| i | | : - & i 3 ; i.3 gº ** Freocr:EroxNGs Gonzazvrºzºry - Gortress-orror:rºrs Grove Y SM E E-ºp º NºrCº FXV’ e- december 6, 7, 8, 1918 WOLUME 2 UNIVERSITY OF MEH!3AN #3RAğ $ MAY 1 1 1979 SPONSORED BY DEPOSITED BY THE FORECASTING BRANCH UNITED STATES OF AMERICA DIVISION OF RESOURCE DEVELOPMENT NATIONAL INSTITUTE ON DRUG ABUSE 5600 FISHERS LANE ROCKVILLE, MARYLAND 20857 CONTENTS BOSton, Massachusetts 9t. John Rennel, Jt. . . . . . . . . . . . . . . . . . . . . . . . . . l Chicago, Illinois M%. Malug Kéol{4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Dallas, Texas Mt. Roſſ Gué6&n . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Detroit, Michigan Mºt. T. He usheſ Galdón. . . . . . . . . . . . . . . . . . . . . . . . . |04 Los Angeles, California Ph. Bačka'i Hu% on . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 Miami, Florida M't. James E. Rºve/Lé . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Minneapolis, Minnesota Mil. Chalºes M. Heinecke . . . . . . . . . . . . . . . . . . . . . . 141 Newark, New Jersey Mt. John Flench . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 New York, New York 9t. Pauč Uppač . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Philadelphia, Pennsylvania 19t. Chyvö&topheh D'Amanda . . . . . . . . . . . . . . . . . . . . . 166 Phoenix, Arizona w M3. Sandº MacConneč . . . . . . . . . . . . . . . . . . . . . . . . . 175 San Diego, California Mºt. Howa'ud DeYoung . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182 San Francisco, California 19t. John A. Neumege/u . . . . . . . . . . . . . . . . . . . . . . . . . 193 Seattle, Washington Mil. Michaeº L. Embu . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Washington, D.C. M/l. Geo/uge E. Powečć, Jºl. . . . . . . . . . . . . . . . . . . . . 206 Ann Arbor, Michigan Rev. Röchayud P. G.Cômo/Lo. . . . 209 Appendices APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F School Report and Questionnaire Paw& Uppalº, New Yoſuk CODAMA - Slide Show Script Sandº MacConno CC, Phoenix Viral Hepatitis Form Mayusha C& Schyueedo/L, Phoenix Rock Survey John Newmeyoſu, San F/Laytc.08 cc Heroin Substitutes Report Raque & Cºvćdoyl, NIDA National Drug and Alcoholism Treatment Utilization Survey Ann Béanken, NIDA NOVEMBER, 1978 SUBSTANCE ABUSE INDICATOR ASSESSMENT FOR BOSTON - PART II Timothy W. Cheney, B.A., Information Systems Coordinator Susan S. Resteghini, M.P.A., Director of Program Development/Research Robert E. Potter, M.Ed., Director of Training/Research Staff Assistant John A. Renner, Jr., M.D., Director City of Boston Drug Treatment Program This report constitutes a follow-up study to the June, 1978 indicator assess- ment prepared by the research staff of the City of Boston Drug Treatment Program. The methodology utilized in the preparation of this report is consistent with that developed for the initial assessment effort in June. That is, the City of Boston Drug Treatment Program is in the process of establishing an ongoing informational network comprised of hard data indicators, as expressed by some of the measures presented below, which have been gleaned from a variety of governmental agencies and the private sector. It is anticipated that once this system has become fully operational, it will produce the kind of relevant and consistent information necessary to project program planning needs in the city of Boston. Information provided by this network will be supplied in a cooperative venture with cities elsewhere in the country in an attempt to standardize data collection and reporting procedures. Methodology Data for this indicator report has been generated from fourteen distinct indicators. They are : Hepatitis Cases "B", Drug-related Deaths - Boston, Drug-related Deaths Total Boston SMSA, Local Health Department and Emergency Room Data, Emergency Room Data (DAWN - SMSA), Opiate Felony Arrests, Property Crimes, Treatment Admissions, Year of First Use, Year of First Continued Use (Addiction), State Prison Incarceration Data, Heroin Price/Purity Data, Probation Data and Demographic Data. The following sources were tapped to provide needed data for the measures listed above: Mass. Division of Drug Rehabilitation Research Section, Mass. Department of Public Health Division of Communicable Diseases, Mass. Department of Correction Research Division, Mass. Department of Probation, Boston Police Department Management and Budget Section, U.S. Drug Enforcement Administration- Boston Office, Drug Abuse Warning Network, IMS America, Ltd., the Mayor's Office of the Coordinating Council on Drug Abuse-Boston and the City of Boston Drug Treatment Program Research Section. Staff emphasis for the June, 1978 report and again for this follow-up study has been directed more toward solidifying process than outcome. Considerable effort has been made to substantiate nine of the potential fourteen indicators avail-> able in the Boston area and used for this report. The following procedures were initiated in Order to facilitate more accurate data gathering. (l) Boston Police Department - The Information Systems Coordinator for the City Drug Program worked closely with the Data Processing and Computer Operations Subsection of the Department's Management and Budget Section in order to obtain print-outs, on a semi-annual basis, of all arrests by category. These figures were then compiled for each relevant category based on a classification code sheet supplied by the Department. Information gathered from these print-outs have produced solid documentation for each of the twelve opiate felony arrest measures and thirty-eight property crime measures used to establish these respective indicators. (2) IMS America, Ltd. – This organization is contracted to serve the data processing needs of the National Drug Abuse Warning Network. Effort was made to contact appropriate individuals from this organization in order to allow the research staff access to their raw data print- outs, prior to publication in the DAWN Quarterly Reports (which often have from four to five months lag time in reaching program staff). In addition to being more readily accessible, the raw data can be more easily tabulated for Boston and was utilized to compute four indicators at one time. Information in the print-out provides local emergency room and medical examiner data. From this can be computed local emer- gency room contacts (overdose), total SMSA contacts, local deaths (Boston), total SMSA deaths and demographic data for all of the above. (3) Department of Public Health - DPH sources are now supplying data either quarterly, semi-annually or upon request. Furthermore, the data which staff are now receiving is already confirmed as Serum B through Austrailian Antigen testing. Previous data had, at times, been unconfirmed B or C and was often unreliable. (*) Department of Mental Health, Division of Drug Rehabilitation - Research Section - DDR research staff are now working closely with City Drug Program and Coordinating Council staffs to examine raw CODAP data On a consistent basis. The three staffs working together have been able to glean fairly pertinent CODAP data, particularly regarding Year of First Use and Year of First Addiction. Further work needs to be done with CODAP data in order to delineate heroin trends from polydrug influences. Methodology for this Presentation As was mentioned above, several of the indicators examined for the June report continue to produce data which can give solid assessment of current substance abuse patterns in Boston. These are: Emergency Room Contacts A. Boston - supplied by local health department and emergency room sources - through the DAWN system and IMS America Ltd. B. Emergency room data for the greater Boston SMSA as supplied by DAWN and IMS America, Ltd. Treatment Admissions - supplied by the Research Section, City of Boston Drug Treatment Program. Property Crime Data - supplied by computerized print-outs of crime categories as was mentioned above. Opiate Felony Arrests - produced by the same source as for property crimes * Drug-related Deaths A. Boston - supplied through local medical examiner sources to DAWN data analysts (IMS America, Ltd.) B. Boston SMSA - supplied by DAWN and IMS America, Ltd. Serum Hepatitis Data - supplied by the Mass. Department of Public Health Division of Communicable Diseases The remaining five indicators can be used to either substantiate or contest the findings of those listed above. Some of the data sources for the remaining indicators have yet to be solidified and refined to the extent that they can give sufficient longitudinal information or be broken-down for specific relevance to Boston. Presented below are the essential findings of the reliable indicators, followed by substantiating data from the remaining measures. These findings will be reported in summary form first, followed by a break-down of each indicator by source, methodology, trend and references (where applicable). SUMMARY OF FINDINGS The most significant finding of this follow-up study is the indication of decrease in heroin use in the city of Boston during 1978. The primary indicators utilized in this study all reflect this feature; with the corresponding suggestion that users are turning to the more legitimately obtained and accessible narcotic analgesics. Additionally, the researchers have noted the continuing extensive use of Alcohol in Combination and poly-drug abuse throughout the Boston SMSA. Presented below is a summarization of the specific findings of each of the primary indicators which substantiate these conclusions. l) 2) 3) ly) Hepatitis figures - Hepatitis reports, demonstrating incidence of new users, have shown a decrease of 36% over the level reported for 1977. Death by Overdose - The rate of death by overdose in the city is approximately the same as last year, 9.5/month (1978) compared with 9.1/month (1977) all categories. Heroin mentions are expected to remain at 50% of the 1976 level, which is consistent with the l977 decline. Poly-drug and Alcohol in Combination mentions are expected to remain abnormally high; also consistent with the l977 levels. Emergency Room Mentions – Heroin mentions in the SMSA continue to decrease as a percentage of total emergency room mentions for all categories. Boston's percentage of heroin relative to all heroin mentions in the SMSA has risen 5.9% over that of 1977, thereby confirming its predominantly urban characteris- tic. However, projected aggregate figures for heroin mentions within the city reflect a possible decrease in use in the city (6.9%) from that of 1977. Thus, heroin abuse is most definitely decreasing within the total SMSA and will most probably decrease within the city itself by the end of 1978. Contrary to this trend is the expected increase in narcotic analgesic use throughout the SMSA (as a percentage of total emergency room mentions) and as a percentage of Boston emergency room mentions against SMSA analgesic mentions. Aggregate narcotic analgesic mentions in the city are expected to increase 39.7% over 1977 figures when projected over a twelve month period for 1978. Alcohol in Combination and Diazepam abuse continue to constitute the two most frequently abused substances in the Boston SMSA: lj.36% and lll .85% of total emergency room mentions respectively. Opiate Felony Arrests - To date, opiate felony arrests within the city illustrate a decrease in heroin use. Opiate arrests as a percentage of total Boston Police arrests (all categories) continue to decline lineally from a high of 5.9% in 1976 to H.0% in 1979 (as of August of that year). 5) Property Crimes - Research staff predicted a 17.3% decrease in Boston's property crimes in their June, 1978 presentation of this data. Recent figures (through August, 1978) suggest that the rate of decrease is approximate to that expected ; 15.0%. 6) Boston Price/Purity Index - The price/purity index for Boston in 1978 presents a classic pattern in terms of less purity (down 6.8% from the last six months of 1977), and increased price (up $3/mg. from February, 1978). Decreased purity generally connotes less availability of heroin on the street. 7) Treatment Admissions - Treatment admissions have increased substantially for all CODAP reporting facilities in the city. The City of Boston Drug Treatment Program, which is the largest program in the city (513 clients), has experienced an 88% increase in admissions and readmissions during 1978. Although the researchers did not specifically examine admission data from all other reporting facilities in the city, a noticeable increase in admissiºns (27%) was detected in the 100% quarterly samples taken for indicators # 9 and 10, Year of First Use and Addiction. Admission increase may suggest that treatment varies as a function of availability of heroin on the street. I. II. l Indicator Trends Hepatitis Figures (Source) - Mass. Department of Public Health, Division of Communicable Diseases (Methodology) - Figure 1, presented below, illustrates the number of Serum Hepatitis (B) cases reported to the state from local health care facilities. The data is available quarterly, semi- annually or upon request. All cases are confirmed Type B. Figure l Hepatitis Figures For Boston for 1975–1978 (Oct.) 1976 l277 1978 6 2 O l, 6 5 2 6 3 6 5 3 5 3 l, l 2 5 ly 3 O 2 3 O 3 l, O 3 5 5 l 3 tºº 6 2 wº l, 3 lily 25 (Trend) - The significant feature of this indicator is the substantial decrease in reported (and confirmed) hepatitis cases for 1978. As of October of this year, hepatitis cases were down 36% and 30.6% respectively from the same October readings of the previous two years. The Department of Public Health has reconfirmed its figures and substantiated that no change in reporting format had been initiated in 1978. The 1978 level appears to be similar to that recorded for 1975. The researchers have concluded from this that the rate of incidence (new users) in the city has decreased substantially during the first ten months of 1978, Drug Related Deaths - Boston III. Drug Related Deaths Total Boston SMSA (Source) - Drug Abuse Warning Network, Quarterly Report, April–June, 1977. IMS America, Ltd., Ambler, Pennsylvania, Drug Abuse Warning Network Medical Examiner and Emergency Room Data, Computer Print-out, October, 1978 (Methodology) - Research staff compiled Boston (local) deaths for heroin and other top-ranking drugs of abuse from IMS raw data which would otherwise appear in published form as part of the SMSA total. Boston deaths were compiled and measured against total SMSA deaths for 1977 and 1978 (through September). 1976 data could only reflect SMSA results as Boston data from that year was unavailable. Death data may occasionally be late in arrival to IMS due to legalities at the local level. Therefore, research staff have chosen to use September's data for analysis. thereby allowing additional time for verification of the October count. (Trend) - Data for local Boston and total SMSA deaths l976-1978 (Sept.) are presented below in Figure 2. The most significant feature for the l978 figures is their consistency with the 1977 findings. That is, the aggregate data when projected over a twelve month period demonstrate a 9.5/month death rate for all categories, compared with 9.1/month in 1977. The individual categories are also reflective in the sense that the opiates and narcotic analgesics or "hard drugs" demonstrate the same low level as was noted last year, while the alcohol in combination and poly-drug levels are expected to remain at the same high level as that of 1977. 1977 figures for these categories are, shown to have risen dramatically from the 1976 levels; particularly d-Propoxyphene and Glutethimide, *ll!!!% and tló7% respectively. Fifture 2 Death by Overdose Drug Name Total SMSA Boston Total SMSA Boston Total SMSA 1976 1977 lºſ” 1978 1978 Heroin/ Morphine 16 6 8 2 l; Other Narc, Analgesics 23 3 8 O 2 Alcohol in Combination ll 5 2}} O l6 d-Propoxyphene 9 10 22 7 17 Drug Name Glutethimide Amitriptyline Cocaine Flurazepam Barbiturates Diazepam Methaqualone TOTAL N Figure 2 (Cont.) Death by Overdose Total SMSA Boston Total SMSA Boston Total SMSA 1976 1977 1977 1978 1978 3 l, 8 3 6 3 l 5 O 3 3 O 2 O l O l l O 2 32 O 17 l; 17 O O O O O 100 29 96 16 72 (Sept.) 83.7% of reported deaths - Projected total = 86 (Reference) - Ms. Barbara Barth, IMS America, Ltd., Ambler, Pennsylvania, October, 1978. IV. Emergency Room Data (DAWN - SMSA) W. Local Emergency Room Data - Boston (Source) - Same as above for indicators II and III. (Methodology) - Both of these indicators were combined for purposes of comparison as they are related and can be retrieved consis— tently from the IMS print-out mentioned above. Figure below indicates total SMSA figures for 1976–1978 (September). Additionally, 1977 and 1978 SMSA figures are shown as percentages of total emergency room mentions for those years. The substances are then listed by rank(Figure lº) in terms of their percentage of total ER mentions for l977 and 1978. Updated and more comprehensive DAWN print-outs have enabled the research staff to gather additional data on Chlordiazepoxide and PCP. This data was not shown in the June, l978 publication of this material. Figure 5 represents Boston emergency room data and this data as a percentage of the total mentions for each substance in the SMSA. Figure Emergency Room contacts for the Boston SMSA 1976 - 9/78 Drug Total SMSA Total SMSA % of Total ER Total SMSA 7% of Total ER Name 1976 1977 Mentions - l97? 1978-9/78 Mentions - 1978 Alcohol in Comb. 721 918 lk.5% 750 15.1% Diazepam 710 90l l!.2 725 l!! .9 Barbi- turates 35, 363 5.7 236 l; .8 Narcotic Analgesics 682 - 33l 5.2 269 5.5 Heroin/ Morphine l;23 322 5.1 219 lº. 5 Flurazepam lºl 2ll 3.3 lb 5 3.0 Chlordia- zepoxide 169 l;8 2.5 126 2.6 d—Propoxy- phene 104 169 2.6 137 2.8 Amitripty- line 82 ll.9 1.8 91 l.9 Amphetamines 37 63 l.0 57 l, 2 Cocaine 25 ly 3 ... ? l,8 l.0 PCP ll, ll.9 l.9 59 l. 2 Figure 4 Rank by Percentage of all ER Contacts 1977 1978 #l Alcohol in - Alcohol in Combination Combination #2 Diazepam Diazepam #3 Barbiturates other Narcotic #ly Other Narc. Analgesics Analgesics Barbiturates #5 Heroin/Morphine Heroin/Morphine #6 Flurazepam Flurazepam #7 d-Propoxyphene d—Propoxyphene 10 #8 #9 #10 #ll #12 Drug Name Alcohol in Combination Diazepam Heroin/Morphine Other Narcotic Analgesics Barbiturates d-Propoxyphene Amphetamines Cocaine PCP Flurazepam Amitriptyline Methaqualone (Trends) - Figure H (Cont.) Rank by Percentage of all ER Contacts 1977 1978 Chlordiazepoxide Chlordiazepoxide PCP Amitriptyline Amitriptyline Amphetamines Amphetamines PCP Cocaine Cocaine Figure Boston Emergency Room Contacts as Percentage of SMSA Contacts per Substance Boston % SMSA Boston % SMSA N for 1977 1977 N for 1978 1978 385 lºl.9 313 lºl. 7 318 35.2 263 36.3 243 75.1; 178 8l. 3 l68 50.7 ll,7 53.6 131 36.0 86 36.l., 8l l;7.9 67 l,8.9 10 lj.8 27 25.7 30 69.7 32 66.6 ly 9 lºl. 2 22 37.3 5l 2|, ..l 36 24.8 23 l9.3 2O 22.0 18 32.7 2l 55.2 Figures 3 & 1 - As could be noted for 1977, the most significant drugs of abuse in the total SMSA were Alcohol in Combination and Diazepam ; both of which have continued their upward trend, percentage-wise, in 1978. Of significance, however, is the substantial decrease in barbiturate abuse. Researchers surmise that this may be a direct result of national policy direction regarding control of barbiturate abuse and corresponding law enforcement efforts to this effect. Equally of note, heroin continues to decrease percentage-wise in the total SMSA while the use of other narcotic analgesics, more legally obtained through perscription, has risen. Researchers surmise from this that legal narcotic abuse seems to be supplanting its illicit use. This can also be noted in Figure lº which indicates a rise in rank from fourth to third for narcotic analgesics overall. Additionally, PCP mentions have dropped noticeably during l978; suggesting that the massive media effort (initiated in the city in 1978) concerning this drug may have reached the younger population as intended. Figure 5 - Of the twelve substances listed in Figure 5, four reflect predominant use in Boston. Boston's percentage of heroin relative to the SMSA has risen 5.9% over that of last year (as of September, 1978). Yet, projected aggregate figures for mentions within the city demonstrate a possible decrease in use for from that of last year. (6.9%). Thus, heroin abuse is most definitely decreasing throughout the SMSA and will most probably decrease within the city itself by the end of the year. However, narcotic analgesic use in Boston, when projected for twelve months, will most probably show a significant increase (39.7%) over last year. The Boston analgesic percentage among total SMSA mentions remains approximately the same as last year. This finding appears to correlate with the figures represented in Figure li. That is, narcotic analgesics, procured through more legitimate means, seem to be replacing illicit heroin use to some extent. ll The remaining substances, with the exception of methaqualone, appear to be used primarily in the suburbs. Methaqualone has begun to appear statistically with regularity during the last year. Its continued presence may indicate a trend in its use rather than a short-lived resurgence of its previous notoriety in the area. (References) - Same as that above for indicator #3. WI, oriate felony Arrests (Source) - Boston Police Department, Management and Budget Section, Boston Police Arrest Report, March, 1978 Boston Police Department, Management and Budget Section, Boston, Ma. , computerized print-out. (Methodology) - The computerized arrest print-out, mentioned above in Methodology was used to compile data from twelve combined categories of narcotic felony arrests. Only heroin, synthetic narcotics (other analgesics) and cocaine were included in the twelve categories. The data is presented below in Figure 6 by month for 1976 through 1978 tº sº. 12 Figure 6 Opiate Felony Arrests 1976 - 1978 Month 1976 1977 1978 Jan. 79 68 91 Feb. 93 lOl 100 Mar. 88 69 67 Apr. 86 83 65 May 79 62 92 Jun. 89 8O 83 July 87 66 60 Aug. ll O 87 71 Sept. l3, 72 * ... º. Oct. ll.0 81 tºº Nov. 110 ll.9 sº Dec. 7, l;9 * . Total Opiates 1,139 937 629 Total All Boston Police Arrests 19,061, l9, 123 15,596 % Narcotic of total Boston Police Arrests 5.9% ly .8% l, .0% (Trend) - The total number of opiate felony arrests for the city of Boston was approximately the same in 1978 (through August) as it was in August of 1977; 629 for 1978 compared with 616 for 1977. The important feature to note, however, is their percentage of the total Boston Police arrests (excluding motor vehicle violations) for each year. As can be noted in Figure 6, the percentage of narcotic arrests of all Boston Police arrests has declined to a substantial degree from the percentage in 1977 . . The percentages for 1977 and l378 are both down from that of 1976. Thus, opiate felony arrests appear to be declining in the city, thereby suggesting a continuing decline in use. WII, (References) - Lieut. Francis R. Walsh, Ms. Ellen Lyons -- Data Processing and Computer Mr. Stanley Pugsley Operations/Management and Budget Section, Boston Police Department Property Crimes (Source) - Boston Police Department, Management and Budget Section, Boston Police Arrest Report, May, 1978 Boston Police Department, Boston Classification of Part I and Part II. Offenses. Services and Incidents (Methodology) - Property crimes were tabulated from the above stated sources in terms of thirty-eight property crime categories. Only those categories which constituted burglary and larceny offenses were considered. Purse snatching and pocket picking, although also considered to be crimes against the person, are included here due to their close association with substance abuse. (Trend) - Property crime statistics are presented below as Figure 7. The trend indicates that the l977 rate is virtually the same 13 as that of 1976. However, figures for 1978 (through August) indicate a decrease for that year of approximately 15% from those of 1977. The June, l978 publication of this report projected property crimes to decrease by 17.3% in 1978 based on first quarter figures. As can be observed in Figure 2, the total for August, 1977 is 3,325 property crimes. This figure for August, 1978 is 2,847. The percentage of these two figures of all Boston Police arrests confirms the decline. Property crimes therefore continue to reflect the same trend noted in narcotic arrest categories, a decline throughout the city. Figure 7 Property Crime Arrests 1976 1977 1978 Month 5,076 ly,988 300 Jan. l,05 Feb. 363 Mar. 372 April 35l May 350 June 313 July –222– Aug. 3,325 (Aug) 2,857 (References) - The same as that above for number VI. 1H VIII. Treatment Admissions (Source) - Research Section, City of Boston Drug Treatment Program, Boston, Ma. (Methodology) - Admission data, as categorized by new admissions and readmissions, cannot be reported here for the entire city due to a difference in reporting format between state funded facilities and federally funded (CODAP monitored) facilities. Additionally, CODAP admission data (by modality) was not readily available for this indicator from all CODAP reporting units of the city. However, admissions data from the City of Boston Drug Treatment Program for the years 1975 - 1978 (through Oct.) serve as a reliable indicator for opiate admissions in the city. This Program is the largest in the city of Boston (caseload = approximately 513) and consists of four out-patient methadone clinics and one residential drug-free facility. Observation of the client-flow for this Program should reflect the status of opiate availa- bility on the street. The data presented below Figure & is broken - down into new admissions and readmissions (inclusive) for each of the years mentioned above. JAN. FEB. MAR. APR. MAY. JUN . JUL. AUG. SEP. OCT. NOW . DEC. (Trend) - The pattern reflected in Figure 8 indicates that new admissions 1975 Admit. Read. ly 5 l;0 37 32 lyl, 58 l;6 19 31 25 30 23 18 2O 27 17 17 32 29 ll 24 27 lly lº; TOTAL ly5O 25l. and readmissions for the Program dropped steadily from 1975 through 1977 (10.3%, 61.2% new admissions, respectively) and (17.2%, 62.1% readmissions respectively). However, data from the first ten months of l978 indicate that new admissions and readmissions have increased 88% over this same time last year. Admissions and readmissions for the first ten months of 1977 totaled 240. The total for 1978 at this time is l; 53. Some of the demographic data characteristic of the Program's 1978 caseload shows the following: Mean age = 29.65 years Mean # convictions/client = l; .68 Last formal school year completed = 10.7 years Unemployed upon admission = 66.8% Sex = 71.7% (male) and 28.3% (female) Race = White Non-Hispanic (63.7%) Black (25.0%) Hispanic Puerto Rican (8.5%) Other (2.8%) Figure 8 Admission/Census Data 1976 1977 1978 Admit. Read. Admit Read. Admit. Read. 20 26 21 6 32 8 27 20 18 6 lb. 3 37 22 ll, 7 33 20 33 10 2l l? 38 lly 18 16 25 8 lyly 16 25 21 17 lo 33 20 l,6 9 l3 5 34 20 30 13 18 8 27 23 18 lly 5 6 35 l? l,7 28 (2,0) 21 9 (1,53) 3!, 12 35 lb. 6 2 23 19 50 lº ll O 23 6 386 208 190 79 370 174 15 88% f (References) - Susan Resteghini, Timothy Cheney, Claire Robinson, Research Section, City of Boston Drug Treatment Program IX, Year of First Use (Source) - Mass. Dept. of Mental Health, Division of Drug Rehabilitation Information Management Section (Research) CODAP Admission Sheets (raw data). (Methodology) - All available CODAP admission and readmission forms for each of eleven reporting units were sampled at 100% for each of five specific months (representing quarterly samples) for July, 1977 through July, 1978. These reporting units include a total of four outpatient methadone maintenance clinics, one methadone detoxification program, and six residential drug-free programs. This population essentially represents the majority of hard-core opiate addicts who are in treatment in the city of Boston. Each of the sample months were tabulated by Year of First Use (primary drug) for each admission during these months. A table of this break-down by years l960–1978 is presented below as Figure 9. The significant years of First Use are indicated by percent of the total sample for 16 each month. Those years which indicate First Use for most of the admissions for each of the given months, are compared against the date of entrance into treatment. This was calculated in order to define a clearer picture of lag- time between First Use and admission to that particular program. Fi e Year of First Use Jul, lºſ/ 9ct. 1977 Jan. 1978 Ap.-1978 Jul, 1978 < 1960 3 3 ly l, 2 1960 3 O 2 O O 1961 O O O O 3 1962 3 O O l l 1963 3 3 O l 3 1961, l 5 l 2 ly 1965 5 6 l, l, l, 1966 6 6 l; 6 6 1967 1968 1969 1970 197l 1972 1973 197ly 1975 1976 1977 1978 TOTAL 1967–70 1973-75 ! tº ºxº 119 39% 21% Figure 9 (cont.) Year of First Use 17 9ct. 1977 Jan. 1978 Ap. 1978 Jul. 1978 9 8 6 9 l2 ll ll 12 38% )12 11%347 17 38% Y?? 20 9 9 l3 \ 10 ll l2 ll 17 9 7 13 10 ly 5 8 8 l!! ( 10 20%. 312 25% # 7 21% P 3 10 8 12 6 3 8 —9– —— tºº —— 150 117 ll.9 151 Significant Years of First Use 9ct. 1277 Jan. 1978 Ap. 1978 July 1978 (68-71) 38% l,l} l;1% 38% (7l-76) 20% 25% 2.1% 22% (Trend) - A lag-time of seven to ten years between First Use and the current treatment attempt appears evident for this population sample. This seems to be consistent with the characteristics endemic of this population. That is, "hard core" users are being observed here by virtue of the fact that most are in maintenance or on drug-free status, either outpatient or residential. Often this amount of time lag is necessary to establish commitment for these modalities of treatment. However, this data is somewhat soft because it does not measure Use against prior treatment attempts. Further refine- ment of data collection processes will be necessary in order to accommodate this variable. 18 It is also useful to note the rise in admissions for the July, 1978 sample month. The July sample had one less reporting unit than April of that same year. Yet, the total admissions and read- missions increased 26.8% from April to July. This appears to correlate with the increase noted for the City of Boston Program during 1978 (as mentioned above in # VIII). (References) - Mr. Bruce Murphy, Supervisor, Information Management Section, Division of Drug Rehabilitation, Mass. Dept. of Mental Health, Boston, Ma. X, Year of First continued use (Addiction) (Source) - Same as that above for # IX. (Methodology) - Same as that above for number IX. Each of the sample months were tabulated by Year of First Continued Use (Addiction) for each admission of these months. A table of this break-down by years 1960–1978 is presented below as Figure 10. Significant years of First Continued Use were too randomized throughout the sample months to gain a clear indication, samplewide, of lag-time between time of first addiction and admission to the current treatment attempt. However, a significant number of July, 1978 admissions (38.4%) indicated that they had become addicted six to nine years prior to their present treatment attempt. An additional 28% indicated that they had become addicted within four years of the July, 1978 treatment attempt. Year of First Use and Year of First Addiction for July, 1978 admissions are plotted against each other in Order to observe lag-time between these two variables. (See below Table I) Based on the above comparisons, the July, 1978 CODAP sample of Year of First Use versus Year of First Addiction indicates very little lag-time between these variables. The researchers conclude from this that the occur- ence of widespread poly-drug abuse during the seventies has hastened the onset of addiction among users. This finding appears to substantiate the data presented by the researchers in their June, 1978 presentation of this material. That publication included a cross-tab of these two variables for an April, 1977 CODAP sample which indicated a lag-time of one year during the late sixties when little poly-drug abuse influenced addiction onset. It also indicated the same finding as that presented above, no lag-time during the seventies due to poly-drug influence. The April, 1977 data is presented again in this document, as Table II, for purposes of comparison. This data must, however, also be considered somewhat soft as there is no break-down for opiate addiction as differentiated from poly-drug addiction. Future utilization of this indicator must cross-tab (through use of a computerized system) drugs of abuse by Year of Addiction for each admission. Also, more longitudinal data must be developed in order to obtain a more meaningful measure. Figure 10 Year of First Addiction CODAP Admissions July, 1977 9ct. 1977 Jan. 1978 Ap, 1978 July 1978 < 1960 3 3 3 3 l l960 2 O l O l 1961 O O l O 3 1962 2 O l l l 1963 3 O O l O 1961, O l O 2 l; 1965 l; ly l 2 2 1966 l; l, l, l, 7 1967 13 7 6 7 7 1968 5 7 ll l, 5 1969 l2 9 l3 l3 17 1970 l3 23 ll 13 l!! 197l 9 12 9 8 ll 1972 5 13 9 16 1973 13 12 6 l2 1974 9 l6 13 8 8 1975 9 15 9 12 l2 1976 6 l6 10 10 12 1977 2 7 9 14 l3 1978 –9– –9– —— —É– –2– TOTAL lll, ll.9 ll 8 119 15l (References) - Same as that above for number IX. ** = T--~ à ſº H "- 935 T-, H 27 H C /* * @ 3 & /* ſº H ON H [x, E-4 r- 3 tº #: - *s 8- O H Prs É Y- H) #5 y >+ º: & O º [+] er- - >{ +* O •r- rC, Q) rC, UA <\; -) A&P --> --> (ſ) U) T - | \ r- C CC (N- \O \ſ) (YN (N) r- ON OC (N- VO \ſ) (YN ON r- Q & Q & 2 % S 3 º' = Q S H VO u \ ºr fić,6I £4.6l 2/6t [4.6L 0.61 696. I 396T 4.96L Table II YEAR OF FIRST USE AND YEAR OF FIRST ADDICTION 30 29 April 1977 First use 26 25 24 23 22 2] 1 | 10 © CO T`~ GO LO <† (Y) CNJ – o 8/6|| //61 9/61 GL6l ț7/61 8/61 Z/6 || l/61 21 28 27 First addiction 20 | 9 | 8 |7 | 6 15 14 T 3 12 0/61 696 l 896 l /96 l 996|| G96|| ț796 l £96 l Z96 1 . 