MA capital of the
U.S.
#Increases in MA ED mentions in the
second half of 1999 were significant in
nine CEWG areas, including four on
the West coast with the highest rates of
MA ED mentions (San Diego, San
Francisco, Los Angeles, and Seattle).
Expansion continues toward the
East:
• State Enforcement Agencies and local Law
Enforcement reported significant and rapid
growth in MA-related activity in Minnesota in
2000
• According to Sioux Falls Resident Office, MA
has surpassed marijuana as the drug of choice
in South Dakota
• The clandestine production of MA in Southern
Illinois is increasing at an alarming rate.
EAST COAST:
Maryland-Baltimore:
Amphetamine
related
treatment admission fell to 0 in 1998, and only a
handful of amphetamine related ED admissions
have been reported.
New York/ New Jersey: Very little in NY. Arrest,
ED, Death: negligible.
Massachusetts /Boston: Stimulant indicators
remain very low, but reports continue to suggest
that amphetamine and MA are available if not
widely abused.
Pennsylvania/Philadelphia:Very little. Present in a
sections of Philadelphia along the Delaware
River; in nightclubs with GHB ecstasy.
FLORIDA:
-Historically, extremely low MA issue. One reason
could be that the cocaine dealers would not allow
MA traffic because it is a concurrent for cocaine.
-Now major MA activity is going on in central
Florida.
-MA has been abused by people relatively close to
the manufacturer.
• Reports from 11 CEWG areas indicate that
MA is being used along with other drugs at
raves
• Ethnographers are reporting a serious and
sometimes fatal practice of using Viagra with
MA and other drugs
• “Box lab”: A portable MA manufacturing setup that can be carried in the trunk
Hepatitis C:
# estimation worldwide:170 millions (3.9 in US; 36,000
new/y -CDC2000-)
# Prevalence rate among drug users who began “last
year”: 60% + for HCV
80% of HIV infected user are co-infected with HCV.
# Snorting is considered as a “safe” drug habit; in reality,
it is a significant risk for HCV+ tuberculosis
# Among intra nasal users the ones who use MA are
particularly at risk because MA is associated with
bleeding
• Indicators are trending UPWARD in 15 CEWG
sites; Atlanta; Baltimore++; Boston; Chicago;
Detroit (price is lowest ever: $.62 per milligram in
99); Miami; Mpls./St Paul.; Newark++; New
Orleans; Philadelphia; Seattle; St Louis.
• Stable but still with high ED mentions in Los
Angeles; Newark; New York and San Francisco
• Decrease in Dallas, Honolulu and San Diego.
• As in the past, increase among young
populations (DAWN ED data; treatment
admissions data)
• Heroin is often used in combination with
cocaine (either concurrently or sequentially)
• Based on DEA’s Drug Monitor Program data
for January-March 2000, purity tends to be
higher in the Northeast (Newark 76.7%;
Philadelphia 72.8% Boston 65.6%; New York
60.2%)
• The 1998 Dawn data from Medical
Examiner show that heroin/morphine
accounted for the largest % of drug
related/ death mentions in 8 CEWG areas:
Baltimore (75%) -Seattle (62%)Boston(55%)-Philadelphia(54%)-San
Francisco(52%)-San Diego(49%)Phoenix(45%)-Los Angeles(39%)
-Between 1990 and 1998
marijuana/hashish indicators increased
dramatically in ALL CEWG areas.
- In 1999 indicators were mixed with some signs
that abuse of the drug is stabilizing.
– Decrease or stabilization in ED mentions
– Increases in primary marijuana treatment
admissions.
Potential reasons for the increase in
mentions/use:
# increased availability
# increased concentration of THC in
commercial street marijuana and in
sinsemilla.
# increased use of other substances in
combination (99:hydrocodone and MDMA)
# packaging forms that permit use of large
quantities of mj. at one time, e.g. in BLUNTS
(common practice in most CEWG areas)
# medico-legal/treatment issues.
Potential reasons for the increase in
treatment admission while other
indicators are decreasing or stabilizing
• ?referrals from drug courts and other criminal
justice agencies accounting for treatment
admission increase?
• ? nature and extent of multiple drug use among
primary marijuana treatment admission?
