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Current Trends in Drug Abuse--2006 Epidemiology of Drug Addiction Jane C. Maxwell, Ph.D. Center for Excellence in Drug Epidemiology Gulf Coast Addiction Technology Transfer Center www.gcattc.net There is no conflict of interest • • • • • • • Data Sources Community Epidemiology Work Group (NIDA) Treatment admission records (TEDS-DSHS) Emergency room data (DAWN) Price, purity, supply, trafficking data (DEA) Surveys (National & DSHS) Forensic laboratory tests by DEA and DPS Maxwell, J. C et al. (2006). Drug use and risk of HIV/AIDS on the Mexico-U.S. Border: A comparison of treatment admissions in both countries. Drug and Alcohol Dependence. • Maxwell, J. C. Substance Abuse Trends in Texas: June 2006. at www.gcattc.net. Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 U.s. Treatment Admissions by Primary Substance of Abuse: 1992-2005 60 50 40 Alcohol 30 Other opiates Heroin Marijuana 20 Cocaine Stimulants 10 Other drugs 0 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 Source: SAMHSA California Treatment Admissions by Primary Substance of Abuse: 1992-2005 Alcohol Crack Powder Cocaine Marijuana Heroin Stimulants 50 40 30 20 10 0 92 93 94 95 96 97 98 99 00 01 02 03 04 05 Source: SAMHSA # Exhibits Identified by Toxicology Labs in U.S: 2000-2005 50% Cocaine 40% 30% Marijuana 20% Methamphet & Amphet 10% Heroin 0% 2000 2001 2002 2003 2004 2005 Source: NFLIS Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Drugs Identified by NFLIS Laboratories by Region: 2005 Marijuana Cocaine Methamphetamine Heroin 50 Percent 40 30 20 10 0 West Midwest Northeast South Substances Identified by California Labs: 2005 100% 80% 60% 40% 20% 0% San Diego Los Angeles Cannabis San Francisco Methamphetamine Statewide Cocaine Heroin Source: SAMHSA Heroin 1998 Miami DMP Samples Southwest Asian 2.1 % Pure Southeast Asian 2.3 % Pure South American 19.2 % Pure Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Opiates • Black tar heroin, few mentions of stronger “white” heroin west of the Mississippi. • “Cheese” is Tylenol PM and 1% heroin. Kids mix it up themselves. Concentrated in a few Dallas schools. • Fentanyl is patches in the West, not the rogue powder seen in the Northeast (where heroin is also a white powder). Heroin Sources and Supply Routes Sources of Heroin Seized in US Based on Net Weight:1989-2004 100 80 60 SEAsian SWAsian 40 Mexican 20 So. American 19 89 19 91 19 93 19 95 19 97 19 99 20 01 20 03 0 DEA Heroin Signature Program Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 100% Average Purity of Heroin Samples in the US: 1992-2004 1992 1993 80% 1994 1995 60% 1996 40% 1997 20% 1998 1999 0% 2000 Southeast Southwest Asian Asian Mexican South American 2001 2002 2003 DEA Heroin Signature Program Heroin Purity: 2004 10% 39% 14% 34% 11% 31% 50% 28% 43% 52% 53% 16% 28% 14% 41% 48% 51% 16% 25% West Average Purity: 26% Mexican 24% 16% East Average Purity: 42% So. American OTHER OPIATES Abuse of different opiates varies by region. Problem with methadone pain pills (as compared to diskettes and syrup used in narcotic treatment programs). Codeine cough syrup and rap music. Kids like pills because easy to get from home, not illegal, cheap, claim it’s prescribed for them if caught, fewer side effects than street drugs, less stigma, parents won’t get as upset as if using illicits, etc. (From Partnership for a Drug Free America’s PATS Survey). Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1993 24 or more Incomplete data 6-9 <6 10-11 12-15 16+ KEY YEAR: 1993 Source: SAMHSA Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1997 24 or more Incomplete data 6-9 <6 10-11 12-15 16+ KEY YEAR: 1993 Source: SAMHSA Other Opiate Treatment Admissions per 100,000 by State, TEDS: 2004 6-9 <6 10-11 12-15 16 or more KEY YEAR: 1992 Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Other Opiate Items Identified in Toxicology Labs by Region: NFLIS, 2005 16000 14270 14000 12000 10000 8000 7140 6000 4000 2412 1789 2000 0 2347 684 West South Hydrocodone 34163848 3164 1482 986 826 Northeast Oxycodone Midwest Methadone Source: NFLIS ARCOS Retail Drug Distribution by Drug Code for the U.S: 1997-2004 Oxycodone Hydrocodone Methadone 35,000,000 30,000,000 25,000,000 20,000,000 15,000,000 10,000,000 5,000,000 0 1997 1998 1999 2000 2001 2002 2003 2004 Source: DEA Treatment Admissions Nationwide by Primary Substance. TEDS: 1992-2004 18 16 14 12 10 Other Opiates Illicit Methadone 8 6 Heroin 4 2 20 04 20 02 20 00 19 98 19 96 19 94 19 92 0 Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Characteristics of Heroin and Other Opiate Treatment Admissions Nationwide, TEDS: 2004 Other Opiates Heroin 100 80 60 40 20 % O ra l U ID % Av is p % H % . an Ag e ic k ac Bl hi W % % M al te e 0 Source: SAMHSA Methadone-Related Unintentional Poisoning Deaths: 1999-2003 from National Center for Health Statistics, National Vital Statistics System 3000 2500 2452 2000 1911 1500 1158 1000 778 623 500 0 1999 2000 2001 2002 2003 ARCOS Methadone Grams Distributed by Type: 2000-2005 Tablets Diskettes Liquid 1800 1600 1400 1200 1000 800 600 400 200 0 2000 2001 2002 2003 2004 Source: DEA Jane Maxwell, UT CSWR, 512 232-0610 2005 Current Trends in Drug Abuse--2006 COCAINE Still Around— with New Users Cocaine • Methamphetamine outselling cocaine and crack in some areas in Texas; coke dealers now fronting cocaine to compete—or shifting to selling Ice. • Purity of cocaine increasing. • Still around with new users. • Proportion of crack treatment admissions who are Anglo or Hispanic continues to increase. • Injecting crack. Race-Ethnicity of US Cocaine Admissions: 1992 v. 2004 100% 80% 60% 40% 20% 0% Crack- Crack92 04 IDU92 Black IDU- Inhale- Inhale04 92 04 White Hispanic Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Cocaine Admissions in U.S. and Mexican Border States: 2003 12% 30% 9% 9% 35% 19% 26% 25% 28% 35% DOWNERS • Potentiate low-quality heroin (and seen in heroin overdoses) • Come down from speed or cocaine trips • Dependence among females • Kids like alprazolam (Four Bars). Benzodiazepines Identified by Toxicology Labs in the US: 2000-2005 1.6% 1.4% 2000 1.2% 1.0% 2001 0.8% 2002 0.6% 2003 0.4% 2004 0.2% 2005 0.0% Alprazolam Diazepam Clonazepam Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 MARIJUANA • Fairly stable. • Influence of Blunts and Wraps • Use with Fry, PCP, DANK, crack, cough syrup, honey, etc., continues. • Continuing references to pot and PCP and embalming fluid (ether). • CJ v. Non-CJ treatment admissions • Primos--marijuana joint and crack. • Fry, Amp--joint and embalming fluid (PCP?) • Fry Sticks & Fry Squares--$10 each. • Fry Sweets--blunts in embalming fluid. • Sweet Houses--sell ready-mades. • Candy Blunts--cigarillos in codeine cough syrup. • Sherms--menthol cigarettes in embalming fluid. % Texas Secondary Students Who Had Used Any Illicit Drug in the Past Month, by Ethnicity: 1988-2004 25% 20% Anglos 15% African Americans 10% Hispanics 5% 04 02 