1961 096|| 096 || > 22 XI. JAN. FEB. MAR. APR. MAY JUN. State Correctional Commitment Data – Narcotics (Source) - Massachusetts Department of Correction, Research Unit - Print-out from automated MIS - State Narcotic Commitments (Class A substances) - 1975 - 1978 (October). (Methodology) - Data presented from the Massachusetts Department of Correction were compiled from print-outs by year and month; 1975 - 1978 (October), for all individuals incarcerated in the state system on narcotic felony charges (Class A only). All categories of Class A narcotic commitments were combined (approximately five for this classification) on the print-out. These include: possession of a controlled substance, possession with intent. possession of a syringe, etc. (Trend) - State commitment statistics are presented below in Figure ll. The significant feature of this data is the dramatic increase §: of the total state commitment population during 1978 through October), and the corresponding dramatic decrease in narcotic commitments. Correction officials have confirmed that state commitments have more than doubled during the last year, primarily due to the sentencing patterns of the judicial system. Accordingly, individuals with primary narcotic offenses are not being remanded to the state unless they have committed concurrent Offenses involving crimes against the person or serious property Offenses. This indicator must be considered inconclusive at this time in terms of its usefulness in predicting narcotic trends. The fluctuation in the criminal justice system due to political and judicial considerations preclude accurate narcotic assessment at this time, particularly for Boston. figure ll State Narcotic Commitments (Class A) 1975–1978 (Oct.) 1975 1976 1977 1978 7 5 2 12 5 5 5 3 ll 15 2 5 10 l, l 8 lly l, 7 l6 9 7 2 Figure il (cont.) State Narcotic Commitments 1975 1976 1977 1978 AUG. 7 3 O SEP. 15 7 O OCT. 6 ll 7 2 NOW . 9 LO 3 dº DEC. –8– –44– + — TOTAL 99 10l. 68 2l TOTAL N ALL STATE *** COMMIT. 1,059 l, 355 l,l}}5 - 2,870 (Through Oct.) % NARC. - COMMIT. 9.3% 7.6% 5.9% - .73% (References) - Frank Carney, PhD 23 Director, Research Massachusetts Department of Correction Charles Metzler, Sr. Programmer, Research Unit Massachusetts Department of Correction XII. Heroin Price/Purity Data (Drug Enforcement administration) (Source) - Drug Enforcement Administration, Regional Intelligence Office Region I, Boston, Ma. (Methodology) - Figure lz below indicates mean purity and price per mg. by month, for all DEA seizures in 1978 (through July). Bulk brown price and purity for 1978 are charted against each other in Table III. Brown bulk purity for the years 1972 - 1978 are presented in Table IV. The mean for six- month intervals for each of these years is charted. Bulk brown seizures were tabulated due to their consistency and availability. 2|| JAN. FEB. MAR. APR . MAY JUN . JUL. (Trend) - Price and purity indicators can generally be used to determine the availability of heroin on the street and therefore its use prevalence. Price indicators generally vary inversely with purity. As purity increases, price usually decreases. Purity varies directly with availability in most instances. Therefore, the greater the purity, the more likely the availability of heroin on the street and or ; the lower the price, the greater the purity and availability of heroin are likely to be. This maxim is true in most cases although local economic fluctuations may result in artificial restructuring of the index. The Boston price/purity index indicates that purity and thus availability on the street has dropped significantly from a mean of 10.7% for the last six months of 1977 to a mean of 3.95% for the first seven months of 1978 (Table IV). This is substantiated by the price/purity index represented in Table III. Price and purity clearly vary inversely during these months, indicating a consistent drop in purity from February, 1978 to July of that year, with the corresponſing increase in price, Researchers conclude from this that 1978 is experiencing a decline in heroin availability on the street. This conclusion is also witnessed by the considerable rise in treatment admissions in the city, which probably reflects treatment as a function of drug availability, and the decrease in city emergency room mentions for heroin and corresponding rise of more legitimately obtained narcotic analgesics. Figure 12 Price-Purity by Month - DEA Seizures 1978 No. Of Brown Heroin Purity Price/mé. White Heroin Exhibits Purity X 3.5% $3.8), X 5 .5-5.8% X 7.9 1.87 O O O X ly. 5 3.l,8 X l; 2.0–6.0 X 3. l ly .02 X l 2, 2-5.0 X 2.l. 2.81 X 2 2.0-2.9 NO DEA SEIZURE REPORTS AWAILABLE X 2.l l! .l;0 X l 2.1 The white heroin was bought in deck form (Range - 50 to 75 decks) (References) - Drug Enforcement Administration, Regional Intelligence Office Region I, Boston, Ma. § * XIſlſº * Nſhſ’ | " XVW * Hºſ.W 25 * HVA * 33.H 'NWſ \g s º º T & 26 i i SS Ş † & & º \g F. § 3 ºft- NWſ 4,46T Oğ(I - Iſhſ 446t Nnſ -- NWſ. 94.6 L OHCI - Iſhſ 94.6L Nſ)ſ - NVſ. 94.6l (‘Ireaeun) t|46T O'HCI - Iſlſº fi/.6 L HNſ)ſ - NWſ’ 94.6T O'HT - Tſ)ſ 94.6L Nſ)ſ - NWſ 24.6T OHCI - Tſ) ſº XIII. Probation Data (Source) - Research Unit, Office of the Commissioner of Probation Massachusetts Probation Department. (Methodology) - The Office of the Commissioner of Probation, Commonwealth of Massachusetts continued its annual drug monitoring program in 1978 by examining all cases remanded to the Department for two five day periods; May 22-25, 1978 and August 21–25, 1978. Official court records including new and additional cases with at least one drug offense were examined. A total of 269 cases were examined in the May, 1978 sample, and a total of lil; 5 cases were examined in the August sample. (Trend) - The results of these two samples are revealing in two ways. #1 - #2 - In both samples the Boston percentage of Class A (heroin) users was well above that noted in the 1977 Probation study (61.7% in 1978 vs. l. O% in 1977). Boston, however, continued to supply the fewest number of Class D (Marijuana) cases, by region. Additionally, Class A cases constituted only 6.22% of the entire statewide sample. Data relevant to multiple offenses is revealing in that it tends to substantiate the commitment pattern 27 noted with the state correctional commitments. That is, individuals with a primary narcotics offense are not being remanded to the Overcrowded state correctional system. Rather, they are appearing on probation, contrary to practice in previous years. The chart presented below in Figure 13 illustrates this finding. Figure 13 Simultaneous Offenses 1978 Sample Type of Offense Percent drug only 62.5% against person 3.6 against property 9.6 all other 24.3 Researchers have concluded from this that Boston continues to experience the greatest incidence of hard-core drug abuse and that the city police continue not to prioritize marijuana. The increased percentage in Boston may well be due to the situation in the prison system. (Reference) - Drug Defendants in Massachusetts Marjorie Brown Roy Director of Research Office of the Commissioner of Probation Massachusetts Probation Department October 24, 1978 XIV, Demographic Data - Boston Emergency Room Mentions (Source) - IMS America, Ltd., computerized print-out; January–September, 1978 (raw data). (Methodology) - Demographic data was generated for all emergency room mentions in the city of Boston for the twelve substances of abuse listed above in indicator #11. Each substance was broken down by race, sex and eight categories of age. (Trend) - Figure lº presented below represents each of the substances and their demographic breakdown as mentioned above. The salient feature, common to each substance, is the predominance of use in the 20-29 yr. age group for every substance. The other variables will be discussed below to the extent that they are pertinent to the specific substance. Among the "hard drugs" or narcotics, heroin continues to exhibit the urban earmarks long associated with its use. For example, it continues to be used predominantly by the Black male population at a 2: l and 3:l ratio respectively. Narcotic analgesic use, however, suggests a somewhat different trend: perhaps reflective of its increased use throughout the city as noted above in indicators #1, and #5. Contrary to heroin demographic data, the analgesics are used primarily by the White population and equally by men and women. The age range, however, 29 is consistent with that noted for heroin use. Alcohol in Combination and the poly-drug phenomenon continue to reflect a white, male incidence; with some increase in use noted for females. Within this category, the tricyclics and benzodiazepines particularly illustrate the increase in use among women. The antidepressant/anxiety effects of these substances may well be attributable to the incidence of women seeking help through the psychiatric/medical profession. Cocaine is distinguished by the fact that over three-fourths of its use occurs within the lC-29 yr. age bracket in the Black community; to the same extent as methaqualone and amphetamines are particular to the White community. The PCP epidemic in Boston was noted extensively in the June, 1978 presentation of this material. According to more recent figures, the use of PCP appears to have peaked in 1977 and is now declining. Its demographic pattern continues to present a pattern of very youthful, white, male usage. (Reference) - Ms. Barbara Barth, IMS America, Ltd., Ambler, Pennsylvania. 30 Black White Other Black White Other Black White Other Black White Other : Ra C e % º : Ra C e º % Figure lº Boston Demographic Data By Substance/Race, Sex and Age 1978 Heroin/Morphine Sex Age Male 72% (10-19 : Female 28% (20–29 yrs 3 (30–39 yrs) 26.4 (Other ) 9.0 Other Narcotic Analgesics - Sex Age Male 52.3% (20–29 yrs) 55.6% Female l;7.7 (30–39 yrs) 23.8 (Other ) lz.7 Alcohol in Combination Sex A£e Male 61.8% (10–19 yrs) 8.5% Female 38.2 (20–29 yrs);6.2 30-39 yrs)26.l. l,0-19 yrs) 8.0 (Other )10.9 d-Propoxyphene Sex A£e Male l;7.7% (10–19 yrs)ll.9% Female 52.3 (20–29 yrs);0.3 (30–39 yrs)22.l. (l,0–19 yrs)13.4 (Other )13.0 Figure lº (Cont.) Boston Demographic Data By Substance/Race, Sex and Age 1978 Amitriptyline Race Sex A£e Black 30% Male 20% §: : l;0% White 60 Female 80". (30–39 yrs) 30 Other 10 Other ) 30 Cocaine Race Sex A£e Black 58.0% Male 80.6% § : lS.6% White 32.3 Female l9.1% 20–29 yrs) 71.9 Other 9.7 (Other ) 12.5 tº gº tº gº tº ſº tº 31 Flurezepam Race Sex Age Black 22.2% Male 36.1% (20–29 yrs) 36.1% White 72.2 Female 63.9 30–39 yrs) 16.7 Other 5.5 l,0–149 yrs) ll.l º yrs 8.3 60+ yrs 13.9 (Other 13.9 Barbiturates Race Sex Age Black l8.9% Male 61.0% § yrs) 7.7% White 77.9 Female 39.0 . (20–29 yrs) l; 2.0 Other 3.1 (30–39 yrs) 6.l. (1,0–19 : 7.7 (50-59 yrs) 6.6 (Other 9.6 Figure lº (Cont.) Boston Demographic Data By Substance/Race, Sex and Age 1978 Diazepam Race Sex A£e Black 23.6% Male 56.3% (10–19 yrs) ll.8% White 70.3 Female l; 3.7 (20–29 yrs) 52.5 Other 6.l (30–39 sº 2l.0 (Other ll; .7 PCP Race Sex Age Black 18.2% Male 81.8% (10–19 yrs) 36.4% White 81.8 Female l8.2 (20-29 sº 54.5 Other O (Other 9.l Amphetamines Race Sex A£e Black l8.5% Male 81.5% (10–19 yrs) 18.5% White 77.7 Female 18.5 (20–29 yrs) 63.0 Other 3.7 (30–39 yrs) ll.l (Other ) 7.1, Methaqualone Race Sex A£e Black 9.5% Male 76.2% (10–19 yrs) 23.8% White 85.7 Female 23.8 (20–29 yrs) 52.1; Other l; .8 (30–39 yrs) 9.5 (Other ) ll; .3 REFERENCES Massachusetts Department of Public Health, Division of Communicable Diseases, 1978 (raw data) Barth, Barbara, IMS America, Ltd., Ambler Pennsylvania, computerized print-out (raw data) Walsh, Lieut. Francis R., Ellen Lyons, Stanley Pugsley, Data Processing and Computer Operations/Management and Budget Section, Boston Police Department, Boston Police Arrest Report, March, 1978 and Boston Classification of Part I and Eart II Offenses, Services and Incidents Resteghini, Susan S. , Timothy Cheney and Claire Robinson, City of Boston Drug Treatment Program, Research Section (raw data print-out) Murphy, Bruce, Information Management Section, Division of Drug Rehabilitation, Massachusetts Department of Mental Health (raw data) - CODAP monitoring system Carney, Frank PhD., and Charles Metzler, Research Unit, Massachusetts Department of Correction (raw data print-out) Drug Enforcement Administration, Regional Intelligence Office, Region I, Boston, Massachusetts,(raw data) Roy, Marjorie Brown, "Drug Defendants in Massachusetts", Commonwealth 33 of Massachusetts, Office of the Commissioner of Probation, October 24, 1978 SUPPLEMENTARY ANALYSIS OF HEROIN PREWALENCE Chicago (December 1978) Mary Kioris Chicago The need 60/1 quantöð (ab&e data, CO.C&ected in a consistent mannoyl ove/l time, (A c/ucia & 60'l both the 60'umuðation 0% nationać and State dug abuše poſicy and the a CCocation 06 Cimited ſlo Soulce & to impõement those požicies. Such data aſle equa&y impoſutant in 2va£uating the 2xtent to which 2x &ting 8tuate- g4.28 aſle a 66.2cting the Öncüdence and pilovač2nce 06 dug abuse. The data p'Lesented in this chapte/l. Suggest that the diamatic incylease in hoſuo in addiction du/ving the past 20ght yea/US has begun to Čevoč 0% as othe/t patte/uns 06 dug usage Öncylease. Mućtépée dug ingo &tion (pa'uticuCayuðy £n combination with a £cohoº and the Ta’win/pg/vibenzamine hoſuc.in Aub&titute), £öcºt dep/L28Aant abuš 2, and Ágn thetic hać Cucinogens Äuch as PCP emo/ig2 as £he Aub&tances being abused with eve/l incyleasing 6/12quency. Serum Hepatitis Graph l reports that the incidence of serum hepatitis has continued to increase since 1970. When viewing the Chicago hepatitis episodes versus those occurring downstate, 57% of all cases in 1977 occurred outside of the City of Chicago. In addition, the rate of increase in reported hepatitis is greater in downstate Illinois, although the vast majority of heroin abuse still occurs within the Chicago area. White males most frequently contract this disease, although downstate hepatitis patients tend to be slightly younger (50.2% between 15 and 24 years of age) than those in Chicago (49.8% between 20 and 29 years of age). Graph 1. Incidence of Serum Hepatitis: 1970–1977 s:0- "Total # cases in Illinois soo- * * # cases Chicago onl eso- I - # cases rest of Illinois 800- 790– 700. ($90– GOO- $50-- 500- 450– 400- 3%.C- 3OO- 250- 2&- 50- ! OO- Jº J J: 1) }4 75 }6 77 SOURCE: Illinois Department of Public Health e Area breakdown for 1973 unavailable Heroin Related Deaths This indicator is considered as one of the most reliable in identifying the prevalence of drug abuse. However, many deaths not directly resulting from drug overdose but which may have involved drug usage escape documentation. Heroin/morphine deaths have steadily declined from 22.8% of all drug deaths in 1974 to 14.8% in 1977, While other drug related deaths have increased, especially among persons abusing alcohol in combination with multiple drugs. In 1977, DDC refined its analysis of drug related deaths by differentiating between actual drug overdose deaths and those where drugs may have been a factor but did not specifically cause the fatality. For example, Talwin emerged as the most prevalent heroin substitute during 1977 and appeared in 24 drug deaths, only eight of which were actual overdoses. The remaining fatalities resulted from stabbings and gunshot wounds, but toxicological tests revealed high levels of Talwin in the blood stream of each of the remaining 16 fatalities. Table 1 highlights the major drug categories and the proportion each represents as actual drug overdoses versus drug related deaths. (See Addendum for additional information.) TABLE T Death by Drug Type in Cook County for 1977* Type of Drug Drug Caused - Drug Related # % # % 1. Tranquilizers 38 l 4.4 | ] 6.0 2. Heroin/Morphine 6] 23.2 69 37.9 3. Other Narcotic Analgesics 3] | ] .8 3 1.7 4. Non-Narcotic Analgesics 42 16.0 2] | ] .. 5 5. Barbiturates 45 17. 1 59 32.4 6. Non-Barbiturate Sedatives 18 6.8 1.7 7. Hallucinogens 3 l. 2 5 2.7 8. Amphetamines & Psycho- Stimulants 8 3.0 3 1 .. 7 9. Other | 7 6.5 | 8 4.4 TOTAL 26.3% + 100.0 182%%. 100.0 *Source: Cook County Medical Examiner - Preliminary **Duplicated Count. Where death due to more than one drug, death count assigned to each drug. Total deaths N = 392. 36 A detailed analysis of the DDC Emergency Room Survey findings reveals that the Chicago area reflects the highest increases in multiple drug and drug/ alcohol combinations, While narcotics related overdoses have remained rela- tively stable between 1976 and 1977. In downstate Illinois, however, narcotic overdoses and Single drug ingestions have increased dramatically, especially in central and Southern Illinois. During the same two-year period, the age distribution of emergency room patients showed only slight geographic variation and concurred with the DAWN findings that most emergency room episodes involve persons 21 to 49 years of age. It should be noted that a significant number of children under twelve years of age are beginning to appear in the emergency room for drug overdose. In Chicago, for example, three hospitals reported six methadone overdoses among children during the past year. DDC Will investi- gate this potential problem during the next fiscal year. Slightly more Women (56%) than men received treatment in downstate emergency rooms, while Chicago area hospitals served an even proportion of men and Women. Although emergency room data are somewhat limited in measuring actual illicit drug use since some overdoses may reflect untoward effects of prescribed drugs—either unexpected reactions or incompatible mixing of a variety of substances—it still remains that at least one-half of all persons experiencing adverse effects from drug use were Women. In analyzing the Chicago metropolitan area DAWN data, tranquilizers ranked first in the total number of emergency room episodes reported since 1975. The proportion of total mentions for tranquilizers has also increased from 16% to over 19% between 1976 and 1977. Persons treated for tranquilizer abuse were mainly females (73%), white (65%), and between 30 and 49 years of age (64%). This pattern has remained constant since 1975. On the other hand, heroin/morphine incidents ranked second in frequency of emergency room mentions, but reflect a 64.7% decrease since 1976. The drug related death information as well as the DDC initiated emergency room data concur With this decline in adverse reactions to heroin, attributed in part to the high price of heroin, its low levels of purity, and a substantial pattern of drug substitution, the most notable of which is pentazocine (Talwin) in combination with pyribenzamine (an antihistamine), known on the Street as "T's and Blues." Street Drug Analysis - Laboratory analyses of illicit drug Samples are an education and health prevention service to the population at risk and pro- vides the primary source of data on the misrepresentation of illicit drugs primarily purchased by recreational and experimental users. Limitations of the drug analysis data for Illinois include: – the frequency of tests by type of drug does not necessarily parallel the true frequency of illicit use by type of drug. – the proportion of drugs misrepresented may be inflated due to bias in the samples, i.e., persons tending to Submit drugs for analysis when they experience no effect or an unexpected effect from the drug. During 1977, the Alternatives, Inc., Street Drug Analysis Project tested 734 Samples. Laboratory analysis showed that 74% of the drugs tested Were in Some Way misrepresented. The most common forms of misrepresenta- tions Were: - - the drug contained not only the alleged drug, but also additional psychoactive substances; - the drug contained none of the alleged drug, but contained another psychoactive drug; or - - the drug contained no psychoactive substances at all. The most frequently Submitted drugs by alleged content were: - amphetamines (237 samples; 32%) – unidentified (108 samples; 15%) - cocaine (65 Sampes; 9%) - THC (56 samples; 8%) - marijuana/hashish (52 samples; 7%) The most common forms of misrepresentation were: - of 237 alleged samples of amphetamines, only 23 were actually amphetamines while 121 (51%) contained caffeine only – an additional 31 samples (13%) contained non-amphetamine Stimulants. - although 48 marijuana samples were claimed to be adulterated, only 5% were identified to have additional active drugs. - of 56 samples of alleged Tetrahydrocannabinol (THC), none were in fact THC. It is generally agreed that there is no THC available due to the difficulty in the synthesis process and the fact that once synthesized, it must be kept under refrigeration in a nitrogen atmosphere. Almost all alleged THC samples were phencyclidine (PCP). - LSD samples submitted to this program had only small amounts of actual LSD present. - the appearance of one sample of PCP and parsley reflects the increasingly prevalent practice of smoking PCP in combination with marijuana, parsley, mint leaves or some other "Smokable." Until recently, snorting (insufflation) has been the primary mode of ingestion in Chicago. – for several months "T's" have been brought in and analyzed as Talwin. In September, Tripelannamine (generic Pyribenzamine) Was identified as "blues" used in combination With Talwin. - 102 samples (13.8% of all drugs tested) could not be identi- fied in available lab tests. - (See the Addendum for this Chapter for a summary of additional data acquired as a result of the street drug analysis program in Chicago.) 38 These trends in drug misrepresentation in Chicago closely parallel those reported in 1975-76 by the Illinois Youth Network Council (IYNC) and the Quincy, Illinois Street Drug Analysis Program. Misrepresentations from the Quincy Program this year again show trends similar to those indicated for Chicago. Drug Related Arrests While drug related arrests seem to be increasing across the State, the City of Chicago experienced a decrease of 3,133 incidents since 1976. However, the 14,440 arrests for drug related offenses still account for 51% of the State total. In 1978, DDC negotiated with the Chicago Police Department and Narcotics Division in order to identify specific drug copping areas throughout the city as well as to be able to aggregate arrest data by police district. This information will then be correlated with other neighborhood level indicator data to map changing drug usage patterns Within the city for FY 1979. Drug Thefts - An analysis of the quantity, type, and location of drug thefts may reveal certain trends in drug usage, demand, and illicit marketing, but are insufficient evidence upon which to base prevalence estimates without corroborating trends reflected by other more reliable drug abuse indicators such as drug overdoses, emergency room episodes, and treatment admissions. The Analytical Services Section of the Drug Enforcement Administration (DEA) began reporting aggregate data of drug thefts in June 1973. A review of Illinois thefts reported by pharmacies, physicians, and manufacturers Since that time shows an overall reduction in total drug thefts. However, when isolated, narcotic thefts seem to be increasing slightly. Thefts peaked in 1974 for all categories of drugs except for non-barbiturate depressants which have increased by nearly 400% in the past four years. Analysis of drug thefts by location reveals a change in the theft pattern from pharmacies and practitioners to drug distributors and manufacturers. The types of drug theft increasing most dramatically are employee pilfer- ages and loss of drugs in transit. (See Addendum at the end of this chapter for specific data summaries.) Drug Seizures - When comparing the quantities and types of drugs seized during the past three years, there have been significant increases in hallucinogens, cocaine, and stimulant confiscations, while heroin Seizures represent an almost 50% reduction between 1976 and 1977. Table 5 depicts these trends. - Price and Purity of Heroin - In addition, DDC's Compliance and Enforcement Division has arranged for regular reports of heroin price and purity through the statewide coordinator for undercover narcotics investigation units in the state. During the last quarter of 1977 and the first two quarters of 1978, the white heroin market re-emerged in Illinois after Several years of a virtually exclusive brown heroin market. More specific information Will be available in FY 1979. TABLE 5 Drug Seizures* In Illinois *Excluding 68 Clients Unknown by Sex. **Excluding 465 Clients Unknown by Race. ***Excluding 11 Clients Unknown by Age 1975-1977 DOSage DOSage DOSage Drug Units 1975 | Units 1976 Units 1977 White Heroi eneroin 56,886 9,998 || 545,319 BrOWn Heroin 564,653 1,006,829 Cocaine 257,100 138,554 181,877 Hallucinogens 141,608 160,145 176,970 Controlled Stimulants 80,397 267,155 374,527 Non-Controlled Stimulants 54,908 6,652 Depressants | 93 39,822 l, 136 *SOURCE: Analytical Services Division, Drug Enforcement Administration TABLE 6 DISTRIBUTION OF CODAP CLIENTS BY AGE, RACE, AND SEX 1976-77 1976 1977 % Change ITEM # % # % ---. SEX: Male 64l 3 77. 4 5107 || 67.4 | – 20.4 Female 1876 22.6 247] | 32.6 | + 31.7 TOTAL 8289 7578 – 8.6 RACE: White 3] 97 38.8 2890 37.8 – 9.6 Black 4535 55. T 3755 49.1 | – 17.2 Spanish 475 5.7 342 4.4 | – 28.0 Other 28 .4 194 8.7 | + 592.9 TOTAL 8235 718] - 12.8 AGE: < 18 3] ] 3.7 544 7. l + 74.9 18–20 563 6.8 833 10.9 || + 48.0 21–25 2203 26.5 2349 || 30.8 || + 6.6 26–30 286] 34.5 2208 || 28.9 || – 22.8 31-44 1924 23.2 1407 | 18.4 – 26.9 > 44 438 5.3 294 3.9 - 32.9 TOTAL 8300 7635 - 8.0 39 l;0 All basic drug indicators seem to Support this downward trend in dysfunc- tional heroin use. High price, low purity, and the six year emphasis on making heroin-oriented treatment readily available—all contribute to What Seems to be a major pattern of drug substitution. Talwin, a pre- Scription pain killer, and Pyribenzamine, an antihistamine, for example, Were found in approximately 20% of all client urines tested at Central Intake, the Chicago based treatment referral center where drugs other than heroin rarely appeared in quantities exceeding 5%. Emergency room and drug related deaths also Suggest that drug substitutions for heroin are becoming more prevalent. Current Trends and Patterns of Drug Abuse Heroin and Other Narcotics – While narcotic abusers continue to be highly represented in drug-related deaths, drug-related emergency room visits, and admissions to drug abuse treatment programs, the yearly increase in narcotic addiction appears to have slowed. Particularly significant is the reduction in heroin-related emergency room visits and in heroin-related deaths during 1977. The heroin abusing population continues to be predominately black and Latino males from lower socioeconomic neighborhoods. More than 90% of persons in treatment for heroin addiction are between the ages of 18 and 30. Of 7,638 clients in DDC funded drug abuse treatment during 1977, 5,442 cited heroin as the primary drug of abuse. Talwin and Pyribenzamine – Beginning in April 1977, drug abuse treatment programs in Chicago began reporting that addicts were switching from heroin to a combination of Talwin (a prescribed pain killer) and Pyribenzamine (an antihistamine). This combination, known as "T's and Blues," is dissolved and intravenously injected in much the same manner as heroin and produces a similar euphorigenic effect. Talwin is obtained primarily through physician prescription and the forging of prescriptions; Pyribenzamine is available without prescription. When taken in proper doses under a doctor's care, Talwin relieves pain and can be used as a surgery related anesthetic. However, a 1978 Northwestern University Hospital study conducted by the Institute of Psychiatry revealed that "T's and Blues" users averaged 21 Talwin pills in combination with nine Pyribenzamine tablets per day. Each Talwin pill costs approximately $2 with slight variations based on quantity purchased, while Pyribenzamine tablets sold for $1 each. The daily drug usage costs among the 73 clients interviewed as part of this study ranged between $25 and $30, far less than the amount required to support a heroin habit. "T's and Blues" abuse in Chicago occurs primarily among young black males with prior histories of heroin addiction, although other urban areas throughout Illinois have begun to experience this drug substitution pat- term among heroin abusers as well. Table 7 highlights the prevalence of Talwin among persons entering Chicago Central Intake screening and referral program between March 13 and May 14, 1978, as compared to all urinalysis conducted during this time period. TABLE 7 Urinalysis Test Results for Talwin During the Period of March 13, 1978 to May 14, 1978 AT CENTRAL INTAKE PRIOR TO ADMISSION | TREATMENT CLINICS--WHILE IN TREATMENT WEEK IN WHICH TEST Total Number Total Number WAS PERFORMED Cumulative | Positive Cumulative | Cumulative | Positive | Cumulative Specimens for Percent Specimens for Percent to Date Tal Win Positive to Date Tal Win Positive March 13 – March 19, 1978 72 | 4 | 9.4 375 33 8.8 March 20 – March 26, 1978 | 34 } 25 18.7 1531 | 48 9.7 March 27 – April 2, 1978 232 : 52 22.4 2866 236 8. 3 April 3 – April 9, 1978 283 . 62 2] .9 4508 328 7.3 April 10 – April 16, 1978 345 72 20. 