Transcript View - Alcohol and Drug Abuse Institute

Drug Trends in Washington State
& King County
Caleb J. Banta-Green MPH MSW
Alcohol & Drug Abuse Institute
University of Washington
http://adai.washington.edu
Substance Abuse Research Forum
October 26, 2004
Seattle WA
Overview
• Washington survey data
• Treatment admissions
• Drugs seized by law enforcement
• Drug use in Northwest jails
• Drug-involved ER visits and Deaths in King
County
Focus
• Prescription Opiates
• Methamphetamine
• Infectious Diseases and Injection Drug Use
Conclusion
2
Alcohol Use and Binge Drinking Past Month,
WA State (2002)
70
60
50
40
%
30
20
10
0
Total
12-17
Alcohol Use
18-25
26 or Older
Binge Drinking
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
NOTE: Binge Alcohol Use is defined as drinking five or more drinks on the same occasion
(i.e., at the same time or within a couple of hours of each other) on at least 1 day in the past 30 days.
3
Illicit Drug Use in the Past Month,
WA State (2002)
25
20
15
%
10
5
0
Total
12-17
Marijuana
18-25
26 or Older
Illicit not marijuana
NOTE: Any Illicit Drug includes marijuana/hashish, cocaine (including crack), heroin, hallucinogens,
inhalants, or any prescription-type psychotherapeutic used nonmedically.
Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2002.
4
Treatment Data
Utility as drug trends measure
• Only a partial measure of drug use and treatment
demand
• Also need to consider:
–
–
–
–
Shifts in priorities, policies, practices
Caseloads
Treatment retention (longer retention fewer open slots)
Treatment availability- facilities, slots, beds, modalities,
staffing
– Funding availability
– Wait lists
– Private treatment utilization
5
Total # of Treatment Admissons, WA State (Publicly
Funded)
16,000
14,000
12,000
10,000
8,000
6,000
4,000
2,000
Al
co
es
Am
ph
ia
op
er
O
th
et
am
in
te
s
in
er
o
H
M
ar
iju
an
a
e)
he
rr
(o
t
e
in
oc
a
oc
ai
C
ou
t
ed
)
ok
(s
m
ne
C
ho
lw
ith
se
co
Al
co
nd
a
ho
ry
lo
nl
y
dr
ug
0
1993
2003
Note- Treatment admissions totaled 43,269 in 1993 and 49,415 in 2003
BRFSS data do not show a decrease in chronic or binge drinking
Source: Treatment Episode Data Set (TEDS), Data provided by the WA St. Div of Alcohol & Substance Abuse to TEDS
6
Female Treatment Admissions, WA State
(Publicly Funded)
60
50
40
% 30
20
10
ia
es
Am
ph
op
er
O
th
e
et
am
in
te
s
in
er
o
H
M
ar
iju
an
a
e)
ou
t
(o
t
he
rr
ok
ed
)
in
oc
a
C
oc
ai
ne
nd
a
co
se
lw
ith
(s
m
ry
lo
ho
Al
co
ho
Al
co
C
nl
y
ta
l
To
dr
ug
0
Source: Treatment Episode Data Set (TEDS)
1993
2003
7
Youth Treatment Admissions, WA State
(Publicly Funded)
60
50
40
% 30
20
10
ia
es
Am
ph
op
er
O
th
et
am
in
te
s
in
er
o
H
iju
M
ar
(o
t
an
a
e)
he
rr
ou
t
ed
)
C
oc
a
in
e
in
oc
a
C
lw
ith
se
co
e
nd
a
(s
m
ry
lo
ho
Al
co
Al
co
ho
ok
nl
y
ta
l
To
dr
ug
0
Source: Treatment Episode Data Set (TEDS)
1993
2003
8
WA State Patrol Drug Seizure Testing, 2003
WA State, Excluding Seattle
Seattle Lab
MDMA,
Heroin, 1.4
5.0
Cannabis,
17.2
Meth.,
27.2
Oxycodone,
0.9
HydroOxy- codone, Pseudo1.1
ephedrine,
codone,
0.8
1.2
PCP, 0.9
Heroin, 6.5
Cocaine,
40.5
Cannabis,
15.5
Meth., 47.8
Cocaine,
20.6
Data in these figures represent 93% of drugs tested in each region
Seattle Lab 3,212 items; WA Labs, excluding Seattle, 12,332 items
Source: National Forensic Lab Information System, Used With Permission. Based upon
data from the Washington State Patrol Forensic Toxicology Laboratory.
9
Male Adult Arrestee's Recent Drug Use (2001)
70
60
50
40
30
20
10
Seattle, WA
Portland, OR
ru
gs
D
M
ul
tip
le
5
NI
DA
An
y
M
Spokane, WA
dr
ug
PC
P
e
ph
et
am
in
et
ha
m
M
ar
iju
an
a
te
s
O
pi
a
e
0
Co
ca
in
% Positive Drug Test
Urine Drug Screen Results
National Median
Source: National Institute of Justice, Arrestee Drug Abuse Monitoring Program
10
Detailed Death and Emergency
Department Data Are Available
Only for King County
12
Street Drug Involved Deaths, King County
150
Heroin/
Morphine
# of Deaths
120
90
Cocaine
60
30
Amphetamines
0
1987
1989
1991
1993
1995
1997
1999
2001
2003
Note: These drugs have been coded consistently over time,
13
Drug Involved Deaths, King County ’97-’03
150
# of Deaths
120
90
60
30
an
t
e
ax
pi
at
re
l
e
cl
M
us
O
th
er
O
O
pi
at
er
o
H
ru
g
D
C
lu
b
in
/
/H
al
es
ep
r
D
e
.
lu
c
sa
nt
e
in
oc
a
C
Am
ph
et
am
in
e
0
Source: Medical Examiners Office, Public Health Seattle
King Count
Duplicated
data, most deaths involve multiple
drugs
Alcohol data excluded
14
E.D. Mentions of Alcohol & Illicit Drugs,
King & Snohomish Counties
250
Alcohol-incombi.