20 00 20 98 20 96 19 94 19 92 19 90 19 19 19 88 0% Source: DSHS Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Addiction Severity Index Problems of Texans Treated with Primary Marijuana Problem: 2005 Sub. Abuse Non-CJ Referral Emotional CJ Referral Social Family Employment Sickness 0% 20% 40% 60% 80% Source: DSHS Cannabis Treatment Outcomes Among Texas Clients • Criminal justice admissions to treatment were less impaired, more likely to complete treatment (42% v. 34%), and abstinent from cannabis at follow-up ( 76% v. 66%). • 55% of all clients met criteria for cannabis dependence. • CJ clients received less intensive services. • Although DSM-IV underreported, voluntary more likely to have mood depressive disorder and be prescribed medications for mental health problems. J. Copeland & J. Maxwell, under review, 2006. Alcohol Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Percentage of Texas Secondary Students Who Reported They Normally Consumed Five or More Drinks at One Time, by Gender: 2000–2004 35% 30% 25% 20% 32% 30% 26% 22% 22% Girls 20% 15% Boys 10% 5% 0% 2000 2002 2004 Liu, L. Texas School Survey of Substance Use Among Students in Grades 7-12, DSHS. Primary Problem Substance of Texas DUI Admissions to Treatment 2005 1996 Alcohol Heroin 1% Other Opiates 2% Amphet/ Meth 75% Powder Cocaine Cannabis 7% 4% Crack Cocaine Other Maxwell, Impaired Drivers at Admission to Substance Abuse Treatment, RSA Poster, 2006. Jane Maxwell, UT CSWR, 512 232-0610 66% Current Trends in Drug Abuse--2006 Methamphetamine Sources of AmphetamineType Substances Sources of ephedrine Major producers of methamphetamine Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Methamphetamine Use in Past Month Among Persons Ages 12 or Older, by Dependence and Abuse: NSDUH 2002-2005 # Past Month Users (in Thousands) 607 597 700 600 63 500 583 92 101 130 103 Stimulant Dependence/Abuse 216 154 Other Illicit Drug Dependence/Abuse 237 255 2004 2005 158 400 300 433 200 512 357 100 No Illicit Drug Dependence/Abuse 0 2002 2003 Source: SAMHSA 4 Most Frequently Identified Drugs by NFLIS Toxicology Laboratories 2000 2001 2002 2003 2004 2005 40% 30% 20% 10% 0% Methamphetamine Cannabis Cocaine Heroin Source: NFLIS Normal Course of a Drug Epidemic (Texas Cocaine Admissions: 1983-2004) 30 Hyperendemic 25 20 15 e br ut O 10 5 Crack ak Endemic Powder 3 20 0 9 1 20 0 7 19 9 5 19 9 3 19 9 19 9 1 9 19 9 19 8 5 7 19 8 19 8 19 8 3 0 Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 The Methamphetamine Epidemic: TEDS Admissions/100,000: 1992-2004 It keeps going up 300 Arkansas 250 Hawaii 200 Iowa 150 California 100 Georgia Connecticut 50 Washington 20 04 20 02 20 00 19 98 19 96 19 92 19 94 0 Source: SAMHSA Stages of Meth Epidemic? • Early Stages—Ice in gay and party scene; powder meth via overnight express from California; crack in urban areas. • Middle Stages—Mom & Pop cookers and large problem in rural areas; crack still strong in urban areas; Mexican meth starts being trucked in to urban areas. • Late Stages—primary problem for treatment admissions; spreads across racial/ethnic groups; Ice is dominant form and powder supply decreases; increasing types of traffickers (criminal groups, ethnic gangs, outlaw bikers). Race-Ethnicity of US Methamphetamine Admissions: 1992 v. 2004 100% 80% 60% 40% 20% 0% Smoke- Smoke- IDU92 04 92 Black IDU- Inhale- Inhale04 92 04 White Hispanic Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Routes of Administration of Methamphetamine of