9 5019 347 6.9 April 17 – April 23, 1978 4|9 83 | 9.8 6567 408 6.2 April 24 – April 30, 1978 496 98 19.8 7336 427 5.8 May 1 – May 7, 1978 560 | | || 0 | 9.6 8842 494 5.6 May 8 – May 14, 1978 617 | 1 || 8 |9. T NA NA { NA SOURCE: Dangerous Drugs Commission Toxicology Laboratory. H= l;2 Approximately 20% of all Chicago drug treatment candidates showed toxico- logical evidence of Talwin abuse, while only an average of 6% appeared in examining Statewide data. Emergency room episodes and drug-related death data also provide evidence of increased Talwin usage among heroin addicts. Although individuals are still obtaining Talwin from physicians and forged prescriptions, there is substantial evidence that large quantities are diverted into the illicit drug market. According to the Northwestern Hospital Study cited above, 80% of the clients interviewed Were able to purchase Talwin Without a prescription Within a mile of their residences. The Illinois Department of Registration and Education is presently investi- gating pharmacies unable to account for large quantities of this drug. In excessive amounts Talwin produces mausea, vomiting, drowsiness, dizzi- neSS, SWeating, headache, euphoria, disorientation, and confusion in individuals. The psychotomimetic reactions include psychosis, visual hallucinations, dysphoria, nightmares, and feelings of depersonalization. Physically, Soft tissue induration, modules, and cutaneous depression can Occur at injection Sites. Ulceration (sloughing) and severe sclerosis of the Skin and Subcutaneous tissues (and, rarely, underlying muscle) have been reported after multiple doses. Seizures have been reported and there is danger of liver disease with a predisposition to greater side effects. By February 1978, the use of this combination as a substitute for heroin Was creating major concern among drug abuse treatment personnel and public health officials. In Cook County, 24 deaths and 150 emergency room episodes during 1977 were attributed to the ingestion of this drug com- bination. DDC is currently researching the extent and consequence of Talwin and Pyribenzamine abuse and hearings will be held in the near future to consider evidence for increasing regulatory control of Talwin. DDC has requested that pentazocine (Talwin) be reclassified as a Schedule II drug pursuant to the Control Substances Act. This more stringent control became effective in November 1978 as a result of testimony offered in pub- lic hearings and documentation of the abuse potential required by law. (Further documentation is available upon request from DDC.) Other Depressant Drugs - The emergence of depressant drug abuse in Illinois has been documented by DDC during the past two years. Tranquilizers, barbiturates, and non-barbiturate sedatives ranked immediately below heroin in drug-related deaths in Illinois during 1977. These same drugs comprised 43.6% of all drug-related emergency room visits (January–June, 1977) in a Sampling of Chicago SMSA hospitals. White women between the ages of 20 and 40 seem particularly susceptible to this form of drug abuse. Of particular concern is the potentially lethal mixture of alcohol and depressant drugs. Of the 1977 drug-related deaths in Cook County, 37.1% involved combinations of alcohol and depressant drugs. DDC is, therefore, increasing its coordinated planning efforts with the Division of Alcoholism in order to address this concurrent abuse of alcohol and depressant drugs. Amphetamines and PsychoStimulants - The abuse of amphetamines and psycho- stimulants (with the exception of cocaine) continued to remain relatively low in Illinois during 1977. Only 182 (2.4%) of 7,638 admissions to DDC funded drug abuse programs during 1977 involved a primary problem of amphetamine abuse. Amphetamines and psychostimulants also represented less than 2% of all drug-related emergency room visits in the Chicago SMSA. Tightened controls on amphetamines and a continuing decrease in thefts of both amphetamines and psychostimulants have significantly reduced the availability of these drugs. Cocaine - NIDA, in its last nationwide Survey of drug use, discovered that Some eight million Americans have used cocaine. A major increase in cocaine use among high School youth and young adults was also noted. Although there are reports of increased cocaine use across Illinois (particularly in urban areas), the casualty rate remains relatively low. There were only 90 persons (less than 1%) admitted into the drug abuse treatment system during 1977 With a primary problem of cocaine abuse and only 39 (less than 1%) cocaine-related visits to emergency rooms in the Chicago SMSA during the first Six months of 1977 and no deaths directly attributable to cocaine have been reported. It seems, also, that cocaine, a drug historically asSociated With heroin addiction in the urban ghettos, has started to emerge as the drug of the affluent during the late seventies. Hallucinogenic Drugs - During 1977, 211 persons were admitted into DDC funded drug abuse treatment during 1977 with hallucinogenic drug abuse as their primary problem. While LSD use continues at a relatively low rate, PCP emerged as the primary hallucinogenic drug of choice among illicit drug users. Current data reveal that the majority of users are between 15 and ||3 25 years of age, predominately White, and predominately male. DDC provided Illinois data to the Food and Drug Administration to support increased regulatory control of PCP and provided information about the drug and its potential effect on users to drug abuse treatment personnel , law enforce- ment agencies, and the general public. - In the sixties and early seventies a large number of illicitly manufactured hallucinogens and stimulants (e.g., LSD, STP, DMT, DET, etc.) dominated the "polydrug scene." The emergence of PCP and cocaine may be setting the stage for the re-introduction of a similar series of hallucinogenic and stimulant drugs. Drug analysis services funded and regulated by the Commission provide an early Warning system that aids in identifying the existence and combination of these new drugs of abuse so that counter- measures can be implemented While incidence is still low. Marijuana – Only 429 persons (5.6%) were admitted into treatment during 1977 with a primary problem of marijuana use. Most of these individuals were diverted from the criminal justice system following arrest for possession of Small amounts of marijuana. Illinois has averaged more than 17,500 arrests a year under the Cannabis Control Act since 1973. Although some persons (137) within the Chicago SMSA were seen in emergency rooms following ingestion of marijuana, these admissions comprised only 2.5% of drug-related admission from the reporting hospitals. |||| A recent concern with marijuana use in Illinois involves reports of mari- juana contaminated by the chemical herbicide Paraquat. The Mexican government has operated a marijuana eradication program since 1975 which involves spraying Paraquat from aircraft onto marijuana plants. The marijuana is contaminated but remains marketable if harvested Within 48 hours of this spraying. Based on the NIDA established danger level of 450 parts of Paraquat per million, toxicological testing of Illinois mari- juana by both DDC and Searle Laboratory revealed little danger to the public health, since only low levels of Paraquat contamination could be found. SUMMARV Tuends and Patto/uns 06 Dºug AbuS 2 ºn I.C.Công.08 - In addition to CO.CC2Ction and anaſſºs oº data to document and 2%2ctivo Cy addyless cuyvuent thends in drug abuše, DDC'A pèanning &ta 66 beaſus the ſlespons.ćbºtſ 60/L pledicting {utu/ue tº 2nds and patte/uns 06 dug use. This plediction phoce&4 & aimed at: - 6ac{Zötating the devel&opment off an eaſučy wayuning 898tem capabče 06 Juapid Cy identiéging the emo/igence 0.6 new patte/uns 06 dug use which pose a th/Leat to community heaòth and Áa 62ty; – incyleasing DDC's capabić.Côty to ſlespond th/wough Æts netwo/uk 06 dug abuse plovention and theatment pluoghams in dete/vving Such emo/ugèng patte/uns beffo/le they bungeon within the State; and - in 60/uming the Dange/uous Dºug & Commissioneſus, the Adv.080/uſ Counct.0 memboyus, and othe/l poºlicy make/US about potentiaº ſtilends in drug abuse that ſloguºue mod{{{cation in Cuvvuent p0.0×c to 3 phog/uams and Čaw8. The 82 aſle the anticipated tº 2nd 8 ºn dug abuše in 100,010.08 – incyleased abuš 2 O 6 dug combinations and the concuſvuent use 06 a Ccoho.2 with otheſi d'ug4; – incyleased thend towavud dug Sub&titution among active he'loºn addicts as Čong as Cow pujućty and high pluice.8 pºlevač; - ſuo-omoyugence 06 white he/uo.ón as a counteſtva….Công 60/uce which coućd be maſuketed at Öncyleased pujućty and Coweſt pºvčco.3 when compotóng with the "Mexican" b/wown 60/L contuo & 06 the CCCCCôt ho/Lo.in mayukot. - incyleased abuše and misuse 06 Cécºèt dug 83 – incyleased use 06 PCP among adoğ08 cent& 600€owed by a . de{{nitive decºno as w80/US become movie awayle O 6 the VučkA Žnv0&ved; - – inclueased use 06 cocaine as a dug 06 choice among young, a 66&went adućts with continuing £ow toxic Cty Cove’s due to high CoA:t and Côttć2 adućte/lation; – incyleased intuanasaº ingestion 06 dºugé, especia!&g PCP and cocaine, causing $2/vious vösk of uppeh hospitatoſuſ damage ſto the use/u. ſle-emo/igence 06 0x0.000 dºugé, payutöcuða'uºy 06 the 8tómuſant and ha&Cucinogenic va/Lö0ty, and mood a Cte/ling he/ubaº pilepajuations ("Čoga & highs") wºº come into Čncyleasing w8 2. ||5 PROBLEM IDENTIFICATION AND ANALYSIS OF INDICATOR DATA ADDENDUM l;6 Fig. A-l Incidence of Serum Hepatitis by Age 1977 AGE 40 + 30–39 25-29 20-24 # Inc idents : | 00 200 300 §::::::::::::::::::... = Chicago CTD = Rest of Illinois SOURCE: Illinois Department of Public Health ||7 ||8 Table A-l -** - ** 2 =="--- Deaths by Drug Type in Cook County for 1977* º, Tºº-Tº- 1. Tranquilizers Crºx Tº: iº | ] 6.0 2. Heroin/Morphine 6] 23.2 69 37.9 3. Other Marcotic Analgesics 3] 11.8 3 1.7 4. Non-Narcotic Analgesics 42 16.0 2] | ] .. 5 5. Barbiturates 45 17. 59 32.4 6. Non-Barbiturate Sedatives | 8 6.8 3 1.7 7. Halluciogens 3 1.2 5 2.7 8. Amphetamines & Psycho- Stimulants 8 3.0 3 1.7 9. Other |7 --- 6.5 8 4.4 i º lºlº l tº lººl *SOURCE: Cook County Medical Examiner Table A-2 Death by Drug and Combinations in Cook County for 1977* Jº tºº. ººzºº ºx. ººº-ºº: bºº - * :- —sº. Drug --- fººd # % # % 1. Drug Only 80 39.2 92 49.0 2. Drug (S) - Alcohol Combination 80 39.2 80 42.6 3. Drug-Drug Combination 44 21.6 16 8.5 TOTAL 20, wº-ººtºººººººººººººº ºt: * ~2: 188 * *SOURCE: Cook County Medical Examiner Table A-3 Drug Related Deaths by Specific Drug Type for Cook County From 1976 - 1977+ —º- *- —º-l—º % Change 1. Tal Win 1 24 +2300.0 2. Phenobarbital 17 64 + 276.5 3. Phencyclidine 1 8 + 300.0 4. Dary On 25 37 + 48.0 5. Amitriptyline 9 10 + 11.1 6. Placidyl 11 12 + 9. 1 7. Tuinal 17 28 + 5.9 8. Seconal 14 12 - 14.3 9. Librium 8 5 - 37.5 10, Walium 49 30 - 38.8 11. DO riden 14 4. - 71.4 *SOURCE: COOk County Medical Examiner Table A-4 Heroin/Morphine Related Deaths in Cook County for 1976-77° wº- +1-7-www.rºr-rººrººz. -º-ºrrºws-rººter-errºrsºr.cº.zr-sºrrºr-nºz-z-zerºxº-ºº-ººrººzs I976 * * *-rºº," ºr * **** **- ~Ig/7 ºf cºis Cause.9f Death.... --- ~. # ~. 1. Morphine Only 70 32.6 66 51.6 2. Morphine/Alcohol 57 26.5 38 29.7 3. Morphine/Drug/Alcohol 39 18.1 6 5.5 4. Morphine/Drug 49 22.8 17 13. 3 cº-ºº: **k, *-ºs---w 1914–1–443– *- 127 *SOURCE: Cook County Medical Examiner l;9 50 f'9: *-* Incidence of Heroin Episodes Appearing FIRST QUARTER SECOND QUARTER THIRD QUARTER FOURTH QUARTER 450 400 350 300 250 200 *SOURCE: DAWN in Chicago Area Emergency Rooms April 1975 - July 1977* 1975 1976 1977 º 390 257 202 429 275 347 397 tº e 428 378 gº lst Otr 2nd Qtr 3rd Qtr 4th Qtr Table A-5 - - - -- -- -- cº - rº, - --> - - - - - - - - - - - - - - - c Total * Q || 3 || > | * - - - - - - - I - ºv - Other - - - - -º- - - - No drug present - - - || | | * | * | * - - ºr c r- Jnknown drug present - - - un u" i u". I ºw - co - - - - r- ~ ~ - c - ºw --> ~ -- Qu -- *— rº - -- - rº -> - = E| E. E. = | 2 | E £, g all 5 s u- I - * - - -- *- ro -- -- - 3 & * - *— - - I - I - I - - E| - el E! :] : El Tel 2 – # º -- rt - - - - - - - - - - 3| G| F. E. F.I - Sº I & 2 & 5 º' = ch -- ro º º - > - ~ r- - + -> º -> ~ c -> - c -- º -- → - C- 3| 3 || 3 || 3 || 3 || 3 || 3 || 2 || 3 || 2 || 3 || || = 3, 5 & 5. 3 a 3| = | E] = - L^ º r- r: - - - * = | 3 || 3 || 0 || 3 || 5 | E. 5 £ E 1 & 1 & = | *| 3 || 3 || 3 C #| || “. E. F. "I e = 51 52 Table A-7 Drug Thefts.” In Illinois By Drug 1974-77** --------_------- * -ºr -Tº-ºr ſea. ºisillºlºlºlºlºl.% biºlº Pººl—º 1974 634,083 744, 841 438,265 758,394 270,977 2,906,560 1975 350, 726 318,853 372,579 538,803 383, 190 1,964, 151 |976 220, 114 164,623 345,086 401,032 1,081,477 2, 212,332 1977 243,648 138,895 112,965 242,439 826, 176 1,564,123 * These figures include thefts from pharmacies, practitioners, distributors, and manufactureS. ** SOURCE: Chart A-l : Drug Enforcement Administration Drug Thefts in Illinois From 1974 - 1977* sºrrºr- keer-as-s-s- x- •ºw 4- 1974 1975 ene- Total # thefts by dosage –––Depressants including barbiturates 1976 — Stimulants including amphetamines . ...... Narcotics *SOURCE: Drug Enforcement Administration 1977 TIME SERIES ANALYSIS Time Series (Y) is a series of values of a variable collected at different points of time. Time Series analysis is a technique that predicts future behavior on the basis of past patterns. A typical time series can be decom- posed into four independent components: trend, seasonal, clyclic and irregular (random) fluctuations. T + S + C + R (Additive Model) T.S. C. R. (Multiplicative Model) Y Y Where: T - is the trend which describes and predicts the general behavior Of a Series of data over a period of time. It could be upward (positive), or downard (negative), or stable (no change). S - is the Seasonal component that describes the variations due to Seasonal changes and are in Cyclic nature. The cycles in this Component are usually of short nature and are usually predictable. C - is the cylic component which serves as 'S' above but the cyclic period may be longer than Seasonal components. This, however, describes less predictable factor in the series than seasonal. R - is the random or irregular component which describes the resid- ual component that remained unexplained by T, S, and C above. Our aim is to predict future treatment entries into DDC clinics. Input data for this analysis is CODAP client admissions, by month, for 1976 and 1977. The following table presents the input: MOnth Year 1 2 3 4 5 6 7 8 9 10 11 12 | Total 1976 541 448 596 598 515 583 578 618 574 609 509 399 6568 1977 348 437 557 478 427 535 493 535 528 524 509 439 5810 Monthly admissions of CODAP clients for narcotic relates cases. Using a computer program designed by Richard Katon & Associates, Inc. * following results were obtained. * CODAP: 76–77 53 T- Mºnth x--- *_-_*__-- Year 1 2 3 4 5 6 7 8 9 10 11 12 || Total Predicted 1978 473 469 466 463 459 456 452 449 445 442 439 435 5449 1979 432 428 425 421 418 415 411 408 404 401 387 394 4955 Predicted monthly admissions of CODAP clients for narcotic related Cases. 5|| SPREAD OF HEROIN USE APPLICATION OF INCIDENCE OF FIRST USE ANALYSIS A model developed by Leon G. Hunt (Drug Incidence Analysis) can be applied º Study present and future trends and patterns which document the spread of heroin use in Illinois. There are two principal measures which can be employed to chart the course of drug abuse in a given population, incidence and preval ance. INCIDENCE is the rate of occurrence of new cases per population unit at any given point of time. PREVALANCE is the number of active cases per unit of population at any given point of time. Incidence shows how rapidly the phenomenon is Spreading while prevalance measures the extent of drug use in the population under consideration. Here the changing pattern of new drug abuse in Illinois is limited to treat- Tent data+ and based on relative incidence rather than absolute incidence (the rate of new cases per unit time for a special population without regard to size of Dopulation base (e.g. , 300 cases per month, etc.)). Use of Incidence Data Due to continuing drug abuse scenario and its impact on our political and social concern an executive, a planner or a researcher in this field would like to know more than just the number of persons entering treatment. He/she must also know if new druq use is spreading or diminishing. The importance of 55 such an idea can hardly be over emphasized in terms of future planning for new sites of treatment demand, more (or less) new treatment centers, more (or less) prevention efforts, etc. Relative incidence of new use is the best index of spread as it is a unique measure of the rate at which new individuals are becoming involved with drugs. Date Sources. Two items of data are essential to analyze incidence of first use of a given drug for each individual user; the year of first use and the year in which he/ She entered treatment. Other client characteristics like age, race, Sex, etc., are important, but shall be studied at a later date. One limitation that should be mentioned is the unavailability of CODAP data prior to 1976. Thus, only two years of treatment entries (1976-1977) were considered in this analysis. Also, those who started using drugs prior to 1974 were Combined together to form one category. The following table exhibits this delineation: *CODAP : 76–77 Actual and estimated admi S SiOnS Of narcotic abu SerS based on clients who never had treatment experience previously (no readmissions). rººf -ºxººctºr-crºzcº. Furrººt:---- º YEAR OF FIRST USE Year Of Admission 1973 1974 1975 1976 1977 1978 1979 TOTAL sº !--~~~~~~~~~~~~~~~~~~~~!------------------~~~~~~~~~~<--------------------, -------------------------------- ~~~~~rº - errº -rvic-, -º- ºr . c. --------axx -- ...~: = , xi.; v.-------~~~~~~~~~~~< * ~ ********** E Stimated Lag Distribution . 20 . 27 . 27 . 19 . 08 1. ()0 On the basis of "lag" distribution, the proportion of clients who will seek treatment during the next two years is declining. | | . 2. 4 |0. | ] . | 2. | 3. l 4. Drug |-iñºsº, sººtº: Fº-ºººº......…?-, 2-zºº.º.º.º...ſº, gºsº Metha done Quinine Antihi Stamine Morphine Tal win Dar VOn Barbiturate Codeine Walium Preludin Phenothiazine Methamphetamine Dil antin DOr iden PCP Placidyl Amphetamine Cocaine Rital in TOTAL Scºtº-1.2-lit-ſc ... --> *-*.*.5 Tºr ºr 3 0% clients positive for : al Cohol. *SOURCE: TABLE 2 Incidence Of Drugs Found In Toxicology Lab Results’ January - June 1978 Fºx-a-si-º-º-, 2-zº-sºº..…< *-ºs-ºs-r-z = z*-*.*.*=***-xº~~~~ :-----cºast: assi-e-z-z-z-za-aºr ====: # Clients 78,644 57, 115 9,959 78, 329 9,959 29,900 26, 138 77,665 7.58 26, 149 26, 150 26, 146 26, 14 l 26, 14 l 18, 732 458 26, 13] 9,072 26, 150 579,737 is ºar-ºr--><-cºº": "…re-tºº-ºº: ... （Fºsº.º.º.º.º. ka-tº-cr:- ºr º-tº ºx2-rº-'ºs-zºg- > *::::…s.º. ~~~~ * , sº ºr *.*.*.*, ex" "...ºts"sºar. * + Cº.J. ::::tº-º-º-º-º: kit a "c.: tººk " .. 7 ºr 6...: ººº... ºr A. " , = {- --> º, tº tº Methamphetamine .78 1.09 1.26 . A2 .05 | Preludin 2.19 1. 10 1.19 1.56 I.79 | Rital in . 20 . 12 . 16 .09 ,04 | Barbiturates 2.61 2.26 1,69 2.06 1.54 Walium <- 36.98 12.68 24, 44 26.88 Librium & Benzodiazepines tº tº 16.73 ºv. º º, Doriden .26 . 15 .17 , 15 .04 Dilantin .41 .54 . 35 .20 .07 Phenothiazines 1.34 1.86 1.42 : 68 .99 59 Quinine 20.95 19.25 16.17 14. 12 15,40 Metha done 73.28 70.06 65.30 66.44 64.78 LAAM G- º Qºm. º º Darvon. 1.41 1.83 2. 12 2,41 3.29 Cocaine wº- -> Q- « La 8.28 Codeine 2.83 2.46 2.00 1.7 2.11 Morphine 13. 18 11.87 8,48 9.03 9.17 PCP . 19 .09 . 16 ſ ,08 .12 Talwin sº " - 9.64 | 5.39 13.31 Antihistamines º <--> 13.84 | 13.23 31.25 Placidyl *—º- <--> <--> <º --> 4 º' sº All methadone maintenance and residential program clients are tested for Opiate use each week, resulting in 44,649 opiate tests performed quarterly. In addition, 16,297 polydrug tests have been randomly performed with this same population. ASSESSMENT OF DRUG ABUSE INDICATORS DALLAS, TEXAS Submitted to : The National Institute on Drug Abuse September 1978 repared by: OY J. GRIFFIN ealth Planning Associate exas Area 5 Health Systems Agency, Inc. 60 Introduction During the past three to five years the National Institute of Drug Abuse (NIDA), state planning agencies such as the Texas Department of Community Affairs/Drug Abuse Prevention Division (TDCA/DAPD) the designated single state agency and various area- wide regional planning bodies such as the newly created Health System Agencies (HSA's), have been mandated by the National Health Planning And Resources Developmental Act of 1974 (Public Law 93-641) to develop sound data measurements on the incidence and prevalence of drug abuse in selected health services areas throughout the country. The present report is concerned with prevalence indicator data in Dallas, Texas. No attempt is made to use these data for providing exact estimates on the size of the drug abusing population. Although such an understanding may not be entirely futile it is believed that the results would be little better than guess estimates. Indi- cator data are useful, however for assessing drug prevalence and trends. This is especially true when the data are viewed in their entirety; no one single indicator 61 should be relied on alone. For example, when a number of indicators appear to be moving in the same direction, the conclusion that these data are reflecting actual drug trends is strengthened. This may be the case even though the data reveal fluc- tuations and are subject to such things as under or nonreporting as well as possible duplicative reporting. These caveats, notwithstanding, it is felt that the infor- mation cited in this report represents the best available summary information on drug abuse in Dallas county. Sources of Data The data utilized in this report are based on national, state and local reporting systems, and include the following: 1. County Medical Examiner: (county) Drug related deaths. 2. Public Health Departments: (city/county/state) Annual counts of serum hepatitis cases. 62 3. Emergency Rooms: (national) Drug Abuse Warning Network (DAWN) 4. Drug Treatment Progress: (state/national) Client Oriented Data Acquisition Process (CODAP) drug patient information admission and readmission. 5. Law Enforcement Agencies: (state/local) Uniform Crime Reporting System (UCR) arrests involving drugs. 6. Probation Departments: (local) Referrals of juvenile drug violators. 7. Drug Enforcement Agency: Price and purity information. Dallas County The city of Dallas is the second largest city in the state of Texas and the eighth largest in the nation. The central city encompasses approximately 297 square miles and is surrounded by fifteen major municipalities. While the city of Dallas and its outlaying suburban area share similar characteristics, some important difference between the two exists. Most of the suburban cities have higher median incomes and proportionately fewer minority group members than does the city of Dallas. The city of Dallas accounts for approximately 57.4 percent of the estimated l977 county population of 1,513, 150. Of special interest is the trend towards continued growth for the nonwhite population in the central city since the l870 census. Nearly 17% of the total Dallas county population in 1970 was Black; and an additional 6.7% were Hispanic. In the city of Dallas it has been estimated that approximately 25% of the inhabitants are Black. Dallas has one of the healthiest economies in the country. Unemployment rates reported for the last part of 1977 ranged from a low of 3.3 percent to a high of 3.8 percent, which appears to be among the lowest reported in the country. In recent years, general indicators such as building permits issued, sales, and wages have shown an increase, which suggests a healthy economy. However, 10.7% of the county population had incomes below the poverty level in 1970. A further breakdown indicated that 6.0% of all White families, 15.0% of all Hispanic families and 30.0% of all Black families were in poverty. Addi— tionally, approximately 14.8% of the Dallas county population is said to be near poverty. Dallas County median family income (1970) was an estimated $10,680. a year. However, as has generally been found not all segments of the population share equally in this prosperity. For example, Hispanic families in Dallas have median incomes of $8,551. while Black families reported a median income of $6,287. and median incomes for White families was an estimated $ll, 457. 63 Finally, it should be noted that Dallas county reports one of the highest crime rates of any city in Texas. More than 80% of Dallas county's reported crimes were Committed in the city of Dallas, which only accounts for 57.4% of the total popula- tion of the county. As described later in this report, drug violations are a major Concern in Dallas county, as suggested by the upward trend in the total number of arrests between l974 and l977; for the latter year a total of 10, 764 arrests was reported, an increase of 13.0% over 1976 reported figures. Information supplied by the Regional Office of the Drug Enforcement Administra- tion (DEA) and the city of Dallas Police Department suggests there are a number of organized major drug dealers in Dallas county supplying drugs, but that Dallas is not considered a high prevalence area when compared to cities of similar size. Dallas 6|| is described as a transhipment area in relation to its geographic proximity to the Mexican border and cities in the midwest and northeast. Drug Abuse in Dallas County In this section information is provided on the magnitude and trends of drug abuse in l977 in Dallas county. The focus of the report has been limited to only Orle county for a number of reasons. Primary among these reasons has been an attempt to refine the various indices of drug abuse, in the interest of obtaining accurate figures for analysis and interpretation. In this endeavor certain data indicators such as serum hepatitis, drug related deaths, and admission to treatment information were obtained from the State level reporting agencies particularly the State Department of Health and the State Drug Abuse Prevention Agency TDCA/DAPD. Each local primary reporting agency such as the city/county Public Health Department, County Medical Examiner's Office, and the local community based treatment facilities were contacted to determine the accuracy of reported information provided by the respective State Agencies. As had been the case in previous years under or non- reporting was found. An additional reason for concentrating on this one county only pertains to the specialized research projects presently being conducted in this area, as well as the present mechanism for collecting data from the emergency rooms. Project DAWN is presently set up to collect information from emergency rooms in the old Dallas Standard Metropolitan Statistical Area (SMSA), which includes six counties (Collin, Dallas, Denton, Ellis, Kaufman, and Rockwall). Among these six counties Dallas county constitutes 83.0% of the 1977 total estimated population in the former Dallas SMSA. The majority of the reporting emergency rooms are located in Dallas county only, and not in the other five counties. In April, 1973 the Bureau of Census established the eleven county Dallas-Fort Worth SMSA which included five additional counties (Hood, Johnson, Parker, Tarrant, and Wise). Within the new Dallas-Fort Worth SMSA Dallas county only constitutes 54.5% of the total 1977 estimated population, and a larger sample of emergency rooms would have been in- cluded. Other consideration for limiting this report to Dallas county pertain to the wider variety and more sophisticated reporting systems available in Dallas County. Drug Law Violations During l977 there were l, 021 opiate arrests reported by Dallas county law en- forcement agencies. This figure includes all those arrests recorded in the category entitled "Synthetic Narcotic - Manufactured Narcotics", which includes such drugs as Demerol and Methadone. Within this category only 100 arrests were made in 1977 by county law enforcement agencies, compared to 921 arrests in the narcotic/cocaine 65 Category. As suggested, drug related arrest information can provide valuable information on the prevalence of drug abuse in a given area. However, there are a number of limitations which must be considered when interpreting these data. Local law enforcement agencies do not always report arrests for the entire year. In some instances reports from the smaller suburban law enforcement departments in Dallas county covered a period of only six to nine months during 1977. Additionally, of the 23 cities located in Dallas county only l8 reported drug arrest information for nine months or more to the Texas Department of Public Safety in 1977. This would suggest these data are under reported. Another caveat to consider pertains to the manner in which arrest information is compiled and reported in the FBI's Uniform Crime Reporting System (UCR) format. This standardized format does not provide a complete breakdown of the various ethnic groups especially Hispanic who are in- cluded in the White category. As a result, the study of trends for ethnic groups 66 is quite difficult. The other area of concern pertains to the misclassification of cocaine, which is a non-opiate. Ideally it would be valuable for interpretative purposes to have this particular drug not included in the narcotic category. According to data collected in 1974 cocaine arrests only accounted for approximately l.0% of the total arrests reported. Similar data for the current time period would be very helpful inasmuch as cocaine use appears to be on the rise among certain groups. In particular, indices such as treatment admission, emergency room admission, and drug related deaths where cocaine is reported as a separate Category point to a rise in the prominence of this drug. Arrest data, for a number of reasons, should be viewed with great caution. As suggested in the last report (Griffin 1977) drug arrests have increased sharply over the past six to eight years, but a clear picture in this regard is lacking because of changes in reporting procedures and law enforcement practices regarding drug violations. To be specific, drug arrest data between 1965 - 1973 were obtained from the F.B.I. Uniform Crime Report. The reporting base was modified in 1974 and a special semiannual instrument was utilized in l974 - 1975. Opiate arrests reported in 1974 totaled 533. This figure decreased in 1975 to under 350 arrests, which can be attributed to a number of factors. Most specifically, the reporting procedures used in l974 - l975 was abandoned and replaced in 1976 by monthly reports using the F.B.I. Uniform Crime reporting categories. This resulted in fewer law enforcement agencies reporting in l975 compared to 1974 and 1976. Of the fifteen law enforcement agencies which reported in 1973 only ten agencies reported the entire year. In reviewing these data it becomes quite apparent that some cases had been duplicated where multiple arrest for more than one drug had occurred - Additionally, during l975 the largest law enforcement agency in Dallas county, the Figure I TOTAL REPORTED DRUG ARRESTS 1974–1977 DALLAS COUNTY ll,000 + 10,764 l0,000 - 9,328 - 9,532 9,000 - 8,000 7, 200 7,000 - 6,000 : 5,000 - 4,000 - 3,000 - 2,000 - § l,000 - § § & ::::::::::::::: § & * * 1974 1975 Opiate Arrest Non-opiate Arrest | Marijuana Arrest Table I Percentage Distribution by Age of the Yearly Total of Opiate, Non-Opiate, and Marijuana Arrests in Dallas County for 1974–77 Age 14 or - 30 or Total Year Under 15-17 18-20 21-24 25–29 Over % No. Percentage of Total Opiate Arrests” 1974° 0. 9 4. 1 17.4 26. l 28.9 22.5 100. O 533 1975° 0.9 6.9 11.9 27. 9 25.9 26. 6 100. 0 330 1976 O. 9 4.8 17 - 2 28 - 5 28.8 19 - 7 100 - O 978 1977 O. 9 4.5 18.4 27. 6 25. O 23.6 100 . O 1021 Percentage of Total Non-Opiate Arrests 1974° 1.9 12.9 24.1 24.6 16.4 19.9 100 . O 1429 1975° 2. 0 11.8 22.8 25.3 17. 9 20. 2 lOO ... O l'738 1976 l. 6 - 9.5 17.7 24. 2 20.4 26. 6 l'OO ... O 886 1977 i.e 7.8 16. 9 23. ]. 20.8 29.7 100.0 ll23 Percentage of Total Marijuana Arrests 1974° 4. O 27. O 31. 7 2l. 5 l0. 2 5.5 100. O 7219 1975° 4.6 26.2 . 24.8 - 21.4 11.9 7. 4 100. O 5132 1976 4. 6 27.1 28.6 21. 1 ll. 8 6 - 9 100 . O 7668 1977 3.2 21.1 29.2 23.2 14.5 8. 7 100. O 8620 *Includes synthetic narcotic category; arrests reported for 1976–1977 were based on the Uniform Crime Report (UCR), a monthly reporting system by law enforcement agencies. *Arrests reported for 1974-1975 based on different reporting procedures than in 1976-1977. Table II Percentage Distribution, by Sex and Ethnic Group of Opiate, Non-Opiate, and Marijuana Arrests in Dallas County in 1976 and 1977 Opiate” Non-Opiate Marijuana 1976 1977 1976 1977 1976 1977 Percentage by Sex Male 74.6 73. 2 71 .. 5 69. 4 85. 9 87. L Female 25.4 26.8 28 - 5 30 - 6 l4. 1 12.9 Total l 00 - 0 100 - 0 100.0 100. 0 100 - 0 100. 0 Percentage by Ethnic Group Black 59.2 48.6 40. 6 35. 1 32.8 32.0 White” 40. 5 5l. 3 59.2 64. 6 66. 9 67. 7 Other ... 3 •l ... 2 .3 ... 3 ... 3 Total 100 - 0 1 00 - 0 l 00 - 0 1 00. 0 100. 