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Drug Trends in Washington State & King County
Caleb J. Banta-Green MPH MSWAlcohol & Drug Abuse Institute
University of Washingtonhttp://adai.washington.edu
Substance Abuse Research ForumOctober 26, 2004
Seattle WA
2
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
3
Alcohol Use and Binge Drinking Past Month, WA State (2002)
0
10
20
30
40
50
60
70
Total 12-17 18-25 26 or Older
%
Alcohol Use 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.
4
Illicit Drug Use in the Past Month,WA State (2002)
0
5
10
15
20
25
Total 12-17 18-25 26 or Older
%
Marijuana 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.
5
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
6
Note- Treatment admissions totaled 43,269 in 1993 and 49,415 in 2003BRFSS 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
Total # of Treatment Admissons, WA State (Publicly Funded)
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
16,000
Alcoho
l only
Alcoho
l with
sec
onda
ry d
rug
Cocai
ne (s
mok
ed)
Cocai
ne (o
ther
rout
e)
Mar
ijuan
a
Heroin
Other
opi
ates
Amph
etam
ines
1993 2003
7Source: Treatment Episode Data Set (TEDS)
Female Treatment Admissions, WA State (Publicly Funded)
0
10
20
30
40
50
60
Total
Alcoho
l only
Alcoho
l with
sec
onda
ry d
rug
Cocai
ne (s
mok
ed)
Cocai
ne (o
ther
rout
e)
Mar
ijuan
a
Heroin
Other
opi
ates
Amph
etam
ines
%
1993 2003
8Source: Treatment Episode Data Set (TEDS)
Youth Treatment Admissions, WA State (Publicly Funded)
0
10
20
30
40
50
60
Total
Alcoho
l only
Alcoho
l with
sec
onda
ry d
rug
Cocai
ne (s
mok
ed)
Cocai
ne (o
ther
rout
e)
Mar
ijuan
a
Heroin
Other
opi
ates
Amph
etam
ines
%
1993 2003
9
Data in these figures represent 93% of drugs tested in each regionSeattle 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.
WA State Patrol Drug Seizure Testing, 2003
Seattle Lab
Cocaine, 40.5
Cannabis, 17.2
MDMA, 1.4
Oxy-codone,
0.9
Meth., 27.2
Heroin, 5.0
PCP, 0.9
WA State, Excluding Seattle
Meth., 47.8
Cocaine, 20.6
Cannabis, 15.5
Oxy-codone,
1.2
Hydro-codone,
1.1Pseudo-
ephedrine, 0.8
Heroin, 6.5
10
Male Adult Arrestee's Recent Drug Use (2001)Urine Drug Screen Results
0
10
20
30
40
50
60
70
Cocain
e
Opiates
Mar
ijuana
Met
ham
pheta
mine
PCP
Any N
IDA 5
dru
g
Mult
iple Dru
gs
% P
ositi
ve D
rug
Tes
t
Spokane, WA Seattle, WA Portland, OR National Median
Source: National Institute of Justice, Arrestee Drug Abuse Monitoring Program
13
Street Drug Involved Deaths, King County
Note: These drugs have been coded consistently over time,
Cocaine
Heroin/ Morphine
Amphetamines
0
30
60
90
120
150
1987 1989 1991 1993 1995 1997 1999 2001 2003
# o
f De
ath
s
14
Duplicated data, most deaths involve multiple drugsAlcohol data excluded
0
30
60
90
120
150
Amph
etam
ine
Cocai
ne
Depre
ssan
t
Club D
rug/
Hal
luc.
Heroin
/Opia
te
Other
Opia
te
Mus
cle re
laxa
nt
# o
f De
ath
s
Source: Medical Examiners Office, Public Health Seattle King Count
Drug Involved Deaths, King County ’97-’03
15
Alcohol-in-combi.
Cocaine
Heroin
Marijuana
Amphet.
Meth.0
50
100
150
200
250
1995 1996 1997 1998 1999 2000 2001 2002
Est
ima
ted
ra
te p
er
10
0,0
00
E.D. Mentions of Alcohol & Illicit Drugs, King & Snohomish Counties
Source: Drug Abuse Warning Network, Office of Applied Studies
16
Anx./Seds./Hyp.
Prescription opiates
Muscle relaxants
0
20
40
60
80
100
120
140
1995 1996 1997 1998 1999 2000 2001 2002
Est
ima
ted
ra
te p
er
10
0,0
00
E.D. Mentions of Prescription Drugs, King & Snohomish Counties
Source: Drug Abuse Warning Network, Office of Applied Studies
18
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
19
Estimated Numbers of Persons Who First Used Pain Relievers Nonmedically in Washington State
0
20
40
60
80
100
120
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000
(1,0
00's
)
Source: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999-2001.
20
Pain Relievers (Nonmedical Use) in Washington State
0
2
4
6
8
10
12
14
16
1999 2000 2001
Per
cent
(%
)
Past Year Use Lifetime UseSource: SAMHSA, Office of Applied Studies, National Household Survey on Drug Abuse, 1999-2001.
21
Prescription Opiate Distribution WA State (DEA) Change 1997-01/02
-50%0%
50%
100%150%200%250%
300%350%400%
Codeine
Oxyco
done*
Hydro
mor
phon
e*
Hydro
codon
e*
Mep
eridine
Met
hado
ne*
Mor
phine
Fenta
nyl
*2002
Source: DEA ARCOS http://www.deadiversion.usdoj.gov/arcos/index.html
Data does not include methadone dispensed and administered at opiate substitution treatment clinics.
22
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
23
Methamphetamine Labs and Dump Sites
King
Pierce
Snohomish
WA State Total
0
200
400
600
800
1000
1200
1400
1600
1800
2000
#
King 6 10 2 7 7 10 23 17 48 107 231 271 241 202
Pierce 10 18 18 12 17 17 53 42 129 318 545 589 438 466
Snohomish 2 2 2 7 6 5 13 37 69 83 98
WA State Total 38 43 40 42 36 54 153 203 349 789 1454 1890 1693 1480
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
Labs and/or dump sites have been found in every county in WA
Source: WA St. Dept of Ecology
26
Newly Diagnosed HIV Cases 2001-’03Exposure Categories
King County
IDU & male-male sex, 7%
Hetero. contact,
11%
Undeterm./ other, 10%
Injecting drug user,
6% Male-male sex,
66%
WA Except King
Injecting drug user,
14%
IDU & male-male sex, 7%
Hetero. contact,
19%
Undeterm.
/ other, 15%
Male-male sex,
46%
Newly Diagnosed HIV cases in King County = 947, 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.
27
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
28
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
29
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:
31
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
Recommended