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I I I I I I I I I I I I I I I I I I I WELCOME SEWG :rvnSSION ELEVENTH STATEWIDE EPIDEMIOLOGY WORK GROUP MEETING ApriI30-?Vfay 1, 1992 Sacramento, California Douglas Anglin UCLA Drug Abuse Research Center Our eleventh meeting starts a second generation of the California Statewide Epidemiology Work Group (SEWG). In 1987 NIDA helped establish in several states an information-sharing mechanism similar to the national Community Epidemiology Work Group, which brings representatives from a number of U.S. cities together to talk about developing trends and patterns of drug use in those respective areas. At the state level, the intent is the , same: to bring together a community of researchers, practitioners, and policymakers with epidemiological interests to identify and monitor drug use trend~, perhaps anticipate them, and provide information useful in addressing drug use problems. With support from the Department of Alcohol and Drug Programs, California has been successful in maintaining biannual meetings and published proceedings. This meeting is the first to expand SEWG coverage to include alcohol epidemiology, and I welcome our new members in this field. COMMUNITY BASED EPIDE:MIOLOGY Susan Nisenbaum California Department of Alcohol and Drug Programs Many of you are aware of the importance of epidemiological information to all levels of government both at the federal and the state level. But, consider the community level-it is difficult to take something called a community, an entity with complex economic and social structures, and try to demographically associate it with drug abuse. A community means many things to different people, and, even within a community, there are subgroups consisting of minorities, special interest groups, and so on. When you want to find what a community looks like in tenns of the epidemiology of drug use, you have to use all the available indicators: drug treatment admissions, emergency room data, deaths, paramedic data, all of the things that are pieces of the jigsaw puzzle that you try to assemble to get a sense of the incidence, prevalence, and patterns of drug use in the community. Ideally, using that data, you develop prevention, treatment, and enforcement strategies that feed back into the community, the efficacy of which is observed in the indicators. The goals of prevention, enforcement, and treatment efforts are, at the highest level, the same; but the data each needs and the strategies each use are quite different; thus each e,ffort will pick up a different picture of the community because it is looking at different indtcators. So the more you understand those points of view and cross-interpret data, the more solidly you can provide a package to policymakers that will improve the efficiency of the whole network of interventions. L DRUG USE TRENDS NIDA COMMUNITY EPIDE:MIOLOGY WORK GROUP John Newmeyer Haight-Ashbury Free Clinic I 'will briefly summarize infonnation presented at the December, 1991, NIDA Community Epidemiology Work Group (CEWG) meeting. A full executive summary is provided as Appendix C. There are two widely available yearly updates of the national drug use trends: the <strong>National</strong> Household Survey (NHS) and the High School Seniors Survey (HSSS). The reports presented at the NIDA CEWG meetings usually do not use these two indicators. The CEWG reports use the Drug Abuse Warning Network (DAWN) data and other local indicators, including crime statistics, arrest statistics. treatment admissions, and hepatitis B surveys to provide a local interpretation of trends in particular metropolitan areas. Most of the CEWG reports present contradictory indications as compared to the NHS and the HSSS with regard to certain drug patterns, especially cocaine. While the NBS and the HSSS have shown a downward trend, CEWG reports have shown that the cocaine problem has become more serious in most of the CEWG cities. The reason is that two different populations are being sampled; the NBS and HSSS are concerned with the general population of the Nation as a whole, and the results have indicated that the number' of sprsewg.dod) O/27/93/vmv
users of cocaine has gone steadily down since 1985. During that same period, CEWG reports have documented a large increase in the severe-level use of cocaine, and that there are hundreds of thousands of individuals who are dependent users. These "addicts" have become an increasingly large proportion of the remaining users, most of whom are casual users and whose numbers do appear to be steadily declining. Although indicators of drug use in general are pointing downward, the most recent indicators of the spring quarter of 1991 showed a slight flare-up in many of !h,e cities. In trus respect, we can see that severe-level cocaine use in some parts of the conn try remain out ofcontro!. In most of the country, effective prevention efforts and effective treatment efforts were directed to cocaine problems in the outer cities, the suburbs, and