0 l O 0.0 *Includes reported arrests for synthetic narcotics and cocaine *Includes Mexican-Americans 69 9,000 8,500 - 8,000 7,500 - 7,000 6,500- 6,000 5,500 - 5,000 - 4, 500 - 4,000 - 3,500 - 3,000 - 2,500 - 2,000 : l, 500 . l, 000 500 - ^J Ga) DRUG ARREST REPORT 1974–1977 DALLAS COUNTY 1974 1975 • * * * Marijuana tºº-º-º-º-º: Non-opiate amºme gammºns Opiate, includes synthetic narcotics 1976 Figure II 1977 City of Dallas Police Department, experienced some major problems in the drug enforcement section with turnover in personnel as well as changes in drug enforce- ment policy and practices, which quite possibly affected these data. The annual totals of opiate, non-opiate and marijuana arrests appear in Table I for the 1974 to 1977 period. As shown in these data marijuana arrests account for the vast majority of all the arrests. In 1977 for example, marijuana arrests accounted for 80.0% of the total arrests (8,620), while non-opiate arrests represented 10.4% and opiates 9.4%. Noteworthy in these data is the increase in opiate and marijuana arrests from 1976 to 1977. Contrastingly there was a decline in non-opiate arrests from 1975 to 1976 with a substantial recovery in 1977. Table II provides information on the percentage distribution by age of drug arrests l974 - 1977. As revealed in this table, persons 20 years of age and under account for the majority of the reported marijuana arrests, whereas persons 21 and 71 over account for the majority of opiate and non-opiate arrests. Additionally, of special interest is the findings that persons 30 years and over accounted for approxi- mately 30.0% of the total non-opiate arrests in 1977. This would suggest that older persons (30 and over) are less likely to be involved with marijuana use and are more prone to non-opiate abuse than are younger persons. A salient point revealed in these data was the noticeable increase from 1976 to l977 in marijuana arrests among 25-29 year olds, which would suggest that marijuana may in fact be becoming a drug of choice among a wider segment of the population. When drug related arrests in 1976 and 1977 are broken down by sex, as shown in Table II, it can be seen that males accounted for roughly two to three times as many of the opiate and non-opiate arrests, and six to seven times as many of the marijuana 72 arrests, as did females. Little, if any, change was shown from 1976 to 1977 in the percentage breakdown by sex. The percentage ethnic distribution in Table II reveals an increase from 1976 to 1977 in opiate arrests involving Whites 51.8%, which includes Hispanics. That Blacks accounted for 48.6% of the total opiate arrests in 1977 is especially interesting since only an estimated 25% of the city population is Black and they represent only 16.6% of the total county population. In the non-opiate arrest category there was roughly a 5% increase among Whites (from 59.2% in 1976 to 64.6% in 1977) and a corresponding decrease (from 40.6% in l976 to 35.1% in 1977) among Blacks. During both l976 and 1977 in the marijuana arrest category about two thirds of the marijuana arrests involved Whites and one third Blacks. Based upon these data it would appear that Blacks are more likely to be arrested for opiate offenses while Whites are more apt to be arrested for non-opiate and marijuana offenses. In conclusion, annual arrests for drug violations remained at a high level in 1976 and 1977. Marijuana and opiate arrests continued to rise from 1976 to 1977 while arrests for non-opiates decreased from the high in 1975 of 1738 to 886 in 1976 followed by an increase in 1977 to ll23. A majority of those arrested for opiate violations were 2 l- 29 years old; while most of the marijuana arrests involved a younger group, 20 years of age or under; non-opiate arrests appear to be increasing for persons 30 years and over. Blacks represent a substantial proportion of the opiate arrests, while Whites dominate other drug categories. There appears to have been a slight in- crease in the number of females arrested for opiates, which should be watched closely in the coming year. Juvenile Probation Data Juvenile probation data are contained in this report to provide additional supportive information on the trend of drug abuse among youth in Dallas county. According to annual reports 735 youths were referred to juvenile authorities for drug offenses in 1977 (see Table IV). Of this number 669 cases were established and these youths were placed on probation. Based on the total number of referrals and established cases, l976 appears to have been a peak year in comparison to l975 and 1977. Other rises and falls in the yearly totals since 1973 can be seen in Table IV. These fluctuations suggest a cyclical pattern and may reflect enforce- ment practices and related policies, as well as the rates of drug offenses. Due to the manner in which these data are reported it is impossible to determine specific drugs of abuse. The assumption is that both opiate and non-opiate offenses 73 as well as charges involving large quantities of marijuana are contained in the felony category, and that the misdemeanor referrals are primarily for marijuana. The Category of inhalant abuse appears only in Table III and is of special interest because of efforts in Dallas during the past several years to discourage youth from engaging in this potentially very damaging form of abuse. The fact that total referrals in 1976 and l977 were virtually identical and were roughly one third less than in 1975 is encouraging, but this might indicate that enforcement of the Dallas ordinance for inhalant abuse has been lessened. Of special interest as revealed by the percentage breakdown of age of refer- rals in Table III, there would appear to be an increase since l975 in the percentage of youth under 15 years of age referred for felony arrests. But it should be pointed 7|| out that 22 or 35.5%, of the 62 referrals in 1976 were below lo and that 21 or 43.7%, of the 48 referrals in 1977 were below sixteen. Thus for 1976 and 1977 there was no difference in the number of felony referrals for youth under 16. In review- ing all drug categories except inhalant abuse 16 year olds account for the majority of all referrals. Inhalant abuse involving 12-l3 year olds appears to account for an increasing percentage of referrals, but again 16 year olds account for the majority of such arrests. Table VI provides a percent distribution for 1975–1977 of the juveniles referred to Dallas Probation Department by race and sex. Over this 3 year period no trends were evident in the percentages of referrals for different ethnic groups. Black and Hispanic youths, however, were over represented in relationship to their size in the total county population; Black youths nevertheless comprised a much smaller percent- age of the juvenile referrals than was reported earlier in Table II for the percentage arrested as adults. This could be attributed to a number of factors, which will be looked at when additional data are collected, specifically from adult probation authorities. In this regard it can be mentioned that in comparison to Whites, a larger percentage of the Blacks arrested as adults for drug related violations are subsequently incarcerated. As shown in Figure III males tend to dominate all juvenile referrals. The number of females referred annually to juvenile authorities in Dallas showed no change from 1975 to 1977, and represented between l8 and 19% of the total referrals for these 3 years. A comparison of some interest can be made with the percentage of females for all drug arrests; 16% of the 10, 764 arrests in Dallas in l977 involved females. This suggests that females are represented in the total drug arrests by about the same percentage for juveniles and adults. Percentage Breakdown by Age of Referrals to the Dallas County Table III Juvenile Department for Drug Offenses, 1975–1977 Age Total l 4 15 16 $ NO . Controlled Substances Act (Felony) 1975 2. 7 6 - 9 17 - 8 68 - 5 4. l l 00 - 0 73 1976 4 - 8 8 . 1 22 - 6 62.9 l. 6 100 - 0 62 1977 2. l 8 - 3 33 - 3 52. l 4 - 2 100 - 0 48 Controlled Substances Act (Misdemeanor) 1975 3.0 l 4 - 6 29 - 2 51 - 4 - 9 l 00 - 0 568 1976 5. 0 ll. 6 26.2 55 - 0 . 9 100 - 0 7.43 1977 3. 8 12. l 29 - 8 52 - 2 ... 7 100 - 0 68.7 Inhalant Abuse (Dallas Ordinance) 1975 3. T 9 22. 4 35 - 5 27. 1 100 - 0 10 7 1976 3. l l. 5 32. 3 24 - 6 26.2 100 - 0 65 1977 3. l 18 - 8 18 - 8 35 - 9 l 00 - 0 64 Combined Total (1975–77) 13 - 4 2.7. 9 5 l. 1 LOO ... O 271 7 *A youth l7 years of age is typically charged as ÜH an adult in the State of Texas 76 Table IV Total Referrals and Established Drug Offenses by Year Reported from Dallas County Juvenile Probation Office, l966-197 7 Total Year Total Referrals Established Cases 1966 9 9 1967 l4 13 1968 117 108 1969 251 211 1970 416 328 1971 489 383 1972 65.6 480 1973 886 705 1974 777 682 1975 64 1 588 1976 805 763 1977 735 669 Total 5796 4939 Figure III PERCENTAGE DISTRIBUTION JUVENILE PROBATION DATA DALLAS COUNTY 1975–1977 1975 Race 1976 Race 1977 Race 416 (64.8) White 482 (59.9) White 435 (59. 2) White 158 (24.0) Black 236 (29. 3.) Black 2O3 (27.7) Black 65 (10.1) Hispanic 84 (10.4) Hispanic 92 (12.5) Hispanic 2 (0.3) Other 3 (0.4) Other 5 (0.6) Other 64l 805 735 YEAR FEMALE MALE l975 l21 | 52O 1976 l2O | 685 1977 125 610 mºm 250 200 150 100 50 O 50 100 150 200 250 300 350 400 450 500 550 600 650 700 S. Further information about the prevalence of drug use by youth in Dallas will be forthcoming from analyses of an anonymous drug survey administered in the spring of l978 to students in grades 7-l2 of public, private, and parochial schools in Dallas. This survey was undertaken by the Institute of Behavioral Research of Texas Christian University under a NIDA-supported grant, as part of a study of the prevalence of drug use and its relationship to sociodemographic factors of neighbor- hoods of residences. In conclusion the value of the juvenile drug offenses data have yet to be determined in relationship to drug prevalence in Dallas. Upon comparison with the results of school surveys of youth and other related indices a more precise picture of the trends and patterns of drug involvement among youth can possibly be discerned. Drug Related Deaths At the outset it should be noted that disparities exist in the drug related deaths which were reported to the Texas Health Department from Dallas county. Special efforts have been made to upgrade the quality of these prevalence indicator data for the last three to four years. In this regard, data presented in this section have been checked for completeness, consistency and reasonableness with both primary and secondary reporting sources. As suggested in a previous report submitted to NIDA (Griffin June, l977) figures obtained from the Texas Department of Health for drug related overdose deaths differed from those reported from the Dallas County Medical Examiner's office. This was again noteworthy in 1977 when only 69 deaths were reported from the State Department of Health whereas the Dallas County Medical Examiner's office reported 93 deaths excluding the 23 for carbon monoxide (see Table V). As revealed in Table V, the annual totals of drug related deaths appear to have shown little or no change from 1975 to 1977. Narcotic deaths dropped from 16 in 1976 to 7 in 1977, but the 18 deaths from non-narcotic analgesics in 1977 were twice the number reported in 1976. Noteworthy in Table V are the increased number of deaths attributed to psychostimulants and the three cocaine deaths reported in 1977. Each of these deaths was verified by toxicological examination and a special report is forthcoming pertaining to the cocaine deaths from the Dallas County Medical Examiner's Office. Although Table V indicated that barbiturate sedatives, non- narcotic analgesics, and tranquilizers were responsible for a somewhat higher per- centage of the total drug related deaths in 1977 than in 1976, this is offset by the sharp decrease in the mixed drug category. This switch in percentages is attributed to the reporting system in which greater care is being given to a more refined method for determining cause of deaths. Further, it may be worth noting that in collabora- tion with the Medical Examiner's Office the DAWN drug categories were used in Table V so that variations in the reporting of drug related deaths from these two can be 79 studied. Table VI provides information on the age, sex and ethnicity of reported drug related deaths 1975–1977. As revealed in this three year period males represented more than one half of the deaths (57.0%) in 1975, but this decreased in 1976 to 49.4% and to 44.0% in 1977. Conversely an increasing percentage of the deaths has been accounted for by females. Whites are the dominant ethnic group, making up 79.5% of the reported deaths in 1977. As shown in Table VI there appears to be an increasing trend in drug related deaths among Blacks; 20.4% of the deaths in 1977 were Black. In unreported cases for 1975 and 1976 toxicology number as well as death certificate number were provided but sex, age or ethnicity had failed to be given. This was corrected in 1977 when special consideration was given to complete- ness of reporting procedures. 80 Number Narcotic l2 Barbiturates Sedatives 23 Non-Barbituate Sedatives ll Alcohol-In- Combination ll Non-Narcotic Analgesics l4 Mixed Drug 20 Tranquilizers 12 Anphetamines 4 Cocaine -tº º Psychostimulants - - Inhalants/Solvents/ Aerosols 7 Subtotal ll.4 Carbon Monoxide 24 Total 138 Table V NUMBER AND PERCENTAGE DISTRIBUTION OF DRUG RELATED DEATHS REPORTED 1975–1977 DALLAS COUNTY 1975 L976 1977 Percent Of Percent Of Percent Of Total Number Total Number Total (10.5) 16 (17.5) 7 ( 7.5) (20.1) 4 ( 4.3) 12 (12.9) ( 9.6) 7 ( 7 - 6) 6 ( 6.4) ( 9.6) l6 (17. 5) l O (1O. 7) (l2.2) 9 ( 9.8) 18 (19. 3.) (17.5) 2l (23.0) 8 ( 8, 6) (10.5) 8 ( 8.7) l O (10.4) ( 3. 5) 2 ( 2. l.) 7 ( 7, 5) - - - - - *- 3 ( 3.2) - - 2 ( 2. l.) 8 ( 8 . 6) 6. l 6 ( 6.5) 3 ( 3.2) 100. O 100. O l OO ... O 91. 93 26. 23 ll 7 ll 6 Total 35 39 24 37 4l 3 16 314 Table VI Number and Percentage of Drug Related Deaths by Sex, Ethnic Group, and Age Reported by Dallas County, 1975–1977 Year 1975 1976 1977 NO. % NO . % No. % Sex Male 65 (57.0) 45 (49.4) 4l (44.0) Female 45 (39.4) 4l (45.0) 52 (55.9) Unknown 4 ( 3.5) 5 (5.4) gº ºn * † tº Total ll.4 (lo 0.0) 91 (100.0) 93 (100.0 Ethnic Group White 98 (86.0) 71 (78. O) 74 (79.5) Black 16 (l.4.0) L5 (lé. 4) 19 (20.4) Unknown tº º fº = Lº 5 (5.4) tº ſº º tº E tº , º Total 114 (100. 0) 91 (100.0) 93 (100. O) Age 9 2 (l. 7) 2 (2. l.) l (l. 0) 1 O – L9 l 4 (12.2) 7 (7.6) 8 (8.6) 20 – 29 29 (25. 4.) 22 (24.1) 26 (27.9) 30–39 17 (14.9) 12 (l 3. l.) 17 (18.2) 40-49 16 (14.0) l4 (15. 3) l3 (13.9) 50 and over 27 (23. 6) 25 (27. 4.) 27 (29.0) Unknown 9 (7.9) 9 (918) l (l. 0) Total ll.4 (l O0.0) 91 (100.0) 93 (100.0) Figure IV S3 RACE AND SEX COMPOSITION OF DRUG-RELATED DEATHS REPORTED 1975-1977 Non-White FEMALE MALE 1975 1976 1977 | NOTE: Data excludes carbon monoxide deaths reported. With respect to age, the 20–29 year olds and those who were over 50 account for the higher proportion of drug related deaths for the three year reporting period. This is interesting in light of the fact that younger persons 10–19 have shown a relatively low share (8 to 12%) of the drug related deaths, compared to the 24 to 25% for persons who are 50 or over. These results, however, are thought to differ according to the drugs involved. For example, of the seven narcotic related deaths reported in 1977 two were Black females and two were White females while two were White males and one was a Black male. In reviewing narcotic related deaths since 1976 there has been a noticeable increase in the percentage of deaths involving females. At present no conclusion can be drawn from these data due to the small number of deaths recorded in 1977 but this will be closely watched in the coming year. Overall it would appear that White females account for the higher proportion of deaths when counting all drug categories. Persons 20–29 (27.9%) and 50 plus 83 (29.0%) represent the highest percentage of reported drug related deaths in Dallas in 1977. An increase was apparent in the number of deaths involving Blacks and females (see Figure IV) over the three year reporting period. Finally, the l977, data brought more attention to deaths associated with psychostimulants, tranquilizers and nonnarcotic analgesics, but revealed a decrease in opiate related overdose deaths. Serum Hepatitis Data Data collected on serum hepatitis consists of information provided in annual reports from the City and County Health Departments of the number of cases in a given area. Apparently each separate city and county where these offices are not combined under one principal head will inform the Texas State Health Department of the total number of hepatitis A, B and more recently, the unspecified cases of hepatitis, for a specific year. This information is them computerized in age/race/ 8|| sex categories, and included in an annual report of selected communicable diseases entitled Morbidity Report. These reports are often used by those agencies which request such data; in this case, health planning agencies (HSA) and more specifi- cally, the State Drug Abuse Prevention Division (SDAPD). As an indicator of drug abuse in a given population, serum hepatitis counts have been of questionable value due to incompleteness, inconsistency, and the uncertainties of diagnosis. Similar to the efforts to refine the drug related death data, special attempts have been made during the last three years to validate these data indices. As in the case of "drug related deaths", we discovered that many of the serum hepatitis cases were not being reported. This was further com— pounded when it was discovered that quite possibly the cases reported by the City Health Department were not being included in the annual reports from the Texas State Health Department. It is anticipated that within the coming year many of the report- ing problems encountered with these data will be rectified. Figure V shows the l970–1977 reported cases of serum hepatitis from Dallas County. Taken at face value it would appear that there was an abrupt decline in the number of cases in 1976. As suggested in a previous report (Griffin, 1977) further investi- gation revealed that these figures did not include all cases in Dallas county. Follow- up on this reporting system disclosed that an additional 185 cases of serum hepatitis and l3 unspecified cases were reported from the City of Dallas Public Health Depart- ment, but were not included in the report from the State Health Department. In Dallas County, the graph reveals a continued increase in reported cases up to l973, a decline in 1974 and a rise in 1975. If the additional cases previously discussed were added to the lC8 reported in 1976 to the state they would total 293 (not counting the 15 unspecified cases reported) for 1976, which would represent the highest number reported since 1970. Additionally the figures reported between 1972 - 1973 are complicated by the inclusion of serum hepatitis cases which were detected in the special study con- ducted on inmates in the Dallas County Jail. Therefore due to the inconsistency associated with these data they must be viewed within the context of other indices and with great caution. Table VII provides the number and percentage distribution by sex, ethnic group and age of the cases reported from the State Health Department 1975 – 1977. Salient factor revealed in these data indicate that males in l975 dominated (63.3%) this indicator, while females only represented (36.7%) of the reported cases. However, there has been a substantial increase in the number of cases reported among females to (49.0%) of the cases reported in 1977. This is especially interesting in light of the other indices reported (opiate and non-opiate arrests and drug related deaths information) where we see the same type trends. At this point no attempt will be made to draw a conclusion until these data can be more completely validated. But 85 if this trend does continue to occur special consideration should be given to address- ing the need of this female population especially if they are involved in opiate and non-opiate abuse as indicated in the current data. Basically it is common knowledge that females are more likely to be seen in emergency rooms. This has been well documented in the DAWN data. In most instances tranquilizers, sedatives and bar- bituates have been the drugs most often mentioned. While males have accounted for the majority of the opiate involvement according to present indices utilized, these data suggest that intravenous drug use, which is commonly associated with Opiates may be increasing with females. But as suggested previously this is only conjecture at present and will have to be researched more closely. Among ethnic groups Whites accounted for the majority of reported cases of serum hepatitis in 1975. Over the three year reporting, period, however, there has 86 260 Figure V REPORTED CASES OF SERUM HEPATITIS DALLAS COUNTY 1970–1977 3OO 280 | 240 30 220 2O7 200 H 193 18O 160 140 120 ll.9 1O8% LOO 233 8O 60 58 40 20 19 1970 197l 1972 1973 1974 1975 1976 * An additional l85 cases of serum hepatitis and 15 unspecified cases from the City of Dallas Public Health Department were not included in the report from the State Health Department. 1977 Table v1.1 Number and Percentage Distribution by Sex, Ethnic Group, and Age of Serum Hepatitis Cases Reported by Dallas County, 1975–1977 Year l975. 1976 aſ 1977. NO . % NO . % NO. % Sex Male l31 (63. 3) 58 (53.8) ll.9 (51.0) Female 76 (36.7) 50 (46.2) ll 4 (49.0) Total 207 (100.0) 108 (100.0) 233 (100.0) Ethnic Group White l24 (60.0) 58 (53. 7) 102 (43.8) Black 68 (32.9) 47 (43.5) 107 (46.0) Hispanic l2 (5. 7) 3 (2.7) l2 (5.1) Unknown 3 (l. 4) tº . . . . . tº gº tº 12 (5.1) Total 207 (100. O) 108 (100.0) 233 (100.0) Age 15 8 (3.8) 7 (6.4) 7 (3.0) 16–24 135 (65. 2) 60 (55.5) 118 (50.6) 25 – 34 33 (15.9) 19 (17.5) 64 (27. 4.) 35 – 44 l4 (6.7) 9 (8.3) 18 (7.7) 45–54 l 0 (4.8) 6 (5.5) ll (4.7) 55-64 3 (l. 4) 3 (2.7) 3 (l. 2) 65 2 (0.9) 4 (3.7) 7 (3.0) Unknown 2 (0.9) tº Eºg tº tº º 5 (2. l.) Total 207 (100.0) 108 (100.0) 233 (100.0) *An additional lä5 cases of serum hepatitis and 15 unspecified cases were reported from the City of Dallas Public Health Department. 87 88 been a gradual increase in the percentage of cases of serum hepatitis in Dallas county accounted for by Blacks from 33% in 1975 to 46% in 1977. In terms of age categories persons between l8-24 and 25-34 represented 78.0% of all reported cases. It is of interest, however, that the percentage of reported cases among persons 16–24 declined from 65% in 1975 to 51% in 1977, while reported cases among 25–34 year olds ascended from lo% in l975 to 27% in 1977. The percentage for all other age groups remained stable over the three year reporting period. At present no speculations are offered regarding age related trends. Over the past three years, however, there do appear to have been gradual increases in the percentage of cases by women and Blacks, which would suggest an emerging opiate problem not revealed in past data. Hospital Emergency Room Data Hospital emergency room data collected on drug emergency in the Dallas Standard Metropolitan Statistical Area (SMSA) are available from Project DAWN. Project DAWN (Drug Abuse Warning Network) is a nationwide program established and jointly sponsored by the Drug Enforcement Administration and National Institute on Drug Abuse to provide identification of drugs currently abused in 29 SMSA's and to facilitate national moni- toring of abuse trends. Data collected by DAWN are used for assessment of relative hazards to health and the abuse potential for various substance. DAWN also provides information needed for the national control of drug abuse. DAWN obtained information from contract reports provided by selected hospital emergency room and inpatient units, medical examiners and crises centers. All of the information reported to DAWN is limited to drug abusers who are treated medically or psychologically. Of the thirty four emergency rooms operated by hospitals in Collin, Dallas, Denton, Ellis, Kaufman and Rockwall counties only 20 hospitals were affiliated with DAWN and only sixteen have consistently reported drug emergency data since January of 1974. By far, the leading drug of mention in emergency treatments was diazepam, better known under the trade name of Valium. This drug accounts for 39.3% of all drug mention in emergency room visits in the six counties during the period from January through September 1977. Table VIII illustrates the number and percentage of drugs mentioned in emergency room treatment from the Dallas SMSA for the 1975 through September, 1977 period. Based on the findings of Project DAWN, it would appear that emergency room treatment largely reflects a section of the drug abusing population which is not found in drug arrest statistics or admissions to non-private treatment programs for drug abuse. With respect to diazepam, for example, it has been reported that the persons typically receiving emergency treatment for abuse of this drug are females between the ages of 20 and 39. Diazepam use was overwhelmingly among females, with 80% of the mentions. Perhaps more striking was the finding that self-destruction was given as 89 the reason for diazepam abuse (65% of the cases) and desire to obtain psychic effects, was the other major reason given. Over-the-counter drugs, mainly nonnarcotic anal- gesics, and prescription drugs (mainly non-barbiturate sedatives) accounted for the majority of the drug mentions in emergency treatments. Of special interest in these data was a slight decline in heroin mentions in 1977. As shown in Table VIII heroin mention represented a 6.1% share of all drugs mentioned in 1976, but in 1977 it was down to 4.4%. There are many factors that may have ac- counted for this movement; one which cannot be discounted is an influx of lower quality heroin during the period in question. According to the most recent information obtained from DEA and local law enforcement agencies the quality of heroin in Dallas is now of low quality and the price appears quite high. Purity levels according to local law enforcement agencies are running between 0.5% and 2.0% pure heroin. Additionally, it might also be noted that there appears to be an interesting trend developing in the psychostimulants category. As noted in Table VIII it appears Table VIII Number and Percentages of Drugs Mentioned in Emergency Room Treatments Reported to Project DAWN from the Dallas SMSA, 1975–1977 1975 1976 1977 1978 (Jan-Sept) Jan-June) Drug No. % NO. % NO. % NO. % Tranquilizers 942 43. 892 39. 747 38. T 356 35. Barbiturate Sedatives | || 4 5. | 12 5. | 16 5.9 62 6. Non-Barbiturate SedativeS 266 l2. 249 ll. 203 10.3 12] | 2. Al Cohol-In- Combination | 88 8. 262 | ] . 269 13.7 150 15. Narcotic Analgesics 82 3. 137 6. 82 4.2 42 4. Non-Narcotic Analgesics 42] 19. 384 | 7. 356 18. |7| | 7. 90 Amphetamines 50 2. 45 2. 37 1.9 20 2. Cocaine 7 0. 2 0. 8 0.4 2 0. Psychostimulants 62 2. 98 4. 99 5.0 44 4. Cannabis (Marijuana/Hashish) | 6 0. 2] 0. 13 0.6 8 0. Hallucinogens 23 l. 20 0. 19 0.9 18 l. Inhalants/Sol Vents/ AeroSol S 17 0. 9 0 9 0.4 2 0. Total Drug Mentions 2188 100. 223] 100. 1958 100.0 996 || 00. Figure VI PERCENTAGE AGE, SEX AND ETHNIC DISTRIBUTION EMERGENCY ROOM ADMISSIONS TO DALLAS SMSA DAWN SURVEY -- 1975-1977 l975 (August) a AGE SEX RACE Female 83% 1976 (July) a SEX RACE 91 Female 65% Other 2% 1977 (July–Sept) b AGE SEX RACE Females 7.1% U/NR lºš 2 50 & Over 2" 10% a. Only covers a one month reporting period b. Only covers a two month reporting period that psychostimulants have become the sixth leading drug of mention. This is especially noteworthy in light of the fact that psychostimulants showed an upward trend as a cause of drug related deaths. Another trend that also seems to be emerg- ing in these data is the increasing share (from 9% in 1975 to 13% in 1977) of treat- ments mentioned in the alcohol-in-combination category. For the first 9 months of 1977, alcohol-in-combination represented the third highest category of mentions. Figure VI provides the percentage age, sex and ethnic group distribution of persons seen in emergency rooms. As noted females have continued to dominate this reporting system. Whites and persons between 20–29 account for a higher portion of mentions than do other groups. Apart from the DAWN data, virtually nothing of a systematic or objective nature is known about the abuse of over-the-counter and prescription drugs in Dallas county. Project DAWN findings suggest that a substantial problem exists. Abuse of the drugs frequently mentioned in emergency room treatment extends to population groups which may be relatively free of illicit drug use. The cost of abuse of over-the-counter and prescription drugs in terms of impaired functioning in social roles is presently beyond speculation, but could be approached through a well-designed household sample survey. Drug Treatment Admission Data The data obtained on treatment admissions are reported to the Client-Oriented Data Acquisition Process (CODAP), as required for all drug programs receiving Federal funds. This information from Dallas county only includes two programs, but these provide a full range of services such as inpatient, outpatient, methadone maintenance, drug free, detoxification and residential services. In addition (l) West Dallas Community Center opened mid 1977 and primarily serves approximately 43 youths below the age of seventeen in a drug free modality; (2) Rehabilitation Services, Inc. is a 20 slot drug free program contracted through the Bureau of Prisons (BOP) to serve federal parolees and probationers, which was closed in mid-1977; and (3) Federal Correctional Institution (FCI) located in Seagoville, Texas. Combined, these three programs only serve about 200 persons a year in a somewhat limited setting. There are also a number of private groups and associations providing ancillary services to the drug abusers, but again their services are quite limited. Table IX covers a three year period l975-1977 and shows the number of admissions for opiate and non-opiate abuse according to whether there had been any prior treatment. As noted, there has been a steady increase in the percentage of admissions represented by clients with prior treatment for both opiates and non-opiates, whereas there has been a decrease in the percentage of clients with no prior treatment. This distinction is believed to be important inasmuch as changes in incidence (new cases) are apt to be reflected in the admissions for first treatment, while the percentage of readmissions reflects the continuing prevalence of drug use in a given community. Many factors, however, impinge on admissions to treatment. For example, opiate admissions may be ºn-" by purity levels or admission policies (e.g. shift to centralized intake only) of particular programs. Both of these factors are believed to have had an influence on the 1977 admissions data. According to some quoted figures offered by DEA, purity levels in Dallas may have been as low as l - 2% throughout 1977. It has been sug- gested that, as a result, opiate users may have resorted to "doctoring" themselves and were not pressed into seeking treatment. An additional point might be mentioned. First, an analysis of the lag between first use and first entry to treatment sug- gested that in 1977 there would be an increase in the admissions to treatment in both the absolute and relative number of first admissions. The fact that this did not materialize may be associated with either purity levels or problems with admission intake. Secondly, opiate users appear to be seeking treatment sooner than in past years. The assumption is that these new admissions were primarily women. As revealed in Table X the number and percentage of drug treatment admissions for all drug categories during 9|| 1975-l977, there appears to have been an increase in the number of females who entered programs in Dallas in 1977 representing 27.6% of the total admissions. Data shown for l977 are incomplete in regard to the age breakdown, since there were l{6 admissions to the Dallas V. A. Hospital for whom this information was missing. The data in question are presently being obtained, but were not avail- able in sufficient time to include in the present report. More importantly only one of the admissions under reanalysis was a female. As indicated throughout this report a number of indicators have revealed this increasing trend among females involved in drug abuse in Dallas county which sug- gests that further investigation needs to be done in this particular area. As shown in Table X, Blacks represented one half of all admissions in 1976 and 60.0% in 1977. Persons between 20–29 represented a majority of the admissions. This may be related to the increasing number of readmissions, as revealed in Table IX. Discussion and Summary In summary drug abuse data indices for Dallas county appear to be revealing three major trends. First, there appears to be an increasing number of females involved in Opiate abuse as indicated by a rise in the percentage of females seen in 1977 drug treatment admission, serum hepatitis cases, drug related deaths and to some degree drug offense arrest information. Secondly, compared to their represen- tation in the population a high proportion of Blacks are involved in opiate abuse as revealed in all data indices excluding the DAWN information. Thirdly, there appears to be an emerging drug problem with psychostimulants and cocaine among young White adult males and females. Lastly, all indices would suggest the opiate problem appears to be somewhat stable with a 50% decrease in the number of deaths reported, DATA ON CODAP OPIATE AND NON OPIATE ADMISSIONS IN DALLAS COUNTY Table IX NO Had With % With Prior Prior No Prior Prior Total Drug/Year Tmt. Timt. Total Trnt. Tmt % Opiate 1975 38O LO9 489 78 22 lOO ... O 1976 37.2 L99 571 65 35 100. O 1977 213 264 477 45 55 1OO ... O Non Opiate 1975 148 27 175 85 15 100. O 1976 138 25 L 78 78 22 100. O 1977 l33 26 l96 68 32 l'OO ... O l. Exclusive of VA Hospital and FCI Seagoville. 