Drug Trends in St Louis - University Of Maryland

Drug Abuse Trends in St. Louis: 2014 Update

Heidi Israel PhD, FNP

Heroin use was present throughout the region in 2014, yet indicators have stabilized.

Treatment slots and deaths related to use are still at high levels but the leveling off in

indicators may be related to aggressive grass roots efforts, the increased use and

availability of naloxone by first responders, and DEA and local law enforcement efforts to

stem availability. Other opiates, including prescription narcotic abuse and illicit fentanyl,

continue to be areas where more focus is needed. Methamphetamine continues to climb,

particularly in areas outside of St Louis City and County. The ongoing discussion on

substituted cathinones and other synthetic cannabinoids is an area requiring monitoring

and new ways to quantify their use.

Data Sources

This report analyzes trends in substance abuse in St Louis area based on the most recent data,

calendar year 2014, obtained from the following sources:

Mortality data- on drug related and accidental overdoses due to drug toxicity are from the St

Louis City and County Medical Examiner¡¯s (ME) office and outlying counties where the St Louis

ME reports the decedents cause of death. Accidental overdose includes cases where drug

toxicity or mixture of drug toxicity significantly contributed to the cause of death.

Addiction treatment data- This data is from the state of Missouri Department of Mental Health,

Division of Behavioral Health and includes detailed information on state supported treatment

admissions in St Louis City and County and overview drug admission information for the 4

regions of the state for specific drugs.

Drug seizure and purity information ¨C is received from the U.S. Drug Enforcement

Administration.

Poison Center data on exposures and calls regarding various substances as reported to the

local Poison Control system.

Heroin and other opiates

Heroin use, purity, and availability have stabilized regionally, including rural and suburban areas

surrounding St. Louis. St. Louis is a destination market and is subject to all the changes that occur

in the supply chain. That being said, supply has continued to be easily accessible. A recent large

heroin bust in 2015 will test the hypothesis on ease of availability in the next reporting year.

Heroin was stable at high levels in the St. Louis area in all indicators in 2014 (exhibit 1). Heroin

availability and purity began to climb in late 2008. Prior to that increase in availability and

purity, heroin was found among small pockets of injection drug users (IDUs). With this

1

Drug Trends in St Louis 2014

increase in deaths and spreading use, many communities became alarmed. Grassroots public

awareness efforts may be responsible for an effect with the young potential new user. Access

to heroin is reported in St Louis County schools, phenomena not seen until 2011. It is a

frequently discussed topic and anecdotal media coverage reports heroin availability throughout

the region.

In 2014, 37.6 percent or 4,727 (of a total 12, 567) treatment admissions reported heroin as the

primary substance of abuse, compared with only 13.2 percent in 2007 (approximately 1,458 of just

under 1,000 treatment admissions) (Exhibit 1). In 2013, there were 4,465 of 13,008 admissions for

heroin. Interestingly, total state treatment capacity has not risen dramatically in the last 10 years.

Heroin indicators surpassed alcohol and marijuana indicators in treatment admissions data

beginning in 2011. Heroin remained the most frequently reported drug on admission in state

supported treatment in 2014. Anecdotal reports indicate that it is also frequently reported in private

treatment admissions. Outlying areas of Missouri have relatively low admissions for heroin

(Exhibit 2).

Two types of heroin continued to be available in the area and remained pure and inexpensive.

Heroin treatment admissions in 2014 (Exhibit 5) represented 37.6 percent of all admissions; this

proportion exceeded those for alcohol admissions, which historically represented the highest

percentage of admissions. This trending upward of heroin admissions began in 2006, and became

the number one reported drug in 2012. In 2013 and 2014, over 60 percent of heroin treatment

admissions were younger than 35, but, on a positive note, clients less than 25 decreased slightly

from 19.8 percent in 2013 to 17.4 percent in 2014 (Exhibit 1).

Admissions to some available treatment depended on ability to pay. Some heroin abusers in need

of treatment utilized private pay methadone programs. Buprenorphine is a treatment option at

private centers, but it is expensive. Some younger users were reporting initial addiction to

prescription pain pills prior to starting to use heroin. Of the methods of administration, 64.5 percent

of heroin treatment clients reported injection use, a slight increase over 66.7 percent in 2013

(Exhibit 1). This trending back to injection has not coincided with lower purity, but widespread

experimentation in the use of the drug. The stability in deaths, increase in treatment admissions,

and consistently high purity of heroin presents a stable, if not saturated, picture of heroin currently.

Among heroin treatment admissions, males accounted for 59.6 percent, while females

represented 40.4 percent. Cocaine and marijuana were the most frequently cited secondary and

tertiary drugs of abuse for heroin treatment clients.