the rural areas. But the cocaine epidemic was neglected in the inner city; almost like fire trucks that were unable to reach the fire because they did not have the resources, agencies lacked the strength to fight this raging fire in the inner city. Appropriate, inexpensive kinds of care and treatment for cocaine abuse in the inner city must be developed and made available. However, estimates of the number of people who recently stopped using cocaine greatly exceed the number who have been in treatment for cocaine. Even if you assume that all those treatments had been successful, this did not explain the estimate of the number of people who stopped using cocaine. Thus, some dependent users cease use without formal treatment. For heroin, a rise in use was observed at the tail end of the 1980s and the very beginniI)g of the 1990s, followed by a decline in most cities, and then a recent flare-up in a mixed pattern. The downward trend' was not seen in all the cities; usually at least 1 or 2 of the 19 cities can be exceptions to the pattern followed by the majority. During the past six months, an increase in intranasal use of heroin in at least five reporting cities was noted, as well as in Newark and New York. The San Francisco data could not coniirm that the local population was supplanting injection with insufflation as a route of use of heroin. This trend. if it is sustained, may have developed because of fear ofmV disease. Insufflation is up in Boston, Chicago, Honolulu, Newark, and New York. Four of those five cities are cities where the mv incidence or prevalence rate has raged above 15~20 percent, and HIV concern among heroin users might eXlllain the rise in intranasal use. Methamphetamine has been, for many years, a phenomenon of cities which either bordered the Pacific Ocean or Mexico: Dallas, Houston, Phoenix, San Diego, San Francisco, Los Angeles, Seattle, Honolulu, and Portland. Unlike San Diego and San Francisco, cities in the rest of the country do not report very low rates of methamphetamine use. In general, there has been a downward trend in methamphetamine use. In contrast to the aforementioned downward trends of drug use, there has been a flare-up in the use of the hallucinogens in a number of cities, where either LSD or MDMA has been reported as a drug of new popUlarity among young people. In San Francisco, this particular phenomenon is an offshoot of the "rave" phe:nomenon, "Raves" are ad hoc dance clubs or disco palaces where up~to~te music is played at a venue which nobody knows about W}til the actual day of the event. The revelry commences at about 1:00 a.m., with hundreds or thouSands of young people dancing v.ildly and many using hallucinogens. Ecstasy houses or "X" houses are also popular for the specific purpose of taking Ecstasy (MDMA), which is experiencing increased popularity among young people. MDMA does not have the same built-in burnout characteristic that cocaine and methamphetamine do, nor is there likely to be the same law enforcement effort to prevent use of these substances since so many users are middle-class kids, as opposed to the inner city users whose involvement with substance use may lead to criminal activities. In terms ofHIV disease, a surprisingly low rate of new contagion has 'Jccurred over the past five years. Of cc,lJrse. we have seen a steady increase in the proportion of AIDS cases that are reported by injection drug \,lsers (IODs). This trend was to be ex-pected because IOU infection with HIV occurred somewhat later than that of gay men, and the increase in the proportion of the AIDS cases among IDUs is consistent with a spread of mv that might have occurred among them in the early to middle 1980s. In most cities, there has not been much seroconversion to HIVpositive status among IOUs in the last four to five years. In most cities, the data are consistent with seroconversion among IODs of 2 percent or less per year. Some cities, however, do document a strong seroconversion to mv: Chicago, Miami, and close inspection of Oakland and Contra Costa and Alameda Counties would reveal seroconversion rates on the order of 3 percent or more. Something has happened in the IDU communities to obviate or avoid the phenomena typical in New York City. Newark. and a few other eastern cities that brought the HIV infection levels an IDUs up to 40 percent, 50 percent, or 60 percent. We are simply not seeing rates of this sprsewg.doc/lO/27/93/vmv 2 I I I I I I I I I I I I I I I I I I I -
Page 1 and 2: If you have issues viewing or acces
Page 3 and 4: TABLE OF CONTENTS TOPIC PREFACE EXE
Page 5: I I I I I I I I I I I I I I I I I I
Page 9 and 10: Sacramento has become the methamphe
Page 11 and 12: procedures. Our survey has examined
Page 13 and 14: at the number of caretakers they ha
Page 15 and 16: parole caseloads. Those coming out
Page 17 and 18: Resource distribution is fraught wi
Page 19 and 20: examine the data systems in existen
Page 21 and 22: We take a different policy approach
Page 23 and 24: ecause of the geographic distance.