2. Exclusive of admissions for marijuana abuse only. Source - R. G. Demaree, Texas Christian University - Institute of Behavorial Research. Table X Number and Percentage Distribution by Sex, Ethnic Group, and Age of Admissions to Treatment for Opiate and Non Opiate Dallas County 1975–19771 - Year 1975 1976 1977a No. % NO. % NO. % Sex Male 72O (77.9) 847 (78.4) 796 ( 76.0 ) Female 201 (21.8) 234 (2l. 6) 249 ( 23.8.) Not Reported 3 (0.3) º GE - tº gº - - 1 ( 0.2) Total 924 (100. O) 1081 (100.0) 1046 (100.0) Ethnic Group White 454 (49. 1) 472 (43. 7) 431 ( 4l. 2) Black 402 (43.5) 540 (50. O) 540 ( 51.6) Hispanic 60 (6.4) 64 (5.9) 69 ( 6.6 Other 5 (O. 5) 5 (0.4) 5 ( 0.4) Not Reported 3 (0.3) sº tº cº º- tº º ºx- --> l ( 0.2) Total 924 (100. O) 1081 (100.0) 1046 (100. O) Age l4 and under 15 (1.6) 3 (0.2) 4 ( 0.4) 15–19 - l23 (l3. 3) 85 (7.9) - 65 ( 7.2) 20–29 543 (58.7) 670 (62. O) 542 ( 60.2) 30–39 164 (17.7) 204 (18.9) 215 ( 23.9) 40-54 72 (7.8) 109 (10.1) 65 ( 7.2) 55 and over 7 (0.8) lC) (0.9) 9 ( l.0) Total - 924 (100. O) 1081 (100. O) 900 (100. O) *These data are incomplete, due to the dropping of 146 admissions to the V. A. Hospital for which age information was lacking, but was listed as "la and under". a decrease in the number of overall new admissions to treatment excluding women, and a leveling off of arrests for opiate offenses. As mentioned in this report, heroin available in the Dallas area is reported to be of low quality and high price. Due to the situation just described maybe many drug users are turning to alternative drugs channeled into the illicit market through theft or by illegal prescription. Noteworthy in this respect was a recently released news story headlining this fact. As stated "... lo area physicians are supplying an estimated one third of the dangerous narcotic pills"l to area drug abusers. As suggested in this article some doctors are alleged to be supplying via prescription Preludin, Elavil, Ritalin, Desoxyn, Vornil and other powerful amphetamines or psychostimu- lants. At present it is assumed that this only represents a small fraction of the legal drugs which are being channelled into illicit markets. Quite possibly many would be heroin users are merely substituting these drugs until new supplies of 97 heroin can be obtained. Drug arrests have continued to increase in Dallas county (10,764 in l977), which represented about a 5% increase over l976 reported figures. Marijuana arrests in 1977 continued to account for the majority of all arrests and were largely made up of White males who were l8-24 years of age. Contrastingly, while year-to-year fluctuations were shown in the non-opiate arrests, a decided increase in the total number of such arrests was shown from 1976 to l977. There is an interesting possibility that the rise in non-opiate arrests could be due, in part, to a shift towards prescription type drugs, resulting from a decrease in the availability of heroin of acceptable quality and price. White males tended to account for the greater proportion of arrestees for both marijuana and non-opiates, while Black males accounted for the majority of *Fort Worth Star Telegram Sunday, June 18, 1978 98 opiate arrests (59% in 1976 and 48% in 1977). It is noteworthy, however, that there was an llº increase in the number of Whites arrested and a loš decline in the number of Blacks arrested in 1977. No specific reason can be offered for this change other than there may have been some change in enforcement policies or prac- tices. Interestingly, in discussing drug activity with local law enforcement officials in Dallas it appears that the major drug dealing operations are located in primarily Black and Brown communities which may in fact limit distribution to these communities only. Additionally it might be worthwhile to point out that the Hispanic population does not show up strongly in the indices presently being utilized to assess drug abuse prevalence; the one exception to this is inhalant abuse arrests involving youth where Hispanic youths are a clear majority. Juvenile probation data were included in the present report as supportive information on the trends of drug abuse among youth in Dallas county. Ideally the same type of information would have been provided for adults, but the value of adult probation information as an indicator of prevalence is even more questionable than the juvenile probation information. The justification for including juvenile probation information pertains to the likelihood that problems associated with early drug abuse are more readily detected by juvenile officers as opposed to adult authorities. This is related to the manner in which the juvenile offender is handled in the criminal justice system. It is further assumed that these data may provide some indication of the magnitude of drug abuse among youth in the absence of annual surveys of school attending youth or other studies of prevalence of drug use by this portion of the population. Examination of the arrest data from both adult and juveniles leads to the suspicion that drug enforcement policies and practices, as well as reporting prac- tices, may have varied from one year to another. In this regard a cyclical pattern is revealed. More precisely, in 1973 and 1976 there were peaks in juvenile arrests. Similar year-to-year swings are shown in total arrests in Dallas county. These perturbation in the data are thought to have little bearing per se on the prevalence of drug abuse. An important finding from the juvenile drug arrest data was the increase in the percentage of referrals, including felony arrests, for youth under 14 years of age. In addition, with the size of the youthful population being as large (39% of the total population under l9) as it is in Dallas we can only expect an increasing amount of drug abuse unless preventative efforts become more wide- spread and effective. Drug related death information has shown little or no change from l975 to l977 in the total number of deaths reported. The salient factors noted in these data pertain to the change in the types of drugs commonly associated with drug related deaths. Of special interest was the drop in narcotic related deaths from l6 in l976 to 7 reported in l977, while the number of nonnarcotic analgesics pri- 99 marily propoxyphene accounted for l8 deaths in 1977, which was twice the number reported in 1976. Another interesting drug group or therapeutic class which emerged in 1977 was the rise in psychostimulants (Elavil and Ritalin) and cocaine deaths; interestingly these persons were relatively young and were typically White males. It was further noted that there appears to be an increasing percentage of female deaths reported since l975 as well as an increased number of Blacks. With regard to heroin use, the lack of heroin of acceptable quality and price is suspected of causing heroin users to seek and use drugs that are more readily available but with little understanding as to the possible lethal effect if administered intravenously or with little understanding of the potency levels. This is particularly noted in the number of Propylhexedrine deaths which have occurred in Dallas county for the last three years. It has been verified through 100 interviews that many established heroin users as well as some new users, believe that ingredients in the "benzedrex inhaler" manufactured by Smith, Kline and French can be used to maintain one's habit until heroin becomes more readily available. Interestingly, this inhaler is easily obtainable over the counter and has accounted for 8 to 12 deaths in the past three years. According to data supplied by the Medical Examiner's Office it appears that persons 20-29 (28%) and 50 plus (29%) represented the highest percentage of drug related deaths reported in 1977. It is suspected that these two groups differ according to suicide or accidental overdoses in that older women indicate a large number of suicide deaths. Information provided on serum hepatitis by the city and county health depart- ments show that there was an increase in the number of reported cases between 1970– 1973 with a relatively stable period between l973 - 1975. Serum hepatitis cases appeared to have dropped 50% in 1976 according to the State Health Department; this was not in keeping with trends shown by other indices. Upon further investigation it was revealed that an additional l85 cases of serum hepatitis had not been reported to the state from the City of Dallas Public Health Department. Special efforts are presently being made to correct this problem in reporting. While an increase was found in the total number of reported cases, this should be viewed in light of the problems associated with this reporting system. Salient factors shown in the age, sex and ethnic groups of serum hepatitis cases were quite interesting. In 1975 males dominated this indicator (63.3%) while females only represented (36.7%) of the reported cases. However, in 1977 females accounted for 49.0% of the reported cases which is quite interesting in light of the other indices where we see the same type trends. As suggested, it is too soon to draw any conclusion but special consideration should be given for addressing the needs of the female population. This would be underscored if the trend continues whereby females are becoming more prominent in the prevalence indicators. Pertaining to ethnic groups, there has been a gradual increase in the per- centage of Blacks reported to have serum hepatitis between 1975 (33%) and (46%) in l977. This result coincides with other indices and suggests that special program- ming might be needed to address the needs of this population group. Age group of reported cases also revealed some interesting findings. The percentage of persons l6-24 declined, while persons 25-30 ascended to 27% of the reported serum hepatitis cases in l977. Based on this finding it might be suggested that there is an older age group becoming involved in intravenous drug abuse or that this group is less likely to concern themselves with proper needle use. Additionally, we might be seeing more group needle use occurring which could account for this trend. Another point to consider relates to the assumed upsurge of drug abuse among prostitutes in Dallas county especially as it relates to the use of stimulants and other type drugs which have been associated with increased sexual productivity. Reportedly it has been suggested that panders in the Dallas area attempt to control their "fille de joie" by administering stimulants to the women which allows for some degree of control and increased productivity. Little is known as to the actual size of this population, and whether or not they would account for an appreciable number of serum hepatitis cases. Hospital emergency room data from DAWN indicates little, if any, change in the total number of drug related emergency room admissions for the Dallas SMSA over the 1975 - 1977 period. Tranquilizers, particularly diazepam, have continued to be the leading drug of mention, with nonnarcotic analgesics making the second highest 102 category of drug mentions in l977. Noteworthy is the decline from 1976 to 1977 in heroin mentions, similar to the drug related death information reported. Another interesting finding in the emergency room data is the increase revealed in the psychostimulant category which was also noted in drug related death information. Females have continued to dominate this reporting system and especially those persons 20-29 years of age. Interestingly Blacks accounted for a lower percentage of mentions in 1976 than in 1975 (5% vs. 24% respectively) and made only a slight recovery to 10% in the 1977 data. This would suggest the possibility that Blacks do not seek emergency room treatment for drugs as readily as Whites in the Dallas SMSA. Roughly, Blacks make up lb. 6% of the total six county population and only account for l3% of the total emergency room mentions, while Whites make up 77.8% of the total popula- tion and account for about 83% of the total three year mentions. Additionally, it might be worthwhile to note that Blacks appear to be more involved in illicit drug abuse which in all likelihood would preclude their seeking emergency room treatment for fear of criminal prosecution. The total number of drug treatment admissions for Dallas county was unchanged from 1976 to 1977. The total of 1046 admission to treatment programs in Dallas county in 1977 was virtually the same in number as the 1081 in l976. As previously mentioned however, three programs were not included in these data. Only one of these could be considered a community based treatment resource, and the other programs served a very select prison-population or youth population in a drug free modality. The treatment admission data suggests that there was an increasing number of non-opiate admissions, while opiate admissions appeared to be decreasing. The number of persons admitted with prior treatment also appear to be on the increase. This is believed to be important because changes in first admissions are said to reflect changes in incidence, while readmissions reflect continuing prevalence of Opiate use. If we assume that this premise is correct then it would seem that incidence is not increasing in proportion to the increase in prevalence. Another interesting factor noted in these data was that in recent years opiate users appear to be seeking treatment in a shorter time beyond first use (i.e., within 5 years); many reasons could account for this result, but indicated among these are the possibilities that incidence has increased or that individuals are tending to enter treatment sooner. As suggested in the report, there appears to be an increase in the number of females entering treatment programs in Dallas, females represented 28% of the total admission in l977. Additionally, Blacks represent over one half of the admissions in 1976 (50% in 1976 and 60% in 1977), based on these results it is possible that special efforts should be directed towards these two groups. In conclusion, analysis of the drug indices suggests that a major Opiate abuse problem exists in Dallas but not at the magnitude previously seen. At best, l opiate abuse does not appear to be increasing, whereas multiple drug use especially 03 with barbiturates, nonnarcotic analgesics, and the psychostimulants may be on the upswing. Marijuana remains one of the primary drugs of choice among youth and Young adults as revealed in the arrest data. In the months ahead, additional indices will be compared with the present findings, and data from the NIDA-supported research grant with the Institute of Behavioral Research of Texas Christian University will also become available. There is every reason to expect that these data will provide a much clearer and more detailed picture of the drug problem in Dallas. 10H ALCOHOL USE IN WAYNE COUNTY: A PRELIMINARY REPORT T. Her shel Gard in Wayne County Department of Substance Abuse Services Detroit, Michigan l;8226 INTRODUCTION Since the last substance abuse Comprehensive Plan for drug treatment was prepared for Wayne County, there has been an increase in interest about al co- holism. Though this interest may be motivated by many different concerns, of major importance to the Wayne County Department of Substance Abuse Services is an analysis of changing trends in alcohol ism and alcohol related health pro- blems. Such analysis is crucial to any future planning of the treatment sys- tem. Basic to such treatment planning is the question, ''how many persons in Wayne County require treatment for alcohol use?'', The answer to this ques- tion is absolutely necessary if accurate, legitimate and consequently, valid and defensible treatment strategies are to be developed. Unfortunately, ob- taining information on the numbers of alcohol abusers has been a very diff i- cult task. This difficulty has been compounded by several different factors. Surprisingly, they all relate significantly to definitional difficulties rather than to actual availability of information. Simply, there is little agreement as to what is meant by alcohol ism. Thus, there is little agreement among those estimates of alcohol ism levels that do exist. Such problems have made it very difficult for the Wayne County Depart- ment of Substance Abuse Services (DSAS) to prepare a Comprehensive Plan that incorporates a clear alcohol treatment strategy. Consequently, it is the purpose of this preliminary report to: a. Assess the State-of-the-Art in alcohol incidence and prevalence measurement; b. Review some national alcohol ism statistics; c. Consider those figures presently available for the Wayne County area; d. Provide some preliminary (DSAS) analyses of numbers of alcohol ics in Wayne County, and ; e. Summarize the collected information in a useable fashion. It is hoped that this strategy will be the basis of a thorough investi- gation of the problem. That is, answering the original question of "preva- lence extent" is only a beginning. Reaching concensus on the number of alcohol abusers will only allow for molar planning and the handling of issues Additional reprints available from author, 76 West Adams, Suite 1010, Detroit, Michigan l;8226. Reference number WCDSAS-1 1-78 (a). such as problem magnitude. However, before actual treatment modalities and locations can be selected, greater refinement of the data base will be necess- ary. Additionally, quest ions such as: what populations are at risk and where are they, will have to be answered. a . STATE OF THE ART At present, identification of persons using alcohol to excess, or at-risk of alcohol excess, is severely limited. This is due, in part, to the serious lack of a national concensus on what constitutes responsible versus irrespon- sible use (1). As the Special Report on Alcohol and Health states, there exists a ". . . current lack of parameters with regard to safe versus compara- tively unsafe drinking patterns...," and therefore ". . . an inadequate and ineffective clinical base for the diagnosis of alcohol ism'' (l). A brief survey of the literature exhibits the diversity and richness of problem drink- ing definitions that exist. Some definitions are quite elaborate linguistically: "Alcohol ism is a chronic illness, psychic or somatic or psychosomatic, which manifests itself as a disorder of behavior. It is characterized by the repeated drinking of alcohol ic beverages, to the extent that exceeds cus- tomary dietary use or compliance with social customs of the community and that interferes with the drinker's health, or the social or economic functioning" (2). Of course, this definition may be put more simply and succinctly: Alcohol ism is a cond it ion when one's drinking frequently interferes with business, social 105 life or health. Perhaps the essential difficulty in reaching consensus on a qualitative definition is that alcohol use has few legal restrictions. With Hero in for example, any use is illegal and consequently problematic for socie- ty. That is, the law constitutes the definition and there are no grey areas of use: if you use Hero in you have a problem and society wants to intercede. On the other hand, society has accepted the use of alcohol as legitimate with- in reasonable limits. However, the concept of "reasonable limits'' allows for no clear guidel ines and debate ensues, For those in the field who prefer quantitative rather than qualitative definitions, many are also available. There is the Index of Uncontrol led Drinking (3) which consists of nine questions about harmful behavior associa- ted with alcohol use. Items include such questions as: Have you had diffi- culty meeting bills and; has a physician told you that drinking is hazardous to your health? According to the Index schedule, two or more positive res- ponses identify the respondent as a problem drinker. Thus, the definition is based on the number of deviant behaviors engaged in rather than the content of the individual acts. Other similar Indexes include an Escape Drinking Index (li), Q-f Index (5), and more indirect measures such as the Ledermann Consumption Model (6) and the Jellinek Formula (7). Of special interest is the Jel linek Formula. Though much of the recent literature indicates the use l06 of this particular indirect method, the author himself, as early as 1972, specifies rigorous prohibition of indiscriminate use and the limited validity of the formula. Though Jell inek has modified constants in the equation sev- eral times and has warned against its general ized use, the original formula continues to be utilized. This may be symbolic of the State-of-the-Art in alcohol research. Assuming that the researcher successfully leaps the hurdle of definitions on alcohol isſm, he/she is faced with producing a taxonomy of use. That is, drinking behavior does not dychotomize into all or nothing categories. Through the use of indexes, it is perhaps possible to produce hierarchical data. But how do these data translate into useable units? Perhaps a four- step classification system is the easiest to conceptual ize and work with. Cahalan offers the following classification system (2, li). 1. Abstainers: persons who drink less than once a year or not at all . 2. Infrequent: persons who drink at least once a year, but less than once a month. 3. Light to Moderate: persons who drink at least once a month but who consume from one to four drinks per occasion. H. Heavy: persons who drink nearly everyday with five or more drinks per occasion at least once in a while, or about once weekly with usually five or more per occasion. Using the above taxonomy, planners can direct prevention activities to all four levels and casef inding and treatment to the fourth level. However, the difficult area lies between steps 3 and H. It is not always clear which individuals belong in level 3 and which belong in level H. Secondly, when data on alcohol use that are already available are evaluated, it is rarely obvious which level or levels are being measured. Thus, for example, while an indicator that relies on the number of highway deaths related to alcohol may be useful in observing changes in drinking trends, it cannot be used to obtain actual figures of level four alcoholics (i.e. those in distinct need of treatment). Unfortunately, many quoted figures on alcohol use in American literature today are based on just such automobile statistics (8,9). Such data may be useful when discussing prevention since these indicators measure a problem that applies to all levels of drinking behavior. However, they are often used by individuals when assessing treatment needs. Clearly, when us- ing such methodology, errors in planning judgement are possible. Even when definitional problems are resolved and taxonomies selected, difficulties still exist in the incidence/prevalence "State of the Art" for the met iculous researcher. The quality of the data available is still below what is typically accepted in more traditional drug abuse research. Alcohol data that have been collected in a reliable fashion, over an extended period of time, typically have one or more problems associated with them. One such problem has already been discussed above. Though alcohol related highway fatalities have been tallied for many years, these data do not measure the actual number of people in need of alco- hol treatment. Even if it may be argued that an increase in such fatalities suggests an increase in problem drinking, incidence and prevalence remain ob- scure. Secondly, it is understood that the collection of these data may not be consistent over time. Changes in police tactics, in legal definitions, and in testing procedures by medical examiners may serve to destroy the validity of comparisons that are made. Similar arguments may be made when considering driving under the influ- ence of alcohol statistics (9,10). In both cases, however, the data may be somewhat useful in determining whether a new need for treatment exists. The essential caveat here is that they cannot be used to plan the type or amount of treatment necessary. Additionally, both fatal it ics and driving under the influence statistics may not be sensitive to changes in the drinking patterns of non-driving sub-populations (e.g. women who tend to stay home and drink alone and members of lower economic classes unable to own cars). Another source of potentially useful data that has been monitored with some degree of regularity is mortality from alcohol ism (l, ll, 12, 13). Again, a definition of alcohol ism (as it relates to death) must be supplied. A typical definition of alcohol ism mortality includes: alcoholic psychosis, alcohol ism, and alcoholic cirrhosis of the liver (13). As is obvious, the definition is almost as vague as the term it attempts to define. However, considering the vagueness of the definition, mortality from alcoholism in the United States is 107 substantial (l, ll, 12, 13). But even with these statistics, the true impact of the disease is difficult to measure because of considerable under-reporting of alcohol ism as a cause of death. The present system of tabulating mortal i ty statistics by selecting the underlying cause of death excludes deaths in those cases where alcohol ism is mentioned only as a contributory cause on the death certificate (13). In addition, many reporting physicians are reluctant to indicate that alcohol ism is the underlying cause of death when it is possi- ble to attribute another cause or complication. Often, the mention of alco- holism is completely omitted (13). Investigation of the various causes of death indicates however, that alcoholics are subject to excess mortality from all the major diseases as well as from accidents, suicide, and homic ide (1,8, 9, 11, 12, 13, ll). Consequently, it is seen that even those data that have been collected for extended periods of time have severe constraints placed on their use. Finally, all the difficulties thus far discussed have related to the problems of general data collection for planning. While problems of alcohol- ism and alcohol abuse (regardless of definition) confront Americans from all backgrounds, certa in population groups may be especially vulnerable, at-risk, or may not even recognize that alcohol ism is an illness requiring treatment. There is clear evidence that these problems vary by such basic characteristics 108 as age, sex, race, socio-economic status, ethnicity, , religion, marital status, urban-rural residence, and migrant status (1,4, 15, 16). The use of a single index or indicator homogenizes the population. It will not reflect the fact that persons from different backgrounds will have different probabilities of encountering difficulties with alcohol, regardless of the measure used. There- fore, after preliminary probes into the establishment of general incidence- prevalence figures, other figures that reflect sub-group differences will have to be obtained. With each refinement of the probe more precision will be gained and a more veridical planning strategy will result. b. NAT I ONAL ALCOHOL | SM STAT | ST | CS This section will report on a cross-section of nation-wide data presently available. No attempt will be made here to determine or defend the reliabili- ty and validity of the statistics presented. Such arguments have already been del ineated in the State of the Art section. Those readers who are not inter- ested in national figures or trends may skip this section without fear of missing crucial information needed for Wayne County treatment planning. That information will be presented in the next section. The most general statement available on national alcohol use is the Second Special Report to the U.S. Congress on Alcohol and Health (l). The following is a brief summary of some of its findings. a. Alcohol ism incidence continues at a high rate. b. Economic cost of alcohol misuse is estimated at twenty five bill ion dollars annually. c. The U.S. systems of alcohol control and treatment are antiquated and provide little support in mitigating alcohol problems. d. Alcohol in combination with tobacco has been implicated in the increasing risk of certain Cancers. e. Heavy drinking among pregnant women can lead to Fetal Alcohol Syndrome (more on this below). f. There may be as many as 10 million people whose drinking has created some problem for themselves or others. g. Consumption of beer, wine, and dist illed spirits has risen by about 32% in recent years. h. U.S. per capita consumption is third highest among 26 reporting countries. i. Recent surveys indicate that 71 to 92 percent of high school students drink at least occasionally. j. There are significant differences in levels of drinking between groups based on race, sex, age, and other ethnographic classifications. k. Alcohol affects the heart, brain, liver, central nervous system, and may be related to various Cancers, infections and circulatory ailments to name a few. 1. Alcohol use can lead to death through disease, accident, homic ide, and suicide. The list in this report continues far beyond what is described here. Recent research into alcohol use by women has indicated increased mortal - ity rates (l, 15, 17, 18, 19,20). Mortality rates reported have been based on illness, accident, and other causes of death. Trends indicate that problem drinking among women is increasing beyond the ability of present treatment systems to cope with (21). As a result, a major Request for Proposals has been issued by the National Institute on Alcohol Abuse and Alcohol ism (see 17 for example). In a similar vein, there is increasing evidence that maternal use of alcohol during pregnancy can lead to Fetal Alcohol Syndrome (FAS) (22,23, 24, 25). The effects of FAS are varied with children exhibiting any or all of the mptoms. Such symptoms include central nervous system dysfunction, lowered 109 ! .. Q. , growth deficiencies, and facial abnormal it ics. In addition, vital organ systems may be damaged, in some cases to the degree that early death occurs, both pre-partum or shortly after birth. Recent studies place the frequency of at least partial FAS in the U.S. at three to five live births per 1,000 (26). The extend ot this problem and the concern that it may be increasing has led to a national ''Health Caution'' issued by the National Institute on Alcohol Abuse and Alcohol ism (June 1, 1978 news brief ing). In essence, the evidence is overwhelming that not only does alcohol abuse effect the user and society in general , but the unborn as well . More generally, mortality rates across groups have been rising sign if i- cantly (l, ll, 13, 14, 18). On an average, across racial and sex groups, death by alcoholic psychosis, alcohol ism, and alcoholic cirrhosis of the liver in- creased approximately 65% during the past 10 years for those 20 years old or older. What has been found to be most alarming is that deaths from alcoholic disorders have more than doubled for nonwhite males at ages 20 and over (107% increase) during the past 10 years, while for white males of the same age group the increase has been H6% (13). Though the disparity between white and nonwhite females has not been as great, the trend is in the same direction. That is, the ten year increase for white females is 36% while for nonwhite females the increase has been 71% (13). 