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CEWG : CURRENT TREND INFORMATION

CEWG : CURRENT TREND INFORMATION. B.Grosjean.MD. UCLA/ISAP. - Established by the National Institute on Drug Abuse (NIDA) in 1976.

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CEWG : CURRENT TREND INFORMATION

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  1. CEWG : CURRENT TREND INFORMATION B.Grosjean.MD. UCLA/ISAP

  2. - 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. WHO?

  3. WHY? • 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.

  4. SOURCES • 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

  5. 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 Report Pattern

  6. LIMITATIONS LIMITATIONS LIMITATIONS

  7. 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…. 

  8. Interpretation of indicator data, therefore, requires an understanding of the weaknessesandthe strengths of each data source and variables within each database.

  9. WEAKNESSES

  10. #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 withinthe 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.

  11. STRENGTHS # 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 withinthe people #“Timing issues”: flexibility, rapidity in the exchange and transmission of the information.

  12. 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); STRENGTHS 2

  13. 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). STRENGTHS 3

  14. WHERE ?

  15. 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, NYPhoenix, AZ • Seattle, WASan Diego, CA San Francisco,CA • St. Louis, MO Texas (Statewide)Washington D.C.

  16. SAN FRANCISCO DECEMBER 2000

  17. COCAINE COCAINE

  18. General Trends • 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.

  19. 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)

  20. methamphetamine

  21. 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 TRENDS

  22. 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). WHERE?

  23. 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. WHERE?

  24. 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. WHERE?

  25. 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. WHERE?

  26. 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 set-up that can be carried in the trunk NEWS

  27. 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

  28. GENERAL TRENDS • 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.

  29. 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%)

  30. 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%)

  31. MARIJUANA

  32. General trends -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.

  33. 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.

  34. 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)

  35. Club Drugs include Alcohol, LSD (Acid), MDMA (Ecstasy), GHB, GBL, Ketamine (Special-K), Fentanyl, Rohypnol, amphetamines and methamphetamine. CLUB DRUG CLUB DRUG

  36. MDMA ECSTASY

  37. #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).

  38. 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. http://www.dancesafe.org/currentresults.html

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  41. 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)

  42. 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.

  43. . KETAMINE Ketamine,cafeine SF2000 # 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. Cali,Ca,Dec 2000 Ketamine,MDMA,cafeine. SF.12/2000

  44. # Ketamine is produced in liquid form or as a white powder that is often snorted or smokedwith 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

  45. 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. LSD LSD

  46. EMERGING DRUGS # 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.)

  47. @INTERNATIONAL@ @ HIGHLGHTS @ • CANADA CCENDU ( Canadian Community Epidemiology Network on Drug Use). • MALAYSIA Amphetamine Type Stimulants(ATS)++. • MEXICO

  48. @INTERNATIONAL@ @ HIGHLGHTS @ • 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

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