Page 25 and 26: Susan Pennell - San Diego Kiku Anno
Page 27 and 28: DRUG ABUSE INFORMATION AND MONITORI
Page 29 and 30: Mary Ann Lewis UCLA School of Nursi
Page 31 and 32: COMMUNITY EPIDEMIOLOGY WORK GROUP I
Page 33 and 34: HIGHLIGHTS The following highlights
Page 35 and 36: HlghUghu • In Hawaii, dc2ths rela
Page 37 and 38: ~~~-----.---- () ~ C) W 8 [.., .. ~
Page 39 and 40: COCAINE 1 . Eastern Region EXECUTIV
Page 41 and 42: ______________ Eu_CUl_ive_S~,JlU'Y:
Page 43 and 44: CIty .... . eta .'.I\;·~·:iil::;:
Page 45 and 46: In Chicago crack cocaine use is wid
Page 47 and 48: In San Diego, whites accounted for
Page 49 and 50: EuCUlive Summary: CocoiM V'''''''''
Page 51 and 52: wClilive Summary: Heroin The' numbe
Page 53 and 54: EuCUlive Summary: Heroin cocaine us
Page 55 and 56: Eucwive SIIntI1ID1y: lIeroin combin
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Area C~Ofado Hon04uJu Los AnGeles P
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following an increase; aVailability
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Ex.eClllive Summary: Marijuana TabI
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Eucutive Summary: Marijuana Table 2
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EuCUl;ve SIllTllM1'Y: Marijuana ---
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Typically, metharnphetanrine ER men
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Table 29. Pwcentsgo and rri by nOl'
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mentions-the leading mentioned psyc
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with cigarette papers, and sold as
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----------------------~- ~~--~-~~--
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APPENDIX D DRUG/LAB SEIZURE ACTIVIT
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BNE DRUG SEIZURE ACTIVITY REPORT '-
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"'Other Labs include: , Designer Dr
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. I OMBNo. ADMS Fonn 08 State: TR
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BNE Drug Seizure Activity Report 19
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(Xl c: LSD SEIZURE ACTIVITY REPORT
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LAB SEIZURE ACTIVITY REPORT 00 P- "
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'DE/! 'D~ ()~ February, 1991 NIJ f
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';et:Weat 7~ 'P~ 00 co I I CSA PEN.
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May 25, 1988 June 23, 1985 Aug. 31,
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.: ".:.: Heroin Cocaine Marijuana H
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----~-~---~~-~----- ~ VI o EXHIBIT
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9,500 EXHIBIT 8 LOS ANGELES HEROIN
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...... VI 00 EXHIBiT 10 LOS ANGELES
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Exhibit 3 DRUG TREATMENT ADMISSIONS
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YEAR 1998 1989 1990 1991 1992 QUART
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APPENDIX G I • TRENDS EOR DRIIG A
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County Reports: San Diego, Californ
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County Repons: San Diego, Californi
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County Repons: San Diego. Californi
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EXHIBIT 1 ADMISSIONS TO COUNTY FUND
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EXHIBIT 3 COCAINE TREATMENT ADMISSI
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EXHIBIT 5 AMPHETAMINE TREATMENT ADM
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EXHIBIT 7 ALCOHOL ADMISSIONS TO COU
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APPENDIXH High Risk Alcohol and Dru
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Findings Trends in Risk Categories
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Frequent and Heavy Use by User Grou
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Cigarette Smoking and User Groups T
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Use of Tobacco, Alcohol and Illicit
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Survey Instrument The questionnaire
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10 9 CI) 8 c: Q) Q) I- 7 ;;;: ....
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75 70 III 65 c: Q) ~ 60 < 55 "- ...