110 Mortal ity rates from alcohol ic disorders have also varied considerably by age. During 1963-1964 the average annual death rate for 20–29 year olds was 2 per 100,000. In 1973-1974 the rate had increased to 3 per 100,000 (13). This increase is exhibited at greater rates as older groups are assessed (as might be expected by the length of time needed to develop critical health problems). The greatest increase has occurred for the 50-59 year old group. During 1963-1961, the death rate was 19 per 100,000. By 1973-1971; this had doubled to 38 per 100,000. Given the tendency toward under reporting of alco- hol related deaths (as described above) some estimates suggest that the figures could be 25% higher (13). In summary, national alcohol ism statistics all appear consistent. Regar- d less of how it is defined or measured, alcohol ism seems to be increasing. Major increases have been indicated for Blacks, women and older Americans. Even though each indicator viewed separately might be subject to intensive criticism, as a group they gain validity. Thus, drug abuse treatment plan- ning on the national level should incorporate increases in alcohol services. This is especially true for the sub-groups that have been shown to exhibit major alcohol use increases. Traditionally, alcohol services have not been made adequately available to Black female, youthful, or older Americans. To intensify the availability of services to these groups is clearly defensible even with the poor quality of the available data. c. WAYNE COUNTY ALCOHOL | SM STAT | ST | CS For those readers who have skipped the section on National Alcohol ism, the following is a brief summary. Most national statistics (regardless of their levels of reliability and validity) indicate that use and abuse of alcohol is up. This is true for the population as a whole, and significantly so for certain sub-groups. Major increases of alcohol use have been exhibited by Black males, all females (including those who are pregnant), and older in- dividuals to name a few. Treatment facilities have been found to be inade- quate. Consequently, on the national level, planning appears to be directed toward specifying at-risk populations and developing treatment modal it ics that address the idiosyncratic problems of these target populations. In focusing on Wayne County specifical ly, the data and planning picture is not significantly different. Information available indicates that al co- hol ism is an increasing problem. This community's health situation appears to be compounded by the ever increasing discrepancy between the level of the pro- blem and the ability of the treatment system to cope with it. The Michigan Health Planning Council has indicated a need for approximately 1,600 patient beds for alcohol ism treatment (27). However, there are only approximately l:00 beds presently available (8). The shortfall of beds is most severe in the City of Detroit where alcohol ism rates are highest and treatment beds per capita are lowest (8). - Additional information of alcohol ism offered by the National Council on Alcohol ism (8) for the Wayne County-Detroit area includes: a ... [n the Greater Detroit Area (Wayne, Oakland and Macomb Counties) there are over 200,000 alcoholics. b. There are no more than 10,000 alcohol ics receiving any kind of treatment (i.e., only about 1 in 20). c. There were 410 cirrhos is deaths in Detroit during 1976, This was 36.3 deaths per 100,000, a rate more than twice the national goal of 15 per 100,000. d. The death rate in Wayne County as a whole as 30.02 per 100,000, indicating concentrated use of alcoholism in the city. e. During 1975 there were k06 automobile fatal it ics where alcohol consumption was a factor, in 1976 the rate had increased to h33. f. More youth are misusing alcohol and treatment centers are experiencing increases in the numbers of youthful patients (some as young as 12 years old). The Detroit Health Department, Bureau of Substance Abuse Services has also monitored increases in certain alcohol related deaths (28, 29). Since 1973, the death rate from cirrhosis of the liver has climbed steadily. In the four years of 1973-1976 the annual rates have been 230,268,208 and 420. Such data indicate rapidly growing mortality (excluding 1975), without a concomitant growth in treatment facilities. - 111 A third source of unique data relevant to changing levels of alcohol use in Wayne County is also available. The State of Michigan Uniform Crime Re- ports has for a number of years listed the arrest rates for various offenses (9). Several of the offenses have been directly or indirectly related to the use of alcohol. Unfortunately, the definition of these offenses and the act- ual listings have changed from year to year. In addition, the types of arr- ests mentioned by counties have also changed through time. Consequently, there is only one category of arrests that may be utilized to analyze changes in trends. As far back as 1973, the number of arrests for Drunk and Disorderly are available for Wayne County. However, even this category has now been render- ed nearly useless since public intoxication has been decriminal ized by Mich- igan Public Act 339. Thus, trend analyses are possible only through 1977. This, though does allow for present planning. The following table lists the number of arrests in Wayne County for Drunk and Disorderly behavior during the five year period 1973-1977 (9). - - 112 Year Arrests Per 100,000 1973 8,257 316 197l; 8,775 343 1975 8,926 355 1976 9,571, 386 1977 10,310 l, 16% (*1976 Census projections used) (30) Again, the trend is quite clear. People in Wayne County seem to be hav- ing more difficulties with their use of alcohol now, then in the recent past. As a somewhat unobstrusive measure, the amount of liquor consumed by the population over time may be measured. Unfortunately, the data that are avail- able are not very precise. Specifically, actual amount of alcoholic beverages purchased in Michigan are only recorded by cases. Since cases do not contain exactly the same quantities of liquid, some error is introduced. However, the Michigan State Liquor Commission assumes that this error is quite small (31). A second problem that exists with the data is that State liquor districts do not follow city or county lines precisely. Thus, only estimates are possible for such corporate limits. These though, should reasonably describe liquor consumption for Wayne County. The first set of data available is for Detroit City and is an approxima- tion based on data from the Detroit District (which includes all of Wayne County and parts of Oakland, Macomb, Washtenaw, Monroe and St. Clair counties (35). The data are only for the two year period 1976-1977 and include the number of cases sold in the city and their gross dollar volume sales. 1976 h, 362,680 cases at $166,283,227.2% 1977 l, h0l., 247 cases at $169,688,059. 18 Clearly sales are up for 1977 over 1976. The significance of this in- crease is enhanced when census estimates for Detroit (30) which indicate a decline in population are considered. That is, fewer people appear to be using greater amounts of alcoholic beverages (as a reminder, these data do not necessarily indicate that problem drinking has increased, only that drinking in general has increased). More precise figures are available if the total Detroit district is considered (32). 1975 = $238,259, h78 1976 = $245,250,941, 1977 = $250, 110, 170 The figures for each year represent approximately 62% of total sales in the state. Consequently, not only is alcohol use increasing steadily in the Det- roit district, but this district accounts for more than half of all alcohol use in the whole state. Such use is quite impressive when it is considered that the district accounts for less than 45% of the State's population (30). d. DSAS PREL |M|NARY ANALYSES In an attempt to assess levels of alcohol ism in Wayne County on a pre- liminary basis, perforce, traditional methodologies as described above will be used. The reader is cautioned however, to keep in mind the severe limitations of each method and that operational definitions are restricted to the value of the data base alone and to the time period during which it was established. Thus, the meanings of subsequent prevalence figures are subject to broad in- terpretive and speculative discussion. (In terms of immediate actual treat- ment planning requirements, all figures are of academic value. Presently, most alcohol treatment agencies in Wayne County are operating at maximum capa- city and with long waiting lists for new admissions (33). Consequently, the need for additional treatment programs has already been well demonstrated.) The first methodology used here is the Jellinek Estimation Formula (7). PXDXR 113 K A = Where A = the number of alcohol ics a live in a given area during a given year P = the percentage of liver cirrhos is deaths attributed to alcohol ism: a presumed constant; males at 62.8% and females at 21.6% D = the number of reported deaths from liver cirrhosis in a given year K = the percentage of all alcoholics with medical complications who die of cirrhos is of the liver (1.079%). R = the ratio of all alcohol ics to alcoholics with medical complica- tions: a presumed constant of 53% Using the Jellinek formula on Detroit data (28,29,34) the following is obtained: Males Females Total Alcohol ics 1973 3,301 8l. 9 l, 150 197l, 5,334 931, 6,268 1975 3,90h 838 l,742 1976 8,020 1,698 9,718 1977 9,809 1,655 il , hól, (See Appendix A for raw data used) As can be seen by the data, except for a decline during 1975, the pre- valence of alcohol ism in Detroit has been increasing steadily according to the Jel linek formula. Additionally, male alcohol ism has accellerated at a greater rate. The prevalence rate for males has nearly tripled since 1973 while the female rate has doubled. A second methodology that might be used to assess alcohol ism prevalence is the Nicholls et al formula (35). A = 9. B Where A = the number of alcohol ics alive in a given area during a given year 11|| º te \ B = the percentages of deaths in the Nicholls study (M=l. 2%, F-2.3%) C = the number of reported deaths from liver cirrhos is in a given year Again, using the Nicholls formula on Detroit data (See Appendix A): Males Females Total Alcohol ics 1973 8,917 3, l;78 12,395 197l; lli, l, 17 3,826 18,213 1975 10,750 3, H35 ll. , 185 1976 21,667 6,957 28,624 1977 26,500 6,957 33, l;57 Here, prevalence predictions are nearly 300% greater than those calcula- ted by means of the Jel linek formula. Of course, the pattern of the pre- valence trends is virtually the same for both Nicholls and Jel linek. This similar ity is merely an artifact of using the same data base, i.e. cirrhos is of the liver deaths in Detroit. Consequently, for trend studies, analysis of the number of deaths by cirrhos is of the liver should be sufficient. Jelli- nek and Nicholls simply offer conservative or liberal estimates of alcohol ism based on the same indicator. An alternate estimate using different indicators is the Marden procedure for estimating the potential clientele of alcohol ism service programs (16). Essentially, by intensively studying various sub-groups of a given population (e.g. age groups, occupational status groups, etc.), Marden established the proportion of each of the sub-populations having a high probability of alco- holism. Having done this, the total census of each group within any community may be obtained. Then, each total census figure is multiplied by the found problem probability and a problem drinking probability estimate for that group is obtained. - Since the Marden probability matrix consists of 69 cells (See Appendix B), for purposes here they are collapsed into two cells: male and female. Thus, the Marden estimate for Detroit during 1976 are as follows: Census (30) Probability of Alcohol ism (16) Total Potential Male 629,390 x , 191, := 122, 102 Female 68l,816 x ,031, 3- 23,281, Total s: ll, 5,386 The estimate of "problems with alcohol" described here is more liberal than the estimates produced by the preceding formulae. However, the defini- tion of problem drinking used by Marden is somewhat broader than those used by Jell inek and Nicholls. In the first case the problem is defined by a specific medical cond it ion while here it is defined by a need for treatment, medical or psycho-social . Consequently, the estimate here is predicted to be a great deal larger. 115 One final measure to be utilized is the Ledermann Consumption Model (6). This particular model uses neither an actual physio-medical indicator nor a set of proportions based on sample populations. Rather, its design provides a convenient mathematical method of establishing how alcohol use is distribu- ted with in any given drinking population. Since it is assumed that most al co- hol drinkers consume small amounts while few drinkers consume great quant it ir es, a lognormal distribution is hypothesized. This assumption appears reas- onable at first glance as many other aspects of human behavior are log- normally distributed (e.g. personal income is closely approximated by a log- normal distribution). Thus, if the per capita annual consumption of alcohol is known along with a census of the total drinking population, the numbers of people drinking specific amounts of alcohol may be calculated. Additionally, if a definition of problem drinking levels is established, a prevalence esti- mate is obtained. In computing the Ledermann estimates for the Detroit area, several other computations must preceed generation of the lognormal distribution. Conse- quently, for this particular index, the reader will be presented with the entire sequence of calculations and its rationale. 116 During 1976 there were k,362,680 cases of distilled spirits sold in Detroit (31). Since the precise volume of beverages was not known, a range had to be established. On the low end were two gallons per case and at the upper limit were four gallons per case, Therefore, the possible range of gallons consumed was 8,725,360 -------------------- 17, H50,720 gallons. To use he Ledermann formula several conversions had to be made. 1. Gallons had to be converted to liters. Therefore, with l gallon = 3. 785 liters, conversion produced a range of 33,025, l;87.6 ------------------ 66,050. 975.2 liters 2. Detroit estimated census for 1976 was 1,314,206 (30) thus the per capita consumption range for the city was 25. 13 ----------------- 50.26 liters 3. Distilled spirits had to be converted to absolute alcohol consumed. Conversion of dist illed spirits to absolute alcohol was based on l: , 376 (36). Thus, per capita annual consumption of absolute alcohol in Detroit was 9. l; 5 ------------------ 18.90 liters H. The drinking population of Detroit during 1976 had to be found. a. Legal drinking age during 1976 in Detro i t = 18+ b. 1970 decennial actual census for Detroit revealed that ages 18+ consisted of .6733 of the total population (30). (Estimates for interim years do not exhibit age categories.) c. .6733 of Detroit 1976 estimated populations yielded an estimated 884,792 persons of legal drinking age. d. Approximately one third of all legal drinking aged Americans have not had any alcohol during past twelve months. This proportion has been found to be stable over time (1). Thus 67% of all legal drinking aged Detroiter's yield 592,810 Detroiters who drank alcohol during 1976. In summary, during 1976 the true per capita consumption of absolute alco- hol in Detroit fell between 9. h5 liters and 18.90 liters. There were an esti- mated 592,810 Detroiters that actually contributed to the per capita consump- tion. Using the Ledermann Consumption Model, levels of daily use among these drinking Detroiters may be estimated (see Table 1.). Day TABLE | . mC) re Ounce Equi- valent of Absolute Alcohol 10. l l;4 Beer Equi- valent in OU In Ce S (5. H% Beer ) | 87.78 or 12 ounce 15. 65 Ca n' S Distilled Spirits Equival ent in Ounces (80 Proof) Percent of Drinkers Using This Amount or More Per Day (Range) Number of Dr inkers Using This Amount or More Per Day (Range) Amount of Absolute Alcohol Used Per | O Cl or 1 5 Cl or 20 C l or 30 Cl or mC) re more more 3. 38+ 5.07+ 6.76+ 62. 59 or 12 ounce 93.89 or l 2 ounce 125. 19 or l 2 ounce 5, 22 Caſh S 7.82 C& IT. S l O. l;3 C & In S 8. l;5 l 2.68 16.90 (approx. a pint) 25.35 (approx. a fifth) 1% – l;% insig-2% 17,784–35, 569 11,856-29,641 5,928–23,712 insig-l l,856 The number of drinking Detroiters that consume a minimum specified amount of alcohol per day as estimated by the Ledermann Consumption model. provided for reader convenience. E Metric and American equivalents are 118 As may be seen by Table l, the Ledermann Model allows for estimation of problem drinking prevalence at several levels. The least conservative defi- nition of problem drinking (i.e., 3.38 ounces or more of absolute alcohol) Yields an involved population size of somewhere between 17,784 and 35,569 (i.e. the range produced by the consumption range-see above). By increasing the daily absolute alcohol minimum to 5.07 ounces, the population at risk is reduced to a range of 11,856-29,641. The larger amounts of daily alcohol use (i.e. 6.76+ and 10, 14+) indicated by Table l are so clearly within the problem area that no debate of problem status is likely. e. SUMMARY OF DSAS PREL |M|NARY ANALYSES Table 2 provides a summary of the four alcohol prevalence probes offered above. Method Def in it ion 1976 Prevalence Comments Jel linek The number of 9,718 Alcohol ism based live alcohol ics solely on cirrhos is deaths. Nicholls The number of 28,621, Alcohol ism based live alcohol ics solely on cirrhos is deaths. Marden The number of ll, 5,386 Potential based on people with high probabilities esta- potential of blished by sample alcohol ism groups. Ledermann The number of Number determined heavy drinkers: by total annual per 3.38+ ounces 17,784 – 35,569 capita consumption. per day or Range is based on 5.07+ ounces 11,856 – 29,6hl range of alcohol in per day case of 2 to H gallons. Table 2. Summary of various prevalence estimates of drinking behavior in Wayne County during 1976. Table 2 presents the problem of measuring alcohol ism quite succinctly. When definitions are ignored (as is so often the case in lay alcohol ism discussions), compelling and authoritative statements may yield demonstrated prevalence for Detroit-Wayne County anywhere between 9,718 and 145,386 (for 1976). Thus, it becomes crucial in any legitimate debate that an accepted definition of the problem be first achieved. Within the parameters of an accepted definition, useful traditional measurement approaches may be attemp- ted or novel ones developed for a specific community. In conclusion, the present paper offers several here in unsupported state- ments about levels of alcohol ism nationwide and in Wayne County, Additional- ly, four empirical methodologies with described limitations are presented with their results. Because of these limitations, use of the figures should be restricted to those treatment planning issues that are identical to the defi- nitions provided by the methodology. Other planning issues will ultimately have to utilize methodologies developed specifically for them. For example, recidivism among alcoholics is not measured by any of the preceding methods. Capture-recapture techniques though could prove useful here. Consequently, future research and planning will have to be more precise than they have been until now. 119 120 REFERENCES 'second Special Report to the U.S. Congress on Alcohol and Health. July, 1971, *Cahalan, D., C is in I. H., and Crossley, H. M. American Drinking Practices. New Brunswick, N. J. : Rutgers Center of Alcohol Studies, 1969 *Mulford, H. A. and Miller, D. E. Drinking In Iowa. IV Preoccupation with Alcohol and Definitions of Alcohol, Heavy Drinking and Trouble Due to Drinking. Quart. J. Stud. Alc. 21: 279-291; 1960 "Cahalan, D., C is in, I. H., and Crossley, H. M. American Drinking Practices; A National Study of Drinking Behavior and Attitudes. Rutgers Center of Alcohol Studies, Monogr. No. 6. New Brunswick, N.J. 1969 *Celentano, D. D. and McQueen, D. W. Comparison of Alcohol ism Prevalence Rates Obtained by Survey and Indirect Estimators. J. of Stud. on Alc. W. 39, No. 3, 1978 ‘Ledermann, S. Al cool, Al cool isme, Alcool isation. V. l. Danees. Scient if idues de Caractere Physiologique, Economidue et Social . Presses Universita ires de France. Paris, 1956 "Jellinek, E. M. Estimating the Prevalence of Alcohol ism: Modified Values in the Jell inek Formula and an Alternative Approach. Quart. J. Stud. Alc. 20:261-269, 1959 -I *National Council on Alcohol ism - Greater Detroit Area. Presentation to Open Hearing on Wayne County Department of Substance Abuse Services Comprehensive Treatment Plan. June, 1978 *State of Michigan, Uniform Crime Reports. Department of Michigan State Police. 1973-1977 "Gardin, T. H. Wayne County Department of Substance Abuse Services, Data Report for the Juvenile Problems Task Force. Unpublished paper. Ref: WCDSAS 07- 77. 1977 ''U.S. Department of Health, Education, and Welfare. Public Health Service. Health Resources Administration. National Center for Health Statistics. Rock- ville, Maryland. Personal Communication, 1978 '*National Institute on Alcohol Abuse and Alcohol ism. Rockville, Maryland. 1978 '*Mortality From Alcohol ism. Statistical Bullet in, December, 1977. Metropol i- tan Life Insurance Company of America. Worchester, Mass. 1977 "Drug and Alcohol Abuse indicators Report for Detroit and Wayne County, 1975- 1976. Program Development Unit. Bureau of Substance. Detroit Health Department. In Collaboration with the Wayne County Department of Substance Abuse Services. 1977 **Extent and Patterns of Use and Abuse of Alcohol. Alcohol and Health. Chapter 2. Secretary of Health, Education, and Welfare, TT97] *Harden, P. G. A Procedure for Estimating the Potential Clientele of Alcohol- ism Service Programs. Paper Prepared for Division of Special Treatment and Rehabilitation Programs, National Institute on Alcohol Abuse and Alcohol ism, NCA 0.19.194. Rockville, Maryland. 1978 '7Ryan, V. and Kovach, J. Treatment Services for Alcohol Abusing Women. Technical Proposal for RFP #N IA 78-005l-WOMAN, to National Institute on Alcohol Abuse and Alcohol ism. Rockville, Maryland. June, 1978. *Jones, R. K. Alcohol and Highway Crashes: A Projection for the 1980's. HSRl Research Review. 7 (5) University of Michigan Highway Safety Research Institute. Ann Arbor, Michigan. 1977 '?cowell, M. J. Vice-President and Chief Actuary, State Mutual Life Insurance Company of America. Personal Communication, 1978 *Homillar, J. D. Women and Alcohol : A Guide for State and Local Decision Makers. Council of State Authorities, Alcohol and TDrug Problems Association of North America, Washington, D.C. 1977 *Ryan, V. Investigator for Women's Drug Research. Personal Communication. 1978 *Clarren, S.K. and Smith, D.W. The Fetal Alcohol syndrome. N.E. J. of Med. W.298, No. 19, 1978 121 **Shaywitz, B. A. Fetal Alcohol Syndrome: An Ancient Problem Rediscovered. Drug Therapy (Hosp.) January, 1978 *Alcohol Use in Pregnancy Poses Fetal Risk. ADAMHA News W. 3, No. 11, June, 1977 **Ellenberg, M. R. Physician, Rehabilitation Medicine (Physiatry) Personal Communication. 1978 *Hanson, J. W., Streissguth, A. P. and Smith, D.W. The effects of Moderate Alcohol Consumption During Pregnancy on Fetal Growth and Morphogenesis. J. Pediat. 92: l; 57-l;60. 1978 */Health Services Plan of Southeast Michigan. Health Planning Council. 1977 **Ross, T. M. Alcohol and Drug Abuse: An Indicator System for Detroit, 1974. Unpublished Paper of Program Development Unit. Bureau of Substance Abuse, Detroit Health Department. 1976 *%arker, J. W. Community Alcohol Services Program. Renewal Grant Application. Bureau of Substance Abuse, Detroit Health Department, 1978 39U.s. Department of Commerce, Bureau of the Census, Data Users-Service Office. Detroit, 1978 *"Michigan Liquor Control Commission. Division of Statistics. Personal Communication. June, 1978 32 Gross Dollar Volume Sales Tables. Michigan Liquor Control Commission. Division of Statistics. Lansing, Michigan, 1975-1977 *Kovach, J. A. Deputy Director, Wayne County Department of Substance Abuse Services. Detroit. Personal Communication 1978 *seligman, S. Detroit Health Department, Statistical Division. Personal Communication. 1978 *Nicholls, P., Edwards, G., and Kyle E. Alcohol ics Admitted to Four Hospi- tals in England. Quart. J. Stud. Alc. 35: 841-855. 1974 *Miller, G. H., and Agnew, N. The Ledermann Model of Alcohol Consumption. Quart. J. Stud. Alc. 35: 877-898, 1971, 122 APPEND IX A ALL CIRRHOSIS OF THE LIVER DEATHS IN DETROIT (28, 29, 34). Year Males Females Total 1973 107 80 187 1971; 173 88 26 l 1975 129 79 208 1976 260 160 l;20 1977 3.18 156 l;7 l; 123 # | : i h ; : i ſ ; i . i i f i | i | š. gº º § § ; § § # | f R §. º § } § § º º º - gº § i º: . ; ; § ;; º; º § º i ; 3 i º . º . ; 3| § ; - : t - —º tº: º: i ºº ;§ i : ; *: | § : : º : §§ : ; § : l § 3. # w § & à -- sº §§§ §§§ º : : § º º . : : § f ; : APPENDIX 3 CURRENT TRENDS OF DRUG ABUSE IN LOS ANGELES COUNTY, CALIFORNIA Balkar S. Husson, Ph.D. Irma H. Strantz, Dr. P.H. Donald M. Long Drug Abuse Program Office Los Angeles County Department of Health Services LAC/USC Medical Center 1937 Hospital Place Los Angeles, California 90033 The drug abuse problem can be measured by a number of indicators. Some of these are direct measures, such as simple enumeration, indicator-dilution, and extrapolations from surveys, etc." Others are indirect measures which include crime data, overdose deaths, emergency room admissions, serum hepa- titis and admissions to treatment programs.l." None of the direct measures have so far been used in Los Angeles County for a variety of reasons. However, we use the following indirect indicators in developing estimates of the drug abuse problem in the county: juvenile arrests adult arrests juvenile probation-marijuana juvenile probation-narcotics 125 juvenile probation-dangerous drugs juvenile probation-miscellaneous adult probation-marijuana adult probation-narcotics adult probation-dangerous drugs 10. adult probation-miscellaneous ll. adult diversion l2. heroin deaths l3. barbiturate deaths 14. other drug deaths © All these indicators have limitations that require considerable analysis to overcome, but they are the best of what is available. Arrest data, for example, would be far more useful in the development of community drug abuse treatment needs if it were available by place of residence rather than place of arrest. This is particularly true in Los Angeles County which is spread over four thousand square miles with a diverse population of over seven million people. For the Health Services Administration, the County is divided into five Health Services Regions. Although this difference may not have any effect on state-wide or national statistics, it distorts the regional pictures in this county because addicts may congregate in specific areas quite far from their residences. Reliance on these figures alone could lead to improper placing of treatment facilities. 126 The principal drug of abuse in Los Angeles County in 1977 was heroin, accounting for 62% of all admissions to county-contracted or county-operated drug abuse treatment clinics. This will be discussed in greater detail after the over-all survey. Phencyclidine (PCP or Angel Dust) is the drug which is much in the public eye now.2 Reports from treatment agencies from January to June, 1978 show in- creasing numbers of patients reporting use of PCP from 6% to 22% of admissions. Usage prior to this year is not directly available as it was too low to be categorized separately. A special report on PCP usage has been designed and is currently collected from the agencies each month. Monthly distribution of agencies reporting PCP is shown in Table l. Table l PCP Admissions January to June, 1978 Jan Feb Mar Apr May June Total Total Admissions 537 l:32 loš3 5||8 636 Hll 3817 PCP 77 l;9 73 128 lO5 90 522 Percent of Total llì.5 ll.3 5.8 23. H 17.0 21.9 13.7 There has been no substantial change in the total number of admissions from 1976 to 1977, approximately eleven thousand each year. There has been a significant shift during 1975–1977, from marijuana to heroin as the present- ing principal drug of abuse. The distribution reflecting this change is pre- sented in Table 2. Table 2 Admissions By Drug Of Abuse lg75–1977 Heroin Marijuana Barbiturates Amphetamines Unknown” Total N % N % N % N % N % 1975 5275 l;6.5 3118 27.5 l{66 H. 1976 5l.O2 l;9.l 233O 21.2 632 5. 1977 6865 62.2 1836 le.6 7||7 6 2|+2 2.l 22/17 19.8 ll, 3148 227 2.l. 2420 22.0 ll, Oll 297 2.7 l.2914 ll.7 ll, O39 ; * Includes Other and Unknown Distribution of sex by ethnicity for total admissions in 1977 shows signi- ficant variation among ethnic groups. As shown in Table 3, Whites have 6'4% male, 36% female while Hispanics have 79% male, 21% female. The over-all ratio is 70 to 30. Table 3 Admissions By Sex And Ethnicity White Black Hispanic Other & Unknown Total N % N % N % N % Male 29||6 63.6 l851, 70.3 287| 79.2 lol; 76.5 7718 70.2 Female 1689 36. H 783 29.7 756, 20.8 32 23.5 326l 29.8 Total l,635 loC).O 2637 loC).O 363O loC).O 136 loC).O ll,039 loC).O Another interesting observation is that Heroin users spend less time in treatment, H5% staying less than a week contrasting with marijuana users where 78% are still in treatment after six weeks. This paradoxical situation where the lesser drug is receiving the greater treatment may be due to the diversion programs with court referral. Marijuana users assigned to diversion programs by the court tend to come in for psychological counseling for long periods of time. Fifty percent of these are eventually discharged as having completed treatment—no drug use. In contrast, only 18% of heroin addicts complete the treatment. Many heroin addicts come for detoxification for short periods only to reduce their habits to affordable levels. This agrees with the findings of an outcome study in Los Angeles County where 64% of the clients surveyed indi- cated thaty they sought treatment to reduce their drug use.9 Data on indicators such as number of emergency room cases, number of over- dose deaths, incidence of hepatitis B, etc., are provided in table H and figures l, 2, and 3. Except for hepatitis, these indicators show a downward trend. For example, deaths in 197l-76 were from H00 to 500 each year, but in 1977 dropped to ljo and the first half of 1978 reported only 77. Likewise, emergency room admissions went down from 2000 in 1975 to only 263 in the first half of 1978. However, there was not a corresponding drop in patient admis- sions. Either heroin usage has gone down or the user has become more careful and adept in the use of heroin. Also, reduced quality and quantity of heroin, coupled with the availability of cheaper drugs, such as PCP, may have attracted heroin addicts to other drugs. Data on hepatitis B is also presented in table H. 127 § UNIFORM DRUG USE INDICATORS REPORT Los Angeles County Community Heroin Use Substance November 27, 1978 Table l; Date I. TABULAR PRESENTATION INDICATOR TIME PERIOD (semi-annual data) Total --> rc --> rC; º, o | 3 o tº S I H S | # co ºft & F. * { & Fº r- [N- CV, CN- r— CN- OU [N- r— DS- -: *****-----1227-l--12, L-2261-22, L-2221-1971-86-l-Z8-l-ZZ-l-1286.