Clients in US Programs: 1993-2004 70 60 50 Oral 40 Smoking 30 Inhalation 20 Injection 10 03 01 20 19 20 99 97 95 19 19 19 93 0 Source: SAMHSA % Methamphetamine/Amphetamine and All Other U.S. Admissions by Urbanization: 2004 40 35 Percent 30 25 Methamphetamine 20 All Others 15 10 5 0 Large Large Small Non- Non- Central Fringe Metro Metro w/ Metro Metro Metro City w/o City SAMHSA DASIS Report, 27, 2006 Large is 1 million or more population; Small is MSA with less than 1 million, & Non-Metro is city of 10,000 or more Percent U.S. Methamphetamine/Amphetamine Admissions by Route of Administration & Urbanization: 2004 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 62 54 50 48 14 24 25 24 15 13 16 19 11 9 9 60 Smoking Injection 15 16 7 Large Central Large Fringe Small Metro Non-Metro Metro w/ City Inhalation Other 9 Non-Metro w/o City Metro SAMHSA DASIS Report, 27, 2006. Large is 1 million or more population; Small is MSA with less than 1 million, & Non-Metro is city of 10,000 or more Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Percent U.S. Methamphetamine/Amphetamine Admissions by Race/Ethnicity & Urbanization: 2004 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 11 28 6 14 3 9 11 2 7 6 1 8 4 1 Other 5 Hispanic 77 78 87 86 Large Central Large Fringe Small Metro Non-Metro Metro Black White 56 w/ City Non-Metro w/o City Metro SAMHSA DASIS Report, 27, 2006. Large is 1 million or more population; Small is MSA with less than 1 million, & Non-Metro is city of 10,000 or more Primary Amphetamine/Methamphetamine TEDS Admission Rates: 1997 (per 100,000 aged 12 and over) > 58 35 - 58 12 - 35 < 12 No data Source: SAMHSA Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003 (per 100,000 aged 12 and over) > 58 35 - 58 12 - 35 < 12 No data Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2004 (per 100,000 aged 12 and over) > 58 35 - 58 12 - 35 < 12 No data Source: SAMHSA Methamphetamine Admissions in U.S. and Mexican Border States: 2003 31% 40% 10% 18% 4% 3% 9% 14% 13% 7% Areas to Watch • Use of meth on the job (Work Force needs) • Truckers, day laborers, people working long hours and boring jobs. • Risky sexual behaviors • • • Heterosexuals & homosexuals. Party people Immigrants/migrants away from home and families. • Increasing criminal distribution • • Traffickers following the migrant trail. More organized and criminal gangs. Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Club Drugs • Problems identified early: MDMA in 1985, GHB in 1990,Ketamine in 1991, Rohypnol in 1993, but slow responses. • Research studies underway but are incomplete and can be problematic. • Use of Internet to obtain information from pro & anti-drug sites (BUT information can be erroneous, untested, outdated, or extreme). And trends move around the world through the Internet. • Problems testing & identifying various drugs. • Lack of detox & treatment protocols. • Misperception that all club drugs are alike. Substances Identified by Labs Participating in the National Forensic Laboratory Identification System: 1997-2005 100% 80% MDMA 60% Heroin 40% Methamphetamine 20% Cannabis Cocaine 20 05 20 03 20 01 19 99 19 97 0% Source: NFLIS Party Drugs Identified by U.S. Toxicology Labs: 2003-2005 14000 12000 10000 8000 6000 4000 2000 0 LSD MDMA PCP Ketamine GHB, GBL, 1-4BD 2003 2004 2005 Source: NFLIS Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Admissions to Texas Treatment Programs by Primary, Secondary or Tertiary Problem with a Club Drug: 1988-2005 900 