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

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Detailed Death and Emergency Department Data Are Available

Only for King County

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

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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

17

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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

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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.

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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

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Meth. Labs & Dumpsites Trend ’01-’02

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Infectious Diseases & Injection Drug Use

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.

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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

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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

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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:

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Needle Exchanges

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

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adai.washington.edu http://depts.washington.edu/adai/wa/

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Drug Use Epidemiology Reports