- -º---ló72-LllZollllzl_32, L-82, L-685 L222-läg-lzé3-l-6305-- —ºnent. Admission ----___ 3778] 238|| 2:8712788.1.2367,12832.É192-EZ36-3239-188996-- Year of lst Heroin Use 1970 | 398 28O *OO 36l liá–1–1455 1971 373 27l. 238 296 Qlt L275 1972 382 338 2146 3||7 I Ol I lil H. 1973 332 3O3 33L *522 93. T 381 1971; 1O3 293 35]. _2O3, 105–1–145– lo/5 tº ºº & º Ill? 38], 335 LT 5 Olilt l976 Gº ºr tº tº ſº -º L32 273 LOO 5OE lo'77 tº ſº mº {-º ſº º * * * _85 OC) 1814 1978 tº gº tºº --- tº tº gº - - - l2 l2 Retail Price of Heroin ense º sm amº m º ºsm ºn tº sm amº m > * * * * * *º sºme sº wºme sm tº - - - - - - * = - - - - - Total.]__ - * * * * * * * * * * * * * * * * * * = as as a - - - - - - ------ ------------|----------- -------------------------------- Hepatitis Type B l;28 | |O5| 325 | 372 º 327–342 | 332-l-525-l--5122 """T"*************** - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ** = * * * * * *m. 275 250 225 2OO = 175 - 125 - 1OC . 150 ! ; : º º . 2OOO 15OO . 1 OOO . 500 j.{ Figure 1 : ſl years Emergency Room Cases Figure 2 : Heroin-Related Deaths | UT —i. ſ I years 129 * U, Figure 5 : Treatment Admissions * 7 5 130 Admissions to treatment is not only a function of prevalence of heroin abuse in the population. The number of admissions depends, among other fac- tors, on the availability of slots. 2 Therefore, the admissions to treatment programs and the incidence of serum hepatitis may not be correlated. The other indicators, such as heroin related deaths and emergency room admissions, however, have no such limitation. The correlations between these indicators over a period from 1974 to 1978 in six month intervals were computed. The table 5 presents these correlations. Table 5 Correlation Coefficients Deaths Emergency Room Admissions Emergency Room .88Ol Patient Admissions - .36O7 - . 1961 Hepatitis — .7l Ol - .77O3 .1732 It can be noted that there is a high positive correlation between emer- gency room admissions and overdose deaths. The correlation coefficients be- tween hepatitis B and deaths and between hepatitis B and emergency room admis- sions is negative. There are many confounding factors in the incidence of hepatitis B that make it less reliable as an indicator of heroin abuse. Its transmission is not restricted to the parenteral use of heroin. Also, the diagnostic and reporting procedures affect the reported incidence. The incu- bation period which lasts from 45–160 days is sufficiently long to affect correlation between this variable and the indicators such as emergency room admissions and overdose deaths which occur at the time of abuse and are more completely reported. The fact that the proportion of reported incidence to actual incidence of hepatitis is not known raises additional questions about the validity of hepatitis B as an indicator of heroin abuse prevalence. Our findings indicate that this is the weakest of the indicators to estimate heroin abuse prevalence. REFERENCES DuPont, R.L. and M.H. Greene (1975) "The Dynamics of a Heroin Addiction Epidemic" Science, August 24, 1975 pp 717–719 Fairchild, H.H., (1978) "Epidemiology, Treatment, and Prevention of Phencyclidine (PCP) Abuse: A Pilot Investigation In Los Angeles County" pp 1-6 Gardin, T. Hershel and Edward Leibson "Heroin Abuse Indicators: A Test of Recent Assumptions" Wayne County Department of Substance Abuse pp 5, 9,13,15 Green, Mark H. (1974) "Estimating the Prevalence of Heroin Use in a Community" Special Action Office Monograph Series A, number 4 pp 5–13 Robison, James O. John E. Berecochea, and Margo N. Robison (1978) "Drug Abuse Treatment Outcome Study" Los Angeles County pp 157–158 State of New Jersey (1977) "Prevalence of Heroin Use in New Jersey p 3 131 132 SUMMARY CURRENT TRENDS IN DRUG ABUSE The purpose of this paper is to examine the drug abuse problem in Los Angeles County with special focus on heroin. The prevalence of drug abuse is estimated by using ll: indirect indicators which have been listed in the paper. Obviously, all of them have limitations but they are the best of what is available. In addition to these indicators, data on emergency room cases, treatment admissions, and incidence of hepatitis B for the period of 1974 to l978 have also been examined. The number of admissions to treatment programs has remained almost con- stant over the last three years although there has been a substantial increase in admissions for patients presenting heroin as a primary drug of abuse. This may be due to availability of more slots for heroin users as a result of libe- ralization of marijuana laws. Another interesting observation is that heroin users spend less time in treatment than the marijuana users. Heroin related emergency room cases and overdose deaths have shown a noticeably consistent downward trend. However, no such trend is noted in incidence of hepatitis B. Correlation coefficients among these indicators show a significant positive correlation between emergency room cases and patient admissions and hepatitis B are virtually non-existent. Our data suggest that the correlation between hepatitis B and other indicators is negative. This may be due to a variety of factors which include mode of transmission of hepatitis, diagnostic and reporting procedures and its unknown incidence among non-drug users. The authors consider hepatitis B as the weakest indicator for heroin abuse. HEROIN TRENDS IN MIAMI- DADE COUNTY, FLORIDA James E. Rivers, M. A. Duane C. McBride, Ph.D. Center for Social Research on Drug Abuse University of Miami In June of 1978, an extensive report was presented to the Community Correspondents Group detailing heroin trends in Miami-Dade County up to that point. The text of that report (Community Correspondents Group Proceedings, pp. 129-147) contained a description of the Center for Social Research on Drug Abuse, its data banks and data collection procedures. The reader is referred to this earlier report for this information as well as a description of the Miami setting. The current report will simply update the June report . HEROIN RELATED DEATHS The Uniform Drug Use Indicators Report (UDUIR) for Miami-Dade County presents semi-annual counts of heroin related deaths from 1971 in both tab- ular and bar graph form. These data plus information back to 1957 are also presented in annual increments in the form of a line graph in Figure 1. The data were extracted by Center staff from the county medical examiner's records. By Florida statute, all suspicious or unnatural deaths, including those suspec- ted of being drug related, must be investigated by the medical examiner. 133 As shown in Figure 1: a. heroin related deaths were rare from 1957 to 1967, averaging one case every two years. b. a dramatic increase occurred in 1968 when 15 heroin related deaths were recorded. c. increases continued in 1969 and 1970 when 24 and 25 such cases were determined, respectively. d. the peak of this upward trend occurred in 1971 when 30 heroin related cases were recorded by the ME; this was the highest annual total for the 22-year period examined. . e. this peak was followed by a two-year decline; there were 21 and eight heroin related deaths found in 1972 and 1973, respectively. f. the down trend was reversed in 1974 and 1975; heroin related deaths rose to 14 and 20 in these two years, respectively. g. the trend was downward again in 1976 and 1977; eighteen cases were recorded in 1976 and only 6 in 1977, the fewest such cases in eleven years. 13|| Figure l. Number of Heroin Related Deaths, 1957 through September, 1978 - Miami, Florida 30 25 20 15 10 57-67 63 69 70 ºn 72 73 7, 75 76 77 78 Although the data are not complete for 1978, it is possible to determine that the familiar two-year cycle in heroin related deaths observed throughout the decade seems to be continuing. During the first nine months of this year, 14 such deaths have been recorded by the medical examiner. is translates to a rate of 1%; heroin related deaths per month. Based upon this rate, it is projected that a total of 19 heroin related deaths will occur in Miami-Dade County in 1978. If the two year cycle holds, it may be that 1979 will yield the highest number of heroin related deaths since the peak year of 1971. TREATMENT PROGRAM HEROIN ADMISSIONS The Dade County Comprehensive Drug Program (CDP) is an umbrella entity which includes all drug treatment service units within the SMSA/county. It currently consists of over 2400 treatment slots with approximately one-third being methadone maintenance and detoxification. Since mid-1974, uniform admi- ission and discharge reports have been collected, processed, and computerized by CDP. The resulting databank currently contains over 18,000 admission records. Through long and continuing association between the Center and CDP (especially its Reporting and Treatment Evaluation/Research unit), these data are available for analysis. The tabulated and graphed data presented in the UDUIR represents semi- annual counts of admitted clients whose primary drug problem was reported via CODAP as being heroin. It should be kept in mind that the uniform and computerized system was initiated in mid-1974; this probably accounts in part for the smaller number of heroin admissions for that year. The UDUIR data on treatment admissions with a primary problem of heroin can be summarized as follows: a, heroin treatment admissions increased through late 1974 and early 1975; the first six months of 1975 was the heaviest period in the past five years. b. clients admitted for a primary drug problem of heroin declined in 1ate 1975, but increased again in early 1976 and again in late 1976. c. each suceeding semi-annual period since 1976 has seen decreases in the number of heroin treatment admissions. d. the last six months of 1978 will yield the lowest number of heroin admissions since early 1974 if the current rate prevails. º: - {{\O fºr "º ld be noted that treatment admissions are a function of the avail- ability of treatment services, among other factors. The total number of treat- ment slots in CDP has incrementally increased during the past five years and there have been changes in emphasis, program locations, central intake unit relocations (three times), as well as changes in the mix of modality/environ- ments. For example, one of four methadone clinics was deactivated in 1976 because of 1ease expiration and has not been reopened due to inability to obtain a suitable new site. It is known that several clients left treatment rather than accept transfer to another clinic. It is not known how many of these organ- izational changes affected treatment admissions of heroin users, however TREATMENT ADMISSIONS - YEAR OF FIRST USE 135 It was assumed that the object of the 'year of first use" portion of the UDUIR was intended to provide information on the incidence of heroin use. If this assumption is correct, it is not desirable to include those clients who have been admitted to treatment more than once; this would tend to skew the year of first use toward earlier dates. Therefore, data presented in this portion of the UDUIR for Miami-Dade County contains only those clients who were reported to have no prior drug treatment. We have also observed that use of the CODAP category 'primary drug(s) prob- lem' presents some methodological problems. The primary problem drug can be used with any frequency or may not even be used at all during the month prior to admission. Also, we have conducted analysis which demonstrates inconsistencies in drug problem categorization; frequent use of hard drugs sometimes is categor- ized as secondary or tertiary to less frequent use of softer drugs. We scanned all four drug problem categories as reported to CODAP and selected all cases which contained heroin used with a frequency of once per week or more often. Approximately ten percent were not classified as the primary drug problem. The heroin users who were using at least once per week at admiss- ion and who had not had prior drug treatment were broken down into groups according to their year of first use. These data are presented in the UDUIR. Since the proportion of clients who began heroin use prior to 1970 ranged from 20–30 percent in the admission years 1975-78 and because the tabular data 156 are difficult to analyze, we have percentaged the year of first use by year of admission and presented these data in Table 1 below. Table I Year of First Heroin Use for CDP Admissions Who Had No Prior Treatment Experience Year of First Use Year of Admission 1975 1976 1977 1978 Before 1960 2.2 2.6 1.9 gºº - º 1960–1964 2.7 2.3 3.4 2.1 1965–1969 25.3 20.1 19.7 17.6 1970 12.5 9.6 8.3 11.3 1971 12.9 9.0 6.6 2.8 1972 12.2 9.2 10.2 7.7 1973 12.3 10.8 8.3 10.6 1974 13.7 13.3 12.1 10.6 1975 4.8 17.0 12.9 15.5 1976 Gº tº mº 5.3 12.4 13.4 1977 tº º ſº ſº tºº tº ºr wº 3.6 7.7 1978 tº ºº & tº - tº dº - Cº- tº º 0.7 The data in Table I show what one might expect; that is, each suceeding admission year had fewer clients who initiated heroin use in the decade of the 1960s or earlier. Keep in mind that these are only those clients who had no previous treatment. As indicated in our June report, there is an increasing proportion of treatment clients who are older and readmissions. Table I also shows that recent admissions who had no previous treatment were less likely to enter treatment in the same year or year following initiat- ion of heroin use. In the peak admission years of 1975-76, over 20 percent of the new admissions were entering treatment within two years of beginning use; in 1977, the proportion fell to 16 percent and in 1978, it has fallen to 8.4 percent. It would appear from the data in Table I that a large cohort of new heroin users appeared in 1975; this was the modal year of first use for heroin treatment admissions in 1976, 1977, and 1978. In 1975 and 1976, the modal year of first use was the preceeding year, but in 1977 and 1978, the modal year of first use was two and three years earlier, respectively. These data are consistent with the information presented in the June report to CCG. In that report, we indicated that a decreasing proportion of heroin admissions to treatment were under 21 years of age, regardless of whether they had prior treatment. New users continue to decline in Dade County. POPULATION TRENDS IN NEW COHORTS OF HEROIN USERS Analysis of the data from Miami has consistently shown that over the last few years, there have been fewer new heroin admissions and that both new admissions and readmissions were aging. Over the past two years, these reports have focused on the aging of the heroin using population in Miami and the policy and service deli– very implications of that phenomena. In this report, we wish to briefly examine the other end of the spectrum. That is the new young cohort of heroin users entering treatment. While our analysis has shown that this group accounts for an increasingly smaller proportion of the total population, it does still exist. Our purpose was to compare the demographic and social character- istics; age, race, sex and social class of admissions to methadone maintenance programs in Dade County from 1974 through the first quarter of 1978. Our analysis showed that over the four year period, the demographic composition of the methadone clients changed very little. Each year individuals admitted to treatment were from the same socio-economic and ethnic backgrounds. There were however, two changes. First, as has been reported, the population aged. Secondly, the population contained an increasing proportion of females. In 1974, about 28 percent of methadone maintenance clients were females. In 1977–1978, that proportion rose to 40 percent. Our next step was to de lineate further what accounted for the increase in the proportion of females. Analysis showed 137 that the increase was not do to an increasing number of females from a particular ethnic or socio-economic group. As is presented in Table II, we found that the increase in the proportion of females in methadone maintenance programs was due to the increasing pro- portion in the younger age groups. Table II CDP Methadone Maintenance Admissions by Sex by Age 18–20 2] – 25 26–30 30 & Over Male Female Male Female Male Female Male Female 1973 N=ll 9 63.6 36.4 73. 6 26.4 61 - 0 39 . 0 75 - 0 25. 0 1974 N- 767 54. 4 45.5 7 l. l. 28.9 72. 1 2.7. 9 76. 9 23. 1 1975 N=9 48 4 l. 3 58. 7 64 - 3 35. 7 7 l. 2 28. 8 70. 6 29.4 1976 N= 690 32. 3 67 . 7 52. 3 4.7. 7 67. 0 33 - 0 73. 9 26.1 1977 N=648 ll. l 88.9 48. l 51.9 68. 0 32.0 69. O 31.0 1978 N=16.5 tº-ºº º ſº tº 100 42. 3 57. T 53.8 36.2 72. O 28.0 The data in Table II show that the youngest age category, l8–20 and 21–25, has changed from primarily male to primarily female. The older age categories, 26-30 and 30 and over have re- mained primarily a male cohort. As the data show, after 1975, there are fewer clients served each year in methadone programs and as other analysis has shown, there are fewer young people. What is implied in Table II is that in the declining population of young people in methadone programs, the decline is primarily due to the rapid decline in the number of young males entering treat- ment. The number of young females entering methadone programs has been stable over the years but the decrease in the number of males has resulted in a primarily female population for treat- ment admissions 25 and under. The data show an almost dicotomus relationship between age and sex. Clients over 25 are mostly male, the reverse of clients 25 and under. The data also suggest that of the new younger cohort of heroin users, females are the most likely to be attracted to treatment. This may suggest the stigma attached to heroin use by females is disappearing. One of the major implications of the analysis is for service delivery. Treatment programs have become aware of the special service needs of women as a minority group in treatment programs. The data presented in Table II suggest that a considerable degree of reorientation toward a predominately female cohort of young admissions may need to take place. 158 HEROIN RELATED EMERGENCY ROOM APPEARANCES The data tabulated and graphed in the UDUIR represents heroin/morphine ment_ons reported via DAWN for fifteen consistently reporting hospital emergency rooms in Dade County. The trend for the three years reported is generally up- ward with 1976 showing 16 percent more mentions than 1975 and 1977 being six percent higher than the preceeding year. Data from the first quarter of 1978 were obtained and doubled to provide an estimate for the first six months. The trend also seems to be that the second half of the year yields more heroin/ morphine mentions in the Dade County ERs than the first six months of the year. The DAWN data is limited in that mentions rather than cases are reported. It is not evident how prominent heroin was in the appearance nor how many indiv- iduals were involved. The Center for Social Research on Drug Abuse has been collecting data on drug related ER appearances at Jackson Memorial Hospital since 1972 (see the June CCG report for details). Each case is recorded separ- ately and up to four drugs are listed in order of their contribution to the ER appearance. Data from the Jackson ER are presented in Figure II below. The lower trend line represents the number of cases where heroin was the primary presenting problem; the upper line includes all cases where heroin was one of up to four drugs listed. These data are consistent with treatment admissions and heroin related deaths in that 1975 and 1976 were peak years. The past two years have yielded a level of heroin related ER appearances comparable to 1972 and 1973. 139 Figure II. Number of Heroin Related Emergency Room Appearances at Jackson Memorial Hospital, 1972 - 1978. 450 400 350 300 250 200 effe § e = ** cºe sº 150 P"emºnsºr-sº *::----- '72 '73 '74 '75 '76 '77 '78 11:0 It is unclear at this point why the DAWN and the Jackson data are so dis- crepant in their trend lines. The difference between mentiona and cases probably has some bearing, but there may be other important factors involved. In 1975, Center staff interviewed and collected records data in twelve Dade County hospital ERs. It was found that most drug related emergencies were being fef- erred to Jackson and that about eighty percent of the drug related cases were being treated at this lar-e county hospital. It may be that attitudes and pract- ices have changed in the Smaller emergency rooms and more drug related cases are being treated there now. We are undertaking an investigation of this possibility and the results should clarify the divergent trend lines from these two data Sources. ETHNOGRAPHIC OBSERVATIONS As discussed in our June CCG report, the quality and general availability of heroin was down in Dade County and had been so for several months. This corresponded with the decrease in treatment admissions and hospital emergency room appearances for heroin problems. The discordant indicator at that time was heroin related deaths and the upward trend in this indicator has continued. Recent ethnographic information has clarified the discordance, however. Through reliable street contacts, the Center's street ethnographer, Mr. Brian Reusse, has learned that high quality Mexican brown heroin has increasingly become available in Dade County in 1978. This heroin is being sold mainly by Cuban dealers working out of the cafes along the major thoroughfare in the Latin community. Although the quality is described as 'very good' to 'excellent', the price at the last level before the street dealer is $1,000 per ounce. This is much cheaper than the $1,800 per ounce that was the going price for the poorer quality heroin being sold in 1977 and early 1978. We speculate that the upturn in heroin deaths was influenced by the sudden influx of a much higher purity drug. We have verbal reports that the volume of heroin related emergency room cases has jumped considerably in the past few weeks. It is unknown at this time whether the availability of this reportedly higher quality heroin will continue. If so, we can anticipate an increasing number of treatment admissions for heroin problems in 1979, a continuation of the upward trend in heroin related deaths, and a rise in the appearances of heroin related cases in the hospital emergency rooms. HEROIN USE INDICATORS HENNE DECEMBER, 1978 Charles M. Heinecke Director, Metro Drug Awareness Minneapolis Health Department 250 South Fourth Street Minneapolis, Minnesota 55l/15 - Introduction This is the third update of information gathered relative to heroin use in Hennepin County. Heroin use indicators originally reviewed in a rather ex- tensive survey completed in 1976 have been monitored periodically since that time. This report will briefly summarize more current data relative to the following indicators: Admissions to Treatment Opiate Related Deaths Hospital Emergency Room Admissions Heroin Samples Confiscated Heroin Purity Admissions to Treatment Previous updates have used data from the five treatment centers which treat the majority of heroin users in Hennepin County. Now that CODAP data is avail- able, admissions information will be reported from this data source. Informa- tion obtained prior to 1976 is comparable in that all major treatment centers 1H1 are included. Unfortunately, only annual data is available from 1971–1975. As * seen in Figure l, overall admissions continue to decline from a peak in 1971, - Figure l Hennepin County Opiate Related Treatment Admissions 1971 – 1978 (Annual Totals) 600 -i #ho sc 500 - based On Six-month figure 100 - | 300 -l 200 --→ 100 -} 71 72 73 71, 75 76 77 78 Year dmissions to the Hennepin County Medical Center as recorded by the Poison Control Center continue to be monitored for current trends. This urce observes the vast majority of Overdose related incidents within the Cºlſ ity © - - - Data collected for the period 1977 through mid-1978 shows an increasing percentage of other narcotics and related analgesics, primarily Darvon, Demerol, Codeine and Dilaudid. These substances were involved in 1/3 of the overdose emergencies reported during the first half of 1977, H6% in the second half and 51% in the first half of 1978. - Figure 2 Hennepin County Medical Center Opiate Related Emergency Room Admissions 1970 – 1978 (Six-Month Totals) &ſ) $º- s 3. E *C) <ſ. *}- Ç $– {} .C. H £ - = 0 - - . . . § § § § Ö § § § § § § § § .# § | a b a b a b a b a b a b a b a b a 70 71 72 73 74 75 76 77 7 Year Opiate Related Deaths No significant increases are observed from medical examiner data in the opiate category. After ten months of observation, the total number of deaths in all drug categories reported appears to be down significantly. The following table demonstrates the total number of deaths reported in 1975 through 1977 along with the first 10 months of 1978 to show where changes have occurred. 15 9 9 ! l3 10 2 l; (propoxyphene) Anti-depressants 2 3 13 9 (tricyclics) Alcohol 23 2|| 29 17 Inhalants l 2 l O .: 2 l 2 O Other ll 16 l, l, Totals 7|| 70 6|| #38 - *10 months only Table l Hennepin County Medical Examiner Drug Related Deaths A graph of opiate related deaths reported in six-month intervals going back to 1||3 1970 shows a continuing low levels Figure 3 Hennepin County Medical Examiner Opiate Related Deaths 1970 - 1978 (Six-Month Totals) 1 O º: : 1|||| Heroin Samples Confiscated While this particular indicator can be significantly affected by the level of police activity, it remains helpful in evaluating overall availability of Street heroin. This figure represents the number of individuals from whom heroin Samples were confiscated by local law enforcement officers. It has been used as an indicator of law enforcement activity because it is readily available and more accurate than, total arrests. After very high levels of activity in 1976 and 1977, 1978 figures are considerably lower. Figure l; Hennepin County Sheriff/Minneapolis Police Department Heroin Samples Confiscated 1970 - 1978 (Six-Month Totals) 75 - 60 45 - 30 - 15 i º a b a b 70 71 Heroin Purity C d ! b a 72 73 º b | | | ! | ſ U | l l a b a b a b a b a b 74 75 76 77 78 Year Declining purity seems to have been the trend for some time now. Table 2 shows that trend to be continuing in the Minneapolis area. Year. 1976a 1976b 1977a 1977b 1978a Number of Samples Average Percent l9 6.45% 13 5.70% l!9 1.56% 59 l. 11% 30 3.62% Table 2 Minneapolis Health Department Laboratory Average Heroin Purity Prior to 1977 samples were quantified only On a randomly selected basis account- ing for the smaller numbers charted for 1976. Of possible significance, how- ever, is that while only one sample confiscated during 1977 was higher than 10%, six such samples were taken in the first half of 1978 averaging almost liO3. These were White powder in contrast to all others which were brown. In addi- tion to the number of confications being down, the amount by weight was Only 66 grams for the first half of 1978 compared to 550 grams for the previous twelve months. No purity or price data has been received from the Drug Education Admin- istration Retail Level Heroin Program for 1978. Discussion Little can be added to conclusions reached in the previous Update, June, 1978. Treatment admissions continue to decline, Overdose deaths remain very low and emergency room cases would also be decidedly lower except for an increase in "other narcotics" and related analgesics. Overall, the picture seems to be that heroin, while available on the streets, can only be found in very low purity. Occasionally, small supplies do arrive in town of higher quality white heroin as verified by law enforcement confiscations and probably by the occasional heroin death. Emergency room data points out that some users have sometimes turned to prescription drugs. This fact has been further underlined by the Minnesota State Pharmaceutical Association in two bulletins sent to metropolitan area pharmacies. The subject of these mailings is prescription forgeries and they 115 state that all pharmacies should be alerted to the possibility of "an upswing in pharmacy robberies, prescription pad thefts and a rash of forged prescrip- tions" due to a "severe shortage of heroin" on the street. The source of this concern is based on recent successful law enforcement operations and the views of local narcotic agents. Recent thefts of prescription pads are listed in the bulletin and over twenty descriptions of persons who have successfully obtained various drugs and their usual pattern for obtaining them is detailed. DRUG ABUSE TRENDS IN ESSEX COUNTY, NEW JERSEY John F. French Donald C. Busch Research and Evaluation Unit New Jersey Division of Narcotic and Drug Abuse Control 146 SUMMARY In Essex County, the indicators of heroin use decreased from 1976-1977. Treatment Data: Using a variation of Hunt's model for estimating incidence and comparing the number of admissions to treatment, an initial indication is that there is a general decline in the incidence of heroin use in Essex County. Serum Hepatitis: There has been a decline in the number of reported casesTof Type B (serum) hepatitis from 1975 to 1977. Deaths Due To Narcotics: The total number of deaths due to narcotics decreased between 1976 and 1977. Arrests: The number of heroin arrests declined between 1976 and 1977. TThe number of drug related violations declined during this same period. Additional information concerning heroin use in Essex County: White heroin, of low purity, is the predominant type of heroin at the Street level in Essex County, New Jersey. Various samples taken during the 1978 calendar year show a range in the purity of from 1.2 percent to 2.1 percent. 1||7 The number of people entering treatment in Essex County with a primary problem of heroin has been decreasing while there is an increase in other drugs. Because of poor quality heroin, some addicts are switching to Empirin Compound with codeine and glutethimide (Doriden). The distribution networks for heroin seem to be drying up in the Essex County area with more travel by addicts to the New York City marketplace. DEMOGRAPHIC OVERVIEW OF ESSEX COUNTY Essex County has the highest population of any of the 21 counties in New Jersey with an estimated 872,000 people. This accounts for 11.9 percent of the State population of 7,339,000. The population for Essex County has decreased 6.5 percent since the 1970 census while the population of New Jersey has increased 2.3 percent. The population density per square mile for Essex is 7,266.6 while the New Jersey State average is only 989. 6. 1970 1975 1976 Essex County 932, 526 881, 599 872, 447 New Jersey 7, 171, 112 7, 333,000 7, 339,000 "Table 1. Population" Male Female Essex County 413, 540 458,907 New Jersey 3,522, 720 3, 816, 280 1||8 "Table 2. Sex-Breakdown of Population" The breakdown of the population by sex shows that 47.4 percent are male and 52.6 percent are female. This corresponds to the State average of 48 percent male and 52 percent female. White Nonwhite Essex County 601,988 270, 459 New Jersey 6, 458, 320 880,680 "Table 3. Racial Breakdown of Population" Sixty-nine (69) percent of the population in Essex is White and 31 percent is classified as Nonwhite, in contrast to the State total of 88 percent White and 12 percent Nonwhite. TREATMENT DATA Summary - Treatment Data - Examination of treatment admission data and an analysis of first heroin admission, a variation of Hunt's model for estimating incidence, provides an initial indication that there is a general decline in the incidence of heroin use in Essex County. Admissions to treatment with a primary problem of heroin have been compared for the two year period of 1976-1977. This decline appears to be steady since 1973. This decline is consistent throughout New Jersey, although to varying degrees. 