800 700 Ecstasy 600 GHB 500 Hallucinogens 400 Ketamine 300 Rohypnol 200 PCP 100 20 04 20 02 20 00 19 98 19 96 19 92 19 94 19 90 19 88 0 Source: DSHS Admissions to Texas Treatment Programs With a 1st, 2nd, or 3rd Problem With a Club Drug: 2005 35 100% 90% 70% 25 60% 20 50% 40% 15 30% 10 20% Average Age 30 80% 5 10% 0% 0 Ecstasy GHB White Halluc Black PCP Hispanic Rohypnol Age Source: DSHS Race/Ethnicity of Texas DSHS Clients Admitted with a Problem with Ecstasy: 1990-2006 White Hispanic 20 06 20 04 20 02 20 00 19 96 19 98 19 94 Black 19 92 19 90 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Source: DSHS Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 LSD and Mushrooms • LSD low dose and more prevalent than we think? • Mushrooms are more popular than LSD? Need to start watching for them. GHB, GBL, 1-4BD “Fantasy” SPECIAL ANNOUNCEMENTS FROM MARK/JLF (updated 12-11-01) SHOP OUR CATALOG DISCLAIMER AND INFORMATION "JLF sells poisonous-non-consumable items, consisting of various raw materials and related merchandise used for art, hobby, science, industry, and/or religion. Products include Amanita muscaria ("Fly Agaric") mushrooms, Claviceps purpurea ("Ergot Fungus") sclerotia , Trichocereus pachanoi ("San Pedro") cactus, Psilocybin mushroom spores and kits, Papaver somniferum ("Opium Poppy") pods, Argyreia nervosa ("Hawaiian Baby Woodrose") seeds, Anadenanthera colubrina ("Cohoba") seeds, and many other ethnobotanicals. Also pure compounds such as yohimbine, L-tryptophan, etc." JLF Poisonous Non-Consumables P.O. Box 184 Elizabethtown, IN 47232 DISSOCIATIVE DRUGS: PCP, Ketamine, DXM Distort perceptions of sight and sound and produce feelings of detachment, but not hallucinations (Zombie effect) Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Phencyclidine • PCP, Angel Dust, Killer Weed • Dissolved in embalming fluid or ether (“Fry,” “Amp,” “Water, Water”). • Swallowed, sniffed, smoked on joints dipped in “Fry”. • Menthol cigarettes are dipped into liquid PCP or blunts are laced with powdered PCP. NDARC Study of Ketamine Users* • N=100; well-educated; older group of party drug users. • Some had access because in medical field. • Used with MDMA, MDA & amphetamines. • Many had regular negative side effects such as inability to speak, blurred vision, lack of coordination. • Issue for warnings: Usually unpleasant side effects seen by some as “positive” and encouraged experimentation. *Dillon, Copeland, Jansen, Patterns of Use and Harms Associated with Non-Medical Ketamine Use, Drug and Alcohol Dependence 69 2003) 23-28. DxM What is ? Dextromethorphan is a psychoactive drug found in common over the counter cough medicines. Source: www.http:third-plateau.lycaeum.org/beginner/index.html Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 • “Robotrip” Robotrip” – high dosages can produce hallucinogenic effects • Part of family of psychoactive compounds called “dissociative anesthetics.” anesthetics.” • Some effects have been described as similar to those of ketamine (Special K) and PCP. • The DxM experience is described as occurring on levels, or plateaus depending on the amount of the dose taken. • Each plateau is different from another. There are 4 major plateaus + a fifth one that is generally unpleasant and involves a possible trip to the hospital Source: www.http:third-plateau.lycaeum.org/beginner/index.html DXM Calculator Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Carisoprodol • “Ds”, “Dance,” Las Vegas Cocktail (with