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57.4% increase in those who had use
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- - - - - - - -. - - - - - ------ T
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FIGURE 7 Drinking to Intoxication A
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drugs (such as cocaine, LSD, amphet
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Apparently, older friends are a sig
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drugs (Table 8). Since our survey i
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All of the options for drinking loc
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students' I\eports regarding fighti
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TABLE 13 Situations of Teens' Drug
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Yolo County teens, the lifetime pre
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APPENDIX I DRUG USE FORECASTING (DU
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--------------- Introduction I •
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Drug Use Excluding Marijuana • A
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30 10 Figure 5 DUF ADULT AMPHETAMIN
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Arrest Charge and Drug Result For t
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Table 2 ARREST CHARGE AND DRUG RESU
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"E \I) u iii Q. Figure 9 DUF ADULT
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CP ~ 'iii 0 Q.. C CP !: (I) Q.. 20
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Nationwide DUF Site Comparison Alth
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Why San Diego maintains higher rate
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County Alameda Amador Butte Calaver
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San Luis Obispo $13.921 San Mateo S
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COUNTY MASTER PLAN FUNDING ASSISTAN
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California Department of Correction
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---------------------------"'----.-
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APPENDIX M en :s ::. w I- tI) ::l >
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OBJECTIVE AND APPROACH N o ex> Reco
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en w :l en en - ..J
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APPENDIX N IMPROVING AND INTEGRATIN
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High School Senior Survey is specif
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At each step we will need to • do
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I -I INTRODUCTION 2 The Netherlands
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4 actions has expressly been minimi
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6 Finally general practitioners pre
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8 DESIGN OF THE STUDY The fieldwork
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PATTERNS AND LEVELS OF DRUG USE' 10
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12 SOURCES OF INCOME During one mon
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14 multiple regression analysis was
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16 income. Table 6 shows the result
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18 habits. The average "dealing jun
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20 join the market of small time pi
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22 pendent effect on the crime leve
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25 Korf, D.J: Jatten alle junkies?
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TABLE 1: MONTHLY PREVALENCE FOR POL
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FIGURE 1: 29 RELATIVE CONTRIBUTION
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31 TABLE 4: DETERMINANTS OF CRIMINA
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I I I 33 ~ 6: A CRIMINAL/ECONOMIC ~
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I Volume 4, Number 12 : March19921
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I volume 4, Number 12 March1992) Oc
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STIMULANTS VS. OPIATES IV Stimulant
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HOUSEHOLD SA vs. OA 1989-90, Sacto.
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SEXUAL PARTNERS (SP) - CHARACTERIST
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Percent I I I WHITE 1990 I 80 I I 6
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Percent 1 O.B 0.6 0.4 0.2 o .6 Gene
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Percent 10 8 6 4 2 a 9.1 General Po
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NEEDS - ASSESSMENT - GOALS & OBJECT
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I GOAL STATEMENT: To develop a sing
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TABLE OF CONTENTS Acknowledgements
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Table 1. . Table2. Table 3. Table 4
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Table E-10. Table E-11. Table E-12.
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SUMMARY ----,-------------------" T
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Developmentally disabled offenders
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YOUTH AUTHORI1Y TREATMENT NEEDS ASS
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Both versions of the MMPI and the J
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Demowphic InfonnMi.rul FINDINGS The
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een hospitalized for psychiatric pr
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impaired, but who has good contact
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The SCPs, like the ITPs, receive of
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The Jesness Inventory and the MMPI
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CONCLUSIONS A total of 851 offender
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REFERENCES Archer, R. P. (1987). Us
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APPENDIXB DEMOGRAPIDC DATA FROM TII
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8·~ __ ----- YA010U (I ·S) ---'--
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TABLED-3. TOTAL No Attempts One or
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TABLE E-1. APPENDIXE TABLES RELATI~
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TABLEE-9. TABLEE-I0. TABLEE-ll. TAB
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APPENDIXF THE MINNESOTA IvfULTIPHAS
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Henggeler (1989) mentions that inca
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APPENDIXG THE JESNESS INVENTORY The
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APPENDIX T DRUG POSITIVE RATES IN C
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Second, and perhaps the larger fact
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.1 As shown in Figure 3, the lowest
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Usually, one tends to see drugs tha
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METHADONE PROGRAM CLIENTS PhannChem
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