(e.g. in Dallas some young mj. abusers dip joints
in embalming fluid containing PCP or in codeine
cough syrup)
Club Drugs include Alcohol, LSD (Acid), MDMA
(Ecstasy), GHB, GBL, Ketamine (Special-K),
Fentanyl, Rohypnol, amphetamines and
methamphetamine.
# MDMA use has been reported as more
widespread in 17 CEWG cities.
Chicago, Denver, Miami, Atlanta, New
Orleans, San Francisco, Austin, Seattle,
Boston, Detroit, New York, St. Louis, Los
Angeles, Minneapolis St Paul, Dallas, and
Washington, D.C.
#Price per pill or dosage unit varies slightly
across CEWG sites e.g., Dallas ($10-$20)
Denver ($15-$20) New York ($20-$25)
Phoenix ($20-$40) Seattle ($15-$30).
• MDMA is now being used in a variety of social
settings, including dance clubs, raves, house parties,
bar, and by individuals “just hanging out” .
• Ecstasy use is hidden in suburban areas
• MDMA is used among a wide variety of age groups
MDMA use in combination with hashish increased
from 8 (1990) to 796 (1999) in Dawn ED mentions.
• It is widely believed by users that Ecstasy pills
contain drugs such as heroin, cocaine or speed.
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• Grievous Bodily Harm, G, Georgia Home
Boy “Liquid ecstasy” “Liquid X” “G”
“Scoop”
# Increasingly involved in poisoning,
overdoses,”date rape” and fatalities.
# GHB (central nervous system depressant)
was placed in Schedule 1 on March 13,
2000.
#GBL listed as chemical.
# DEA has documented over 5,700 overdoses
and/or law enforcement encounters with
GHB (1999)
• CEWG cities in which GHB use has
been reported include: Detroit,
Phoenix, Honolulu, Miami, New
York , Atlanta, Minneapolis/St. Paul,
Dallas, Seattle, San Francisco, San
Diego, New Orleans, Newark, Los
Angeles, Baltimore, Boston, and
Denver.
.#
Ketamine (or special K), is an injectable
anesthetic that has been approved for both
human and animal use in medical settings since
1970. About 90 percent of the ketamine legally
sold today is intended for veterinary use.
# Ketamine is produced in liquid form or as a
white powder that is often snorted or smoked
with marijuana or tobacco products. In
some cities (e.g. Boston, New Orleans, and
Minneapolis/St. Paul), ketamine is reportedly
being injected intramuscularly. It is also
reported in the composition of pills.
# CEWG cities in which Ketamine use has been
reported include: Seattle, Miami, New York,
Chicago, Minneapolis/St. Paul, Newark,
Boston, Detroit, New Orleans, and San Diego
Acid, Boomers,
Yellow Sunshine
CEWG cities in which LSD use has been
reported (ED mentions per 100,000 pop
year 1999) include: Phoenix (8), New
Orleans, Seattle and Denver (6), Boston,
Detroit, Chicago, San Francisco, Atlanta.
# CLONAZEPAM
# HYDROCODONE (e.g.,Lortec, Lortab,Vicodin)
139% increase in ED mentions from 1993 to 1999.
Often associated with marijuana
# HYDROMORPHONE (e.g., Dilaudid)
# OXYCODONE (e.g., Percodan, Percocet.)
• CANADA
CCENDU ( Canadian Community
Epidemiology Network on Drug Use).
• MALAYSIA
Amphetamine Type Stimulants(ATS)++.
• MEXICO
• THAILAND:
# Dramatic increase in Amphetamine Type
Stimulants(ATS)-Manufacturing of ATS and
retail market have expanded extensively.
Indictments for distribution were increasing
dramatically for women age 40 and older.
# Heroin, opium and other narcotics indicators
have been decreasing
• Are amphetamine indicators rising ? ( apart from
methamphetamine indicators)
• Why are treatment admission for primary abuse
of marijuana is increasing so dramatically?
• To what extent is hepatitis C increasing among
different drug using population?
• What are the health risks associated with
different combinations of drugs used
concurrently and sequentially?
• http://www.nida.nih.gov/
http://165.112.78.61/CEWG/CEWGHome.html
• http://165.112.78.61/ClubAlert/Clubdrugalert.html
• http://165.112.78.61/CEWG/Retro.html
http://www.dancesafe.org/currentresults.html