hydrocodone), “Soma Coma” (with codeine). • Reported as problem by CEWG members in Washington, South Florida, and Texas. • Texas PCC abuse calls from 1998 to 2003—39% involved only carisoprodol. More likely males, adolescents, happened at other residences, schools, public areas; serious medical outcomes • 2004 Texas deaths with mention of carisoprodol: 60% male, 93% white, av. age 41. Only 3 of 87 were just carisoprodol; the rest also involved other substances, especially hydrocodone and alprazolam. Inhalants % Texas Secondary Students Who Had Used Inhalants Ever or in the Past Month, by Grade: 2004 25% 20% 15% 10% 5% 0% Grade 7 Grade 8 Grade 9 Grade 10 Grade 11 Grade 12 Lifetime Use Past-Month Use Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Percentage of Texas Students Who Had Ever Used Inhalants, by Grade and Number of Different Types Used: 2004 20% 15% 4+ Types 10% 2-3 Types 1 Type 5% Gr ad e Gr 4 ad e Gr 5 ad e Gr 6 ad e Gr 7 ad e Gr 8 ad Gr e 9 ad e Gr 1 0 ad e Gr 1 1 ad e 12 0% % Texas Reform & Secondary School Students Who Had Ever Used Specific Inhalants: 2000-2001 Correction Fluid 8% 6% Glue 5% 7% Aerosol Sprays 4% Lacquer/Toluene 4% Octane Booster 2% Freon 2% Gasoline Secondary School 11% Reform School 13% 14% 17% 6% 41% 8% Spray Paint 0% 10% 61% 20% 30% 40% 50% 60% 70% Age Groups of Inhalant Abusers As Seen in National Data Sets 100% 80% 60% 21% 9% 7% 18% 31% 37% 16% 24% 40% 20% 18% 52% 46% 21% 0% TEDS Tmt.-2004 NSDUH Survey-2005 PY 12--17 18--25 26--34 DAWN Eds--2005 35+ Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Occupation by Type of Inhalant Mention, Texas Deaths: 1988-1998 100% 10% 22% 80% 37% 60% 5% 40% Blue Collar Mechanics 40% 49% 42% 20% 4% Student 16% 0% Freon CHC Toluene Percent of AIDS Cases Reported by Selected Modes of Exposure: 1987-2005 90% 80% 70% 60% 50% MSM IDU 40% 30% 20% 10% M-M & IDU Hetero 20 05 20 02 19 99 19 96 19 93 19 90 19 87 0% Texas Male and Female AIDS Cases by Race/Ethnicity: 1999-2005 100% 80% Hispanic Male Black Male 60% White Male Hispanic Female 40% Black Female White Female 20% 05 03 20 20 99 01 20 97 19 19 93 95 19 91 19 19 87 19 19 89 0% Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 WWW.GCATTC.NET SPECIAL K (Ketamine) • Anesthesia doses 2-10 mg/km; recreational doses 50-100 mg. • Unsafe sexual behavior associated with frequent use of Ketamine. Use at gay circuit parties of concern. • Taken in cyclical binges similar to cocaine or methamphetamine. • Available as powder to snort or as liquid to inject; used with “puffers” to get exact dosing. • Users can become psychologically dependent but no evidence of physiologic withdrawal syndrome. Conclusions from NSDUH: Nonmedical Use of Rx Pain Relievers • Increases in lifetime users, but current users relatively stable • Ages 18-25 had highest rates for all pain relievers reviewed • Little variation in rates across States, regions, metro/non-metro areas • Most OxyContin users (lifetime) also used other opiates Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610 Current Trends in Drug Abuse--2006 Conclusions from DAWN: Nonmedical Use of Opioid Pain Relievers • ED visits in 2004 > 150,000 (131k-185k) – Oxycodone, hydrocodone, methadone > fentanyl, morphine, propoxyphene – Polydrug use is typical – About half of oxycodone products are SR type • Patients aged 21-54 had highest visit rates • Rates vary across metro areas examined • Majority of patients treated and released Source: SAMHSA Jane Maxwell, UT CSWR, 512 232-0610