Both the DEA and DMP made buys in the area. Purities of 25-55 percent have been reported for

the off-white or tan powdered heroin. Additional heroin in St Louis has not been identified as to its

origin (signature) and was assumed to be Mexican. The consistently higher purity heroin in St.

Louis has allowed for expansion into a larger market with inexperienced users. Most heroin was

purchased in a capsule (one-tenth-gram packages of heroin) for $10¨C$20 or as one-half-gram

baggies that sold for $100 each (exhibit 2). Quetiapine (Seroquel?) has been identified as a cutting

agent in many samples, as well as the standard cutting agents typically used (such as

diphenhydramine). Fentanyl has also been noted with heroin and is discussed later.

2

Drug Trends in St Louis 2014

The ME data report for 2014 showed a slight down tick in heroin-related deaths in an area covering

St. Louis City and St. Louis County and rural counties of Franklin, Jefferson, and St. Charles. The

ME identified 217 heroin-related deaths, down from 310 in 2011. (Exhibit 3) Of these deaths, 35.4

percent were younger than 30; 71.4 percent were Caucasian. There were 67 deaths in the city and

108 heroin-related deaths in St Louis County. Of the total heroin deaths, 42 were reported from

Jefferson, Franklin, and St. Charles Counties. Even with the decreased availability of cocaine

outside of the city, a small percentage of these deaths represented use of heroin and cocaine

together, many times also mixed with alcohol.

Other opiates represented 3.6 percent (or 474) of all treatment admissions in 2014. These

admissions for abuse of other opiates seem to represent a slight increase in treatment

admissions, but this may be under-represented by the lack of treatment availability.

Prescription opiates are believed to be linked to the introduction of younger users to the effects

of opiates, possibly assisting in the fueling of heroin use by a wide range of users. No

pharmacy database exists in Missouri to monitor these prescriptions. These abusers were

diverse: young users recreationally getting high, chronic pain medication abusers, and more

recently, discussions of polydrug geriatric abusers.

Hydrocodone and oxycodone were the two most frequently identified opiates other than heroin

detected in drug items seized and analyzed by NFLIS laboratories in the St. Louis MSA in 2014. Of

the NFLIS items seized, oxycodone and hydrocodone represented 6.2% of these items (Exhibit 4).

OxyContin? (a long-lasting, time-release version of oxycodone) abuse remained a concern for

treatment providers and law enforcement officials and was seen in emergency departments by

patients requesting refills. Many emergency rooms have adopted restricted refill policies for

narcotics to prevent abuse. Abuse of oxycodone remained a concern in medical settings,

where the drug is preferentially sought. The use of hydromorphone remained common among

a small population of White chronic addicts, based on anecdotal information (Exhibit 2). New

extended release narcotics will complicate the prescription drug abuse picture.

Fentanyl, methadone, oxycodone, and hydrocodone continued to be reported in ME and

treatment admissions data. Heightened availability of prescription narcotic analgesics were

reported in the more rural areas of the metropolitan statistical area (MSA). Fentanyl was found

in combination with heroin in ME data, and occasionally alone in decedents that also were

using cocaine or methamphetamine, which may indicate that they expected to use heroin in

conjunction with these drugs. This mixture of fentanyl and heroin suggests that it may possibly

be done at the seller level.

Fentanyl was identified in 27 deaths in St. Louis City and County and the 4 targeted rural

counties (St. Charles, Jefferson, Franklin, and St Francois) in 2014. l. Methadone abuse again

was seen in ME data. Methadone overdoses were reported 18 cases. The use of illicit

methadone versus prescription methadone remained difficult to establish.

Cocaine

3

Drug Trends in St Louis 2014

While the DEA¡¯s emphasis in the St. Louis area has shifted from cocaine to methamphetamine

and heroin, reports from law enforcement sources, the DEA, and street informants indicated

consistent quality and availability of cocaine (Exhibit 2). Because cocaine and heroin were used

together in the past, the presence of heroin and methamphetamine in some drug related deaths

suggests that users may have believed they were using cocaine with heroin instead. No new

information was available on pricing and purity of cocaine in Kansas City and smaller cities

outside St. Louis.

Cocaine treatment admissions declined markedly in recent years. In 2014, only 5.7 percent or

712 treatment admissions reported cocaine as the primary substance problem, compared with

22.8 percent (or 2,250 admissions) in 2007 (Exhibit 1). Most primary cocaine treatment clients

(86 percent) reported smoking crack cocaine. A decrease in the use of combined cocaine and

heroin (¡°speedball¡±) by injection drug users (IDUs) has been noted.

Cocaine was reported as the fourth primary drug of abuse among all treatment admissions in

2014, following heroin, alcohol, and marijuana. This represents a change for the region over the

past 7 years, as the numbers of primary cocaine admissions have decreased. Of these cocaine

treatment clients, 85.9 percent were older than 35. Marijuana, heroin, and alcohol were the most

frequently cited secondary and tertiary drugs of abuse among primary cocaine admissions.