Estimated rate per 100,000
200
Cocaine
150
Heroin
100
Marijuana
50
Amphet.
Meth.
0
1995
1996
1997
1998
1999
Source: Drug Abuse Warning Network, Office of Applied Studies
2000
2001
2002
15
E.D. Mentions of Prescription Drugs,
King & Snohomish Counties
Estimated rate per 100,000
140
Prescription
opiates
120
100
80
Anx./Seds./
Hyp.
60
40
Muscle
relaxants
20
0
1995 1996 1997 1998 1999 2000 2001 2002
Source: Drug Abuse Warning Network, Office of Applied Studies
16
17
Prescription Opioid Trends
• Increases in Emergency Department visits
and Deaths in which prescription opiates
are mentioned or identified 1997-2002,
King County
• The majority of cases involve multiple
drugs, assigning causation to a particular
drug very difficult
• Appears to be an increase in appropriate
and inappropriate use of these drugs
across WA
18
Estimated Numbers of Persons Who First Used Pain
Relievers Nonmedically in Washington State
120
100
(1,000's)
80
60
40
20
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999-2001.
19
Pain Relievers (Nonmedical Use) in
Washington State
16
14
Percent (%)
12
10
8
6
4
2
0
1999
2000
2001
Past Year Use
Lifetime Use
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999-2001.
20
Prescription Opiate Distribution WA State (DEA)
Change 1997-01/02
Source: DEA ARCOS http://www.deadiversion.usdoj.gov/arcos/index.html
Data does not include methadone dispensed and administered at opiate substitution treatment clinics.
Fe
nt
an
yl
or
ph
in
e
M
Co
de
in
e
O
xy
co
do
Hy
ne
dr
*
om
or
ph
on
e*
Hy
dr
oc
od
on
e*
M
ep
er
id
in
e
M
et
ha
do
ne
*
400%
350%
300%
250%
200%
150%
100%
50%
0%
-50%
*2002
21
Methamphetamine Manufacturing
and Dump Sites
• Methamphetamine is the only drug, other
than marijuana, that is manufactured in
WA State
• Increasing control of precursor chemicals,
such as pseudoephedrine, appears to
have helped decrease manufacturing
• Chemicals used in manufacturing are
dangerous to people and the environment
22
Methamphetamine Labs and Dump Sites
2000
1800
1600
1400
WA State Total
1200
#
1000
800
Pierce
600
400
King
200
Snohomish
0
King
Pierce
Snohomish
WA State Total
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
6
10
2
7
7
10
23
17
48
107
231
271
241
202
10
18
18
12
17
17
53
42
129
318
545
589
438
466
2
2
7
6
5
13
37
69
83
98
38
43
153
203
349
789
1454
1890
1693
1480
2
40
42
36
54
Labs and/or dump sites have been found in every county in WA
Source: WA St. Dept of Ecology
23
Meth. Labs & Dumpsites Trend ’01-’02
24
Infectious Diseases &
Injection Drug Use
25
Newly Diagnosed HIV Cases 2001-’03
Exposure Categories
WA Except King
King County
Undeterm./
other, 10%
Undeterm.
/ other,
15%
Hetero.
contact,
11%
Hetero.
contact,
19%
IDU &
male-male
sex, 7%
Injecting
drug user,
6%
IDU &
male-male
sex, 7%
Malemale sex,
66%
Newly Diagnosed HIV cases in King County = 947,
Injecting
drug user,
14%
Malemale sex,
46%
WA except King= 534
* Cases diagnosed with HIV infection between January 2001 and December 2003, and reported to PHSKC or WA
DOH as of 3/31/04.
26
HIV infection among non-MSM/IDU
in King County remains low
•
•
•
•
HIV incidence (<.05%/year)
HIV prevalence (1-2%)
MSM/IDU
14% HIV prevalence
MSM/IDU Meth. Users 47% HIV prevalence
Source: Public Health-Seattle & King County
27
Hepatitis in King County
• Unchanged in recent years
• Hep B among IDU
– 70% prevalence of markers (total # of people)
– 10% incidence annually (new cases)
• Hep C among IDU
– 85% prevalence
– 21% incidence annually
Source: Public Health-Seattle & King County
28
Injection Drug Use
• Approximately 1/3 of those admitted to drug
treatment are or have been an injection drug
user
Needle Exchange
• Key informants in counties adjacent to those
with needle exchanges report regular use of
their neighbors’ exchanges
• At least 5,353,158 syringes were exchanged in
Washington in 2003 (WA St. Dept of Health,
SHARE)
• Needle exchanges are available in the following
counties:
29
Needle Exchanges
30
Conclusion
• Alcohol is the predominant drug of use and
abuse in the State
• Marijuana is the most common illicit drug used
• Heroin and Cocaine continue to be major drugs
of abuse, with substantial morbidity and mortality
• Over the past 5-10 years use and abuse of
Methamphetamine and Prescription opiates
have increased, with increasing morbidity and
mortality
31
adai.washington.edu
http://depts.washington.edu/adai/wa/
32
Drug Use Epidemiology Reports
33