NFLIS data indicated that 8.9 percent of the drug items seized for the St. Louis MSA contained

cocaine in 2014. This placed cocaine as the fourth most frequently identified substance in the

NFLIS system during 2014 (Exhibit 4).

The ME data report for 2014 for the St. Louis area showed that cocaine-involved deaths showed a

small uptick compared to 2012 and 2013. Deaths declined from 167 in 2007 to 64 in 2014 (Exhibit

1). Some deaths in older cocaine users were associated with cardiovascular catastrophic incidents

such as aneurysm or intracranial hemorrhage. Cocaine was the drug identified in three of four

stillborn infants in the ME data.

Methamphetamine

Methamphetamine indicators remained elevated in cities and rural areas other than St. Louis City

and County in 2014.The distribution networks are believed to be different for methamphetamine,

unlike cocaine and heroin, which has led to increased availability throughout the region.

Clandestine laboratories, which account for a small amount of the methamphetamine available in

Missouri, decreased statewide to 1,045 in 2014 from 1,985 in 2012. Jefferson County, 20 miles

outside of St Louis, reported 205 incidents for 2014, the highest of any county in Missouri

Methamphetamine (¡°crystal¡± or ¡°speed¡±), along with alcohol, remained a primary drug of abuse in

both the outlying rural areas and statewide. Most of Missouri, outside of St. Louis and Kansas City,

is rural. Methamphetamine continued to be identified as a problem in rural communities. The drug

appeared regularly in treatment data in rural areas, and methamphetamine has been identified as

a problem in all parts of the State (Exhibit 2).

4

Drug Trends in St Louis 2014

Primary treatment admissions for methamphetamine in 2014 in St. Louis represented 4.1 percent

or 514 of total admissions (Exhibit 1). While the treatment admissions have increased gradually

over the past few years in St Louis, methamphetamine is available and used at higher levels in

other parts of the State. Marijuana and alcohol and some heroin were the most frequently cited

secondary and tertiary drugs of abuse among these clients. Clients entering treatment were

typically self-referred. Methamphetamine use increased in both the Southwest and Southeast

regions of Missouri (Exhibit 2), with a net increase of more than 10% in the Southeast region (1300

admissions in 2014, up from 1173 in 2013) and Southwest region (.2,170 admissions in 2014, up

from 1,936 admission in 2013).

Hispanic traffickers were the predominant methamphetamine distributors in St. Louis. Shipments

from ¡°super laboratories¡± in the Southwest were trucked in on the interstate highway system. This

network contrasts with the local ¡°mom and pop¡± laboratories that fueled much of the

methamphetamine debate in the State over the past 10 years. The purity of the methamphetamine

obtained through this source has improved in recent years. Crystallized methamphetamine was

available in Kansas City and outlying areas of the State, with some availability in St. Louis.

Because methamphetamine is so inexpensive and appeals to a wide audience, it is likely that its

use will continue, particularly in rural Missouri.

NFLIS data for 2014 showed methamphetamine among 11.5 percent of drug reports among drug

items seized and analyzed, ranking third. This reflects an increase over both 2013 and 2012.

Pseudoephedrine legislation has had an impact on the ease of producing clandestine

methamphetamine. NFLIS reported 1.0 percent of total reports were pseudoephedrine among

seized drug items analyzed during this period (Exhibit 4).

Of the 38 deaths involving methamphetamine in 2014, almost half were in Jefferson County. The

number of reported methamphetamine related deaths in the region in 2012 and 2013 was 27

deaths (Exhibit 3).

Marijuana

Marijuana admissions in 2014 (n=2,173) accounted for 16.9 percent of all admissions in the St.

Louis region. Many factors may account for the continual decrease of marijuana admissions from

2,836 in 2008 including heroin prevalence and treatment slot availability (Exhibit 1). Marijuana,

viewed by young adults as acceptable to use, was often combined with alcohol. Some prevention

organizations reported resurgence in marijuana popularity, and a recent decrease in penalties in

St. Louis City brought opposition from prevention organizations. The 25-and-younger age group

accounted for 52.9 percent of primary marijuana treatment admissions in 2014. The 12¨C17 age

group entering treatment represented 28.2 percent of treatment admissions in 2014. Increased

THC (tetrahydrocannabinol) content of marijuana should not be ignored as a component of

voluntary admissions.

Marijuana was available from Mexico or domestic indoor growing operations. The going rate for

an ¡°eighth¡± (about 3.5 grams) was $60. Marijuana prices in Illinois were similar. The Highway

Patrol Pipeline Program monitors the transportation of all types of drugs on interstate highways.

Much of the marijuana grown in Missouri is shipped out of the State. Marijuana remains the most

5

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download