1976 1977 Percent Decline Essex County 4, 858 4,092 15.8 New Jersey 15, 543 13, 607 12.5 "Table 4. Admissions/Primary Heroin" Using a variation of Hunt's model for estimating incidence based on the distribution of lag from time of first use to first treatment admission, for prime heroin only, the following results obtain: Year of First Use 1975 1976 1977 11:9 1972 & Earlier l, 651 1, 726 1, 158 1973 150 179 141 1974 116 153 111 1975 34 108 127 1976 tºº 37 73 1977 G-3 º 8 TOTALS 1,951 2, 203 l, 618 "Table 5. Year of First Use/First Admission" Analysis of this data indicates a general decline in the incidence of heroin use in Essex County. 150 TREATMENT DATA This method estimates the proportion of users who will enter treatment for the first time during each year of the addiction career. For instance, as the table shows, 6.9 percent of all admissions will enter during the first year of use, while only 5.6 percent of Black females will enter during their first year of use. All Admissions Black Males Black Females First Year . 069 .074 .056 Second Year . 177 . 207 . 127 Third Year . 220 . 208 . 235 Fourth Year . 211 . 18.7 . 240 Fifth Year . 194 . 186 . 214 Sixth Year . 130 — = —º Percent of All 100 60. 9 26. 3 Admissions "Table 6. Lag Distribution for Selected Populations" There are differing pressures, external or internal, on various groups to enter treatment. Analysis of the lag distribu- tion show that Black females enter treatment for the first time less frequently during the first two years of use than the average for Essex County. They enter treatment with greater frequency during later phases of their addiction. Our suggestion is that treatment processes might be constructed in such a way that they are more appealing to Whites and to males. Or it could be, if one takes the view of treatment as being the refuge of the incompetent abuser, that the "career" of heroin abuse is one of the few processes in which the White male is at a disadvantage compared to Blacks and females. It may be that there are certain skills involved for survival in the drug using milieu. SERUM HEPATITIS Summary - There has been a decline in the number of reported cases of Type B (serum) hepatitis from 1975 to IV77 of 48.5 percent. The serum hepatitis data used in this report was compiled by the New Jersey State Department of Health, Bureau of Vital Statistics. Traditionally, serum hepatitis has been used as an indirect indicator for estimating the addict population. Recent findings regarding its spread through homosexual activities mitigates its impact here. - The number of reported cases of Type B (serum) hepatitis in Essex County declined from 227 in 1975 to 134 in 1976 and then to 117 in 1977. The trend for the last eight years shows a peak in 1970-1971, followed by sharp decline to 1973, rising again to 1975, and then declining in 1976 and 1977. Analysis of serum hepatitis trends is complicated by a change in the reporting system which occurred in 1974. During this year, an "unspecified" category was added to the categories of Type A and Type B. There is not sufficient data at this point to comment on how this practice has affected reports of Type B hepatitis incidence. The decline in Essex County was greater than that for the entire State. Between 1975 and 1976 the decline in Essex was 151 41 percent as compared to 30.5 percent for the State. Between 1976 and 1977 the decline in Essex was 12.7 percent and the State was 5.8 percent. 1975 1976 1977 Periš); P3%ine Essex County 227 134 117 48.5 New Jersey 1, 235 859 809 52.6 "Table 7. Type B Serum Hepatitis" In 1975, Essex County accounted for 18.4 percent of all the Type B hepatitis cases in New Jersey. This declined to 15.6 percent in 1976 and 14.5 percent in 1977. 1975 1976 1977 Essex County 128 109 80 New Jersey 952 937 84.4 "Table 8. Type A Infectious Hepatitis" Meanwhile, Essex County accounted for 13.5 percent of all Type A cases in New Jersey in 1975, 11.6 percent in 1976 and 9.5 percent in 1977. This similarity of patterns as well as other new information on hepatitis, calls for further investigation of the use of Type B hepatitis as an indicator for heroin use. 152 DEATHS DUE TO NARCOTICS Summary - The total number of deaths due to narcotics rose 10.2 percent between 1975 and 1976, then decreased 46.2 percent between 1976 and 1977. It is virtually impossible to estimate, with any certainty, the number of deaths due to heroin overdose in New Jersey given present reporting practices. In seven years only eight deaths were directly attributed to overdose of heroin, while during the same time, for example, 99 were attributed to methadone. Because of this, overdose deaths in this paper are reported in a single category - "deaths due to overdose of narcotics," which includes those listed as due to heroin, morphine and "unspecified" narcotics. The number of deaths rose 10.2 percent between 1975 and 1976, then decreased 46.2 percent between 1976 and 1977 in Essex County. This compares to a steady decline in the State of New Jersey over the same period of time. During 1975 - 1976 the number of deaths declined 12 percent while during 1976 - 1977 there was a decline of 8.7 percent. Between 1975 and 1977 this decline amounted to 19.6 percent. 1975 1976 1977 Essex County 59 65 35 New Jersey 275 242 221 "Table 9. Deaths" In 1975, Essex County accounted for 21.5 percent of all the cases of "Deaths Due to Narcotics" in New Jersey. This increased to 26.9 percent in 1976, then declined to 15.8 percent in 1977. This might support other data which indicate that heroin purity has declined sharply. ARRESTS Summary - The number of heroin arrests in Essex County declined between 1976 and 1977 and the number of drug related violations declined during this same period. In 1976 there were 671 individuals arrested for a violation of statutes involving heroin. This declined to 434 in 1977, a decrease of 35.3 percent. In both years, Blacks accounted for more than 85 percent of those arrested. Females represented 20 percent of the 1976 violators and about 17 percent of those in 1977, as shown below. 1976 1977 Essex County 671 434 New Jersey 2,040 1, 279 "Table 10. Heroin Arrests" In 1976 Essex County accounted for 32.9 percent of all the heroin arrests in New Jersey. In 1976 Essex County accounted for 8.3 percent of all drug abuse violations in New Jersey, although, as previously reported, 153 Essex County accounts for 32.9 percent of heroin arrests. Between 1976 and 1977 the number of these violations in Essex County decreased 1.1 percent while the number was decreasing 18.1 percent throughout the State. Consequently, in 1977 Essex County represented 10 percent of all drug abuse violations in New Jersey. 1976 1977 Essex County 3, 287 3, 250 New Jersey 39, 523 32, 368 "Table 11. Drug Abuse Violations" ARRESTS In 1976 drug abuse violations were 7.8 percent of all the violations in Essex County, while they represented 11.9 percent of the violations in New Jersey. In 1977 they were 7.9 percent of the violations in Essex and 10 percent in New Jersey. Essex County 1976 1977 Drug Abuse 3, 287 3, 250 All Violations 42,385 41, 374 New Jersey 1976 1977 Drug Abuse 39, 523 32, 368 All Violations 331,899 322, 355 "Table 12. Drug Abuse vs. All Violations" Narcotics Bureau Intervi €WS Two members of the Newark Narcotics Bureau were interviewed in November 1977, in open ended interviews intended to elicit their personal impressions of changing patterns in the "drug scene" since 1970. The comments are, regarding different drugs: Heroin - Purity is declining while price per "bag" has remained stable for the last few years. They have not seen any "half loads" (what was once 15 bags, each containing about 0.1 gm of powder) or "bundles" (what was once 25 bags, each containing about 0.25 gms of powder) for almost three years. What was many years ago, the "deuce," or $2.00 bag, containing about 0.1 gm, now sells for $10, with purity of about 2% or less. Beyond this, the next higher Order of sale is three bags for $25, and then above that the "New York Quarter" containing 1-2 gms, and selling for about $85 in Newark and $65 in New York. These respondents claim that New York Quarters are purchased in New York, "stepped on" twice and resold or bagged into $10 bags for resale in Newark. An ounce of heroin sells for $375 - $1, 200, depending on quality. - Other Drugs - They report tremendous increase in the availability of other drugs, particularly barbiturates ($2/pill) and cocaine ($65/gm), with lesser but increasing availability of methaqualude ($3/pill), and what has become a new "combo," Doriden and Empirim with Codeine #4, the combination selling for $7. Pills have become so prevalent that there is a particular area in Newark, referred to by both police and members of the drug subculture as "pill hill," where one can obtain as wide a variety aS One Cares to . PCP - Not seen with the same frequency as it is in New York, and much of it is sold as THC or found in marijuana. Cocaine - In addition to being widely available at about $65/gm, is also available for $1,200 per ounce. Concern was expressed about the Street sale of valium and ellavil in close proximity to methadone clinics, although no claim was made that clients were involved in these transactions. One respondent commented on what is to this writer a new phenomenon. The claim is that younger users are inhaling the nitrous oxide used as the propellant in "Reddiwip." Users in Treatment Eleven heroin users currently in treatment were interviewed regarding prices and quality of heroin and comments were elicited On other drug availability and prices. Heroin - There is a distinct trend for more involved users l to go to New York to buy heroin. Although heroin is readily 55 available in Newark, the price is higher and the quality lower than in New York. Prices quoted for a "New York Quarter" were from $35 in the early 1970's to a range of $50-$65 per quarter in 1978. All but one respondent reported the price for one ounce as $375 - this one respondent, an older, probably more sophisticated user, reported a price of $275 in New York. It is interesting that Several respondents had no idea of the cost of a Quarter or ounce - they had never bought other than the $10 bags. The consensus was that heroin use is declining, most confined to "old timers." Other Drugs - All respondents reported mixing other drugs with, Tor substituting them for, heroin. Barbiturates (at prices ranging from $.50 to $3 per pill) were mentioned most frequently. Cough medicines containing codeine were mentioned as being used by Several respondents. Cocaine is claimed to be readily available at $55/gm (somewhat below the police estimate). Street methadone is available with price quotes ranging from $10–$25 a bottle. These eleven respondents, all Black, with an average age of 26.5 years, indicated that pill use among youth is increasing dramatically. Once again "pill hill" was mentioned as a reflection of this growing phenomenon. Finally, another changing pattern became evident as a result of these interviews. In the past, barbiturates were not as popular among Black users as among Whites. Apparently this is changing, as indicated by unanimous reports of barbiturates being used in conjunction with or as substitutes for heroin, as well as the tremendous increase of use among inner city youth. 56 CURRENT DRUG USE TRENDS IN NEW YORK CITY, DECEMBER 1978% Paul S. Uppal, Ph.D. Research Scientist New York State Division of Substance Abuse Services This paper describes current trends of drug activity in New York City, as monitored by the Division of Substance Abuse Services. The findings are based on several indirect indicators of drug use and on DEA reports about the current drugs of choice among dealers and street addicts. The citywide presentations of current drug use trends have become an integral part of the Community Correspondents Group meetings. At the last meeting in June 1978, there was a strong consensus that heroin activity is declining and new drugs of choice are emerging, such as PCP, cocaine, and several licit substances. Increased use and misuse of psychotherapeutic drugs among the general population was also reported in several areas. The discussions that ensued from these presentations were immensely helpful in a number of ways. First, it became evident that there are many more similarities than differences in drug use trends 157 throughout the country. The meeting also provided an excellent forum for a methodological discussion of indirect indicators and their interpretation. Several new data sources and means of analysis Were pointed out in these discussions. The findings that follow are an update of the trends described at the last meeting. Trends in Heroin Activity Heroin activity continues to decline, although not nearly as rapidly as during 1977. Table lpresents quarterly data on several New York City heroin indicators for 1975-1978. In addition, the trend in admissions to methadone programs is shown graphically in Figure l for the 1970-1978 period. *For presentation at the fifth meeting of NIDA Community Correspondents Group, Phoenix, December 6–8, 1978. g Table l. New York City Heroin Indicators” 1975 - 1978 Admission to * * Opiate Opiate - Infectious Serum b Drug-Dependen; Prison New Admissions to Re-admissions to Year Quarter Felony Arrests Misdemeanor Arrests” Hepatitisb Hepatitis Mortality Detoxification Methadone Treatment Methadone Treatmen. 1975 lst 1,226 820 22] 6] 151 2,999 1,987 1,311 2nd 1,077 890 235 105 126 2,971 l,659 1,304 3rd 789 668 215 137 120 2,881 l,56] l, 483 4th 959 71.6 253 14] 132 2,915 1,549 l, 606 Total 4,05] 3,094 924 444 529 ll,766 6,756 5,704 1976 lst l, 344 965 255 22] 142 2,692 1,480 1,609 2nd 997 776 262 188 117 2,737 l, 401 l, 492 3rd l, iół 843 220 223 13] 3,244 l, 418 1,550 4th 1,466 947 290 239 92 2,817 1,531 1,700 Total 4,968 3,531 1,027 87] 482 ll,490 5,830 6,351 1977 1st l,846 l,553 15] 174 87 2,662 l,l 23 1,289 2nd 1,528 867 | 64 191 80 2,713 l,022 1,314 3rd l,040 483 T 10 | 43 82 2,548 896 1, 183 4th l,033 503 | 47 1.65 69 2,366 809 l, 180 Total 5,447 3,406 572 673 3.18 10,289 3,850 4,966 1978 112 Not 857 1,072 686 119 * 2,003 486 ; 9|8 477 172 135 Available 1,864 493 855 *Source: New York City Police Department. *Source: New York City Department of Health. *Source: New York City Department of Correction. dSource: Community Treatment Foundation. *NOTE: Difficulties in interpreting indicator data over time are presented by changing data collecting procedures and changing policies of agencies that generate data. For instance, the New York City Department of Health recently instituted a more rigorous scheme for categorizing hepatitis cases, which may be reflected in a reduction of reports from 1975-1976 i evels. Figure 1. New Admissions and Readmissions to Methadone Maintenance and Methadone-to-Abstinence Programs in New York City 1970-1978 - - - - * Ti | | | | | | ſ 1 97 O 1971 1972 1973 1974 1975 1976 1977 1978.* :k - e ę g 1978 values are projections based on nine months. 2O 15 New Admissions IO 5 – T Readmissions _--~~ . _ – ~ T Ye C. r § 160 Opiate felony arrests and serum hepatitis cases during the first two quarters of 1978 declined slightly compared to the previous six months, and remain much below the peak levels of late 1976 and early 1977. A slight increase, however, was found in opiate misdemeanor arrests and infectious hepatitis cases during January–June 1978 as compared to July- December 1977. Admissions to prison detoxification and methadone treatment programs show a sharp decline since 1977. New admissions during the first half of 1978 were only about half the number compared to the last half of 1977. This decline appears to be simply a reflection of the declining number of new narcotic addicts. Persons admitted to methadone programs also tend to be older compared to admission cohorts of the past. The median age of applicants to New York City programs is currently 29.4 years, with 90% reporting having been in treatment previously and/or detoxified. The trend in admissions to drug free treatment programs of clients giving either heroin or illicit methadone as their primary drug of abuse closely parallels the decline in new methadone program admissions. These data are shown in Table 2. It is estimated that the number of heroin addicts in New York City has declined from 172,780 during the first half of 1977 to 166,700 at the present time. Both White and brown heroin continue to be available on the street, While retail purity remains low. DEA reports that during January–August 1978, average purity of street-level brown heroin was at 2.5%, and White heroin averaged a little below 2%. The New York City Police Department also confirms this finding, and further reports that white heroin continues to appear at a two to one ratio over brown heroin. "New York Quarters," ranging in Weight from two grams to four grams (gross), packed in glassine bags, are the most popular form of street heroin being sold. Price remains stable at $55/$65 per bag. A NYC Police Department study based on street level packages revealed that heroin addicts received a decreased average dose during 1977 (20 mg.) compared to 1976 (28 mg.). At the street level, white heroin is readily available in the Harlem area. However, distributors are unable to procure enough on a regular basis to supply addicts with a good quality product. Thus, heroin abusers are turning to other dangerous drugs to achieve an euphoric effect. The result has been a dramatic increase in PCP sales, particularly in Harlem where it may be purchased as early as 7:00 A.M. It is marketed in the same manner as heroin, and sales are brazenly open. Most sales are in locations where there was once a flourishing heroin market, indicating the overall acceptance of PCP by Harlem addicts. The New York City Police Department is also making an increasing number of PCP purchases (18 in 1976, 80 in 1977, and 50 during the first five months of 1978). Table 2. Percentage of Admissions to N. Y. S. Community Based Residential and Ambulatory Drug Free Programs Giving Heroin or Illicit Methadone as Their "Primary Drug of Abuse"k . . With Heroin or Illicit Methadone AS Year Primary Drug of Abuse 1970 92% 1971 93% 1972 95% - 1973 83% 161 1974 71% 1975 66% 1976 76% 1977 55% 1978 46%kk **Based on January through July *Persons claiming no primary drug of abuse or for whom data are missing are excluded. (This ranges from 255 for 1970 to 2909 for l972.) This amount of missing data makes interpretation of absolute numbers less reliable than percentages. 162 Nonnarcotic Drug Activity Concomitant with declining heroin activity, most indicators of nonnarcotic drug use show substantial increases. Figure 2 presents the number of nonnarcotic drug arrests in New York City since 1970. Cocaine and depressant/stimulant arrests have been increasing since 1975, while arrests for hallucinogens have generally increased since 1973. There is also evidence that an abundant supply of nonnarcotic drugs exists on the street. DEA data on drug thefts for the New York SMSA (Table 3) indicate that the number of dosage units stolen have remained consistently high since 1974. About 40 to 50 percent of these thefts tend to be for nonbarbiturate depressants, followed in order by barbiturates, amphetamines, Stimulants, and cocaine. Emergency room data reported to DAWN also indicate substantial use of nonnarcotic drugs. The most severe problem apparently stems from tranquilizers. During the period covered by DAWN WI (May 1977 through April 1978), tranquilizers accounted for nearly 24 percent of all emergency room mentions, making it the leading drug of mention. Barbiturate and nonbarbiturate Sedatives also account for Sizeable proportions of ER mentions (6.2% and 8.4%, respectively). A plausible explanation for this phenomenon may be the continous availability of these drugs from other than legal sources (see Table 3). In addition to the increased availability of PCP as mentioned earlier, cocaine sales have recently increased in New York City, with Jackson Heights, Queens being the major trafficking center. Street purity averages about 25% to 30%, with most of the cocaine originating in Colombia. The Jackson Heights area has been the scene of several angry protests by local residents and businesses who accuse the law enforcement agencies of failing to halt the cocaine dealing in numerous bars and Social clubs. The marijuana market also continues to flourish in the city. Low risk factor and increased demand by the population are creating a ready market to be exploited by organized crime in a fashion similar to the prohibition era of the 1920's. 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T Ca ſº Source 6 N 1 #. Monnarcotic Drug Thefts in Dosage Units for The New York SMSA, 3 466,623 (TOOT) | 2.7 31.4 1.8 Quarterly, January 1975 - June 1978 4 558,565 (100.0) } 6.4 4.8 33.4 2.9 *Due to rounding procedure, percentages may not add to 100. Total Thefts” % Amphetamines 3. Other Stimulants : BarbiturateS ; Other Depressants % Cocaine *-* Table 3. l 2 454,032 452,175 (100.0) (99.9) 34.0 $2.7 3.5 6.4 36. I 40. 9 23.7 38. 3 2.7 |.. 6 13. I Source: Federal Drug Enforcement Administration. 1976 l977. l 2 3 4 l 2 666,286 532,276 590,879 2,293,005 || 1 ,082,576 739,618 (IOO.O) (100.0) (IOO.0) (IOO.O) (IOO.1) (100.0) 13. 13.8 19.7 17.8 l 6.3 20. l 5.9 7.4 5.9 45.2 3.3 4.0 26.3 28.5 3] . . 6.0. 37.9 22.0 50.9 46.8 42.0 30.0 41.4 52.6 3.8 3.5 l. 3 l.0 1.2 l. 3 3 4 1,838,794 634,622 t; (TUDIO) 4.0 29.9 |. 5 8.0 9. 1 20. 1 85. I 38.8 0.2 3.2 1978 l 779,277 60 (TOOO) f 24.9 6.2 25.6 42.5 0.8 2 l,758 00. l 3. 6 6.7 29.8 47.4 2.6 students responded to a questionnaire administered in classrooms. The findings indicate that New York City has the highest rate in the state of cocaine and PCP use. Nearly 19 percent of the students (or 112,000) had tried PCP and 15 percent had used cocaine (or 87,000). Current use (i.e., in the past 30 days) of PCP was reported by about six percent of the students, while five percent were current users of cocaine. Furthermore, use rates of most substances have increased dramatically since the early 1970's, especially the licit substances such as tranquilizers and stimulants. Heroin use, meantime, has remained Virtually the same. Summary This paper has described current trends of drug activity in New York City, culling data from a variety of indirect indicators as well as survey results. All available evidence indicates that heroin activity remains low and continues to decline, although not as sharply as during 1977. Heroin is still available on the street, especially in Harlem, and retail purity remains at about 2.5 percent. Dealers, however, are unable to procure enough of it on a regular basis, resulting in increased PCP sales to addicts. Concomitant with decline in heroin activity, use of nonnarcotic drugs is increasing. In addition to PCP, cocaine sales are increasing in the city. According to a classroom survey among secondary school students, PCP and cocaine use in New York City is the highest in the state (lifetime use reported by 19% and 15% of the students, respectively). DAWN data indicate that tranquilizers remain the leading drug of mention in hospital emergency room cases. An abundant Supply of nonnarcotic drugs continues to be available on the street, as evidenced by DEA theft data. 165 166 REPORT TO COMMUNITY CORRESPONDENTS GROUP DECEMBER 6–8, 1978 Christopher D'Amanda, M. D., Chief Medical Officer, Coordina- ting Office for Drug and Alcohol Abuse Programs, Department of Public Health, City of Philadelphia, Philadelphia, Penna. OVERVIEW: For the first time in reporting to the Com- munity Correspondents Group (CCG), data for all indicators was available in the report period and, was of sufficient extent to supply most retrospective periods listed for the UNIFORM DRUG USE INDICATORS REPORT form prepared by the Steering Committee for the December, 1978 meeting. A decrease is observed for the following indicators in Philadelphia: treatment admissions, heroin-related emergency room Visits, Hepatitis B rates, and heroin price and purity. The Medical Examiner data, even though incomplete, show a significant change of direction from previous report periods. Combined with patterns of Year of First Use, subsequent to the pivotal year in Philadelphia of 1975, the conclusion is difficult to avoid that heroin use is increasing in our com- munity. While the trend observed previously for users of barbi- turates has not been maintained, the incidence of ampheta- mine use does continue to mount. The current picture is significantly added to by a remarkable increase in the users of Other Synthetic Opiate (OSO) drugs. The overall picture of substance use in the City of Philadelphia, for the first 6 months of '78, is of a slowly growing but generally more compact core of users, gradually extending their involvement beyond illicit heroin to include other Opiates and ampheta- mines. This direction, while ominous in its obvious impli- cations for morbidity and mortality, also provokes consider- ation of other countermeasure systems (beyond law enforce- ment) which involve manufacturing sources and distribution Systems associated with these licensed drugs. Attention should be generated to develop control mechanisms appropriate to and accepted by authorities responsible for these acti. Vities, including the prescribing physician. DETAILS: Data reported from the treatment system of community-based programs in the City of Philadelphia's , Via the Uniform Data Collection System (UDCS), came under the direct supervision of the Coordinating Office for Drug and Alcohol Abuse Programs (CODAAP) beginning in the mid-portion of 1976. The UDCS was developed by the Governor's Council on Drug & Alcohol Abuse Programs to include the Federal CODAP require - ments. The 6 months' cohorts of new intakes, developed in the previous report are continued as the analysis units. The population reported in Tables 1-3, then, is composed of persons admitted to the treatment network within four 6 month cohorts beginning July 1, 1976 and finishing on June 30, 1978. A major caveat to these data should not be forgotten: we have no description of the relationship between new intakes to treatment and users in the general population. It may be correlative or it may be a reflection of chance. Intake data is helpful by itself, but provides a partial perspective only of events in the community. The general trend observed previously of a declining total admission is observed to continue. There are , how- ever, striking changes within this overall declining popu- 1ation. The most significant is found in users of "heroin substitutes," i. e. Illegal Methadone and Other Synthetic Opiates (OSO). Also there is a continued increase in the use of amphetamines, while barbiturates, as a primary drug of use maintains a declining incidence, however, the de- crease between the last two cohorts is only a third of the difference between the second and third cohorts. Hero in Amphetamines Barbiturates Illegal Methadone Other Synthetic Opiates TOTAL 2nd '76 39.83 262 179 36 76 1st '77 34 6 5 261 193 66 166 2nd '77 23.56 3.36 224 59 221 1st '78. 2214 3.85 169 75 255 45 36 415 1. 31.96 3098 COMPARISON AMONG DRUGS LISTED AS PRIMARY INTAKE-TO-TREATMENTOWERTFOURTE=MONTTPER TABLE I - A I ODS 167 168 The primary observation to be made from Table 1B is the change in percentage contribution made by the five drug classes. Other Synthetic Opiates (OSO) has increased nearly 800% and I11egal Methadone has increased some 300% from the first to the fourth cohort. The combination of these "heroin substitutes" account for some 10% of the drugs listed as primary by the most recent cohort as compared to being men- tioned by slightly over 2% of the earlier cohort. It is clear that heroin is still the most common primary drug at intake but its prominence is giving way to substitute Opiate S and to the continued rise of amphetamine use. An earlier para11e 1 increase in barbiturate mentions has sharply reversed. 2nd '76 1st '77 2nd '77 1st 78 Heroin 87.8% 83. 4% 73. 7% 71.5% Amphetamines 5. 7% 6.2% 10.5% 12.4% f . 9% 4. 6% 7. 0% 5.4% 3 Barbiturate S Illegal withºne 0.8% 1. 6% 1.8% 2.4% Other Synthetic §te;" 1. 7% 3.9% 6.9% 8.2% TOTAL 99.9% 99.7% 99.9% 99.9% TABLE 1 - B -- T COMPARISON OF DRUGS LISTED AS PRIMARY *#. J - DS i- What appears to be a major change in direction of heroin use is seen in yearly data for Year of First Use on the Tabu- lar Presentation form. For the initial five years, 1970-74, the number of new intakes in the fourth cohort (entering treat- ment Jan. - June '78) can be observed to be approximately 60-70% of those in the first cohort (entering treatment July-Dec. '76). In '75, however, this percentage climbs to approximately 87%. One of at least two explanations is possible; users of heroin were entering treatment earlier, i. e. the 1 ag between first use and first treatment was decreasing, or the population of new heroin users was increasing. For the year 1976 the ratio has entirely reversed and there are twice as many persons in the fourth cohort than in the first. This difference increases some 20 fold the next year. We know that recidivism is high, approximately 50% across our network, but, (1) this level has been observed for several years, and (2) other observations need to be available (an increase in age of the treatment population). This last does not seem to be occurring (Table 3). We cannot separate which of these three events may be occurring to the exclusion of any other, or their relationship to each other. We accept some impact from all. In Tables 2A and 2B a comparison by Year of First Use is made for the five categories of drugs for the four cohorts. Again the pattern for heroin can be observed to change for those first using heroin during the years 1975-78. The most striking increase is noted for OSO (Table 2B) but nearly similar elevations can be observed for illegal methadone and amphetamines. HEROIN AMPHETAMINE BARBITURATE Year 2nd 1st 2nd lst 2nd 1st 2nd 1st 2nd 1st 2nd 1st 1st Use 76 77 77 78 76 77 77 78 76 77 77 78 <1960 287 297 15 4 160 4 3 3 8 l l 6 5 60 - 64 421 329 241 227 16 10 21 18 11 9 7 4 6.5 - 69 1805 1445 940 856 70 71 83 82 40 46 48 46 70 - 74 1332 1245 843 766 142 119 144 14.5 106 113 112 65 75 - 78 138 149 178 205 30 58 85 13.2 21 24 51 49 TOTALS 3983 $4.65 2.356 2214 262 26 1 336 385 179 19.3 224 169 TABLE 2 - A COMPARISON OF PRIMARY DRUG OF ABUSE AT INTAKE TO TREATMENT BYTYEARTOFTISTUSETOWERT FOURTGTMONTHTPERIODS Illegal Methadone Other Synthetic Opiates Year 2nd ist 2nd 1st 2nd 1st 2nd 1st 1st Use 76 77 77 , 78 76 77 77 , 78 <1960 0 2 4 2 2 7 4 5 60 - 6 4 2 l 2 4 5 5 ll 17 65 - 69 10 12 14 13 19 55 49 58 70 - 74 20 22 20 31 39 78 92 114 75 - 78 4 29 19 25 11 21 65 61 TOTALS 36 66 59 75 76 166 221 255 TABLE 2 - B COMPARISON OF PRIMARY DRUG OF ABUSE AT INTAKE TO TREATMENTBYTYEAR OFTSTUSE-OVERT FOUR 6-MONTH per IoDS 170 Table 3 compares Year of Birth data among three major primary drugs of abuse. Figures for heroin change pattern between the third and fourth cohorts. The largest group of users entering treatment in the 1977 period were born between 1940–49, whereas, in the '78 cohort the largest number of users were born ten years later, between 1950-59. Barbitu- rate users continue to show the major peak during the five year period 1955-59 which is now the same for amphetamine users. This represents a shift for amphetamine use to a somewhat younger population, the Year of First Use being recorded in greatest numbers during 1950-54 for the three preceding cohorts. In summary, these data suggest a shift among amphetamine and heroin users to a younger population where as the barbiturate users seem to be entering treatment at a Constant age. AMPHETAMINES 39 , 40- 44 ° 45- 49 50- '54 , 55-'59 '60-'69 Total 2nd' 76 11 25 4 3 71 88 24 262 1st '77 9 17 48 91 67 32 264 2nd 77 14 25 62 111 94 32 338 15 tº 78 23 30 68 106 116 43 386 BARBITURATES ! 39 40 - " 44 ° 45 - 49 * 50- 54 55 - '59 ' 60 - '64 Total 2nd '76 10 22 47 65 31 181 1st 77 2nd 77 1 St" 78 8 27 44 79 32 195 11 29 49 98 36 229 5 17 54 58 26 1.65 HEROIN • 19 20- 29 30- 39 40- '49 50- '59 ' 60 + Total 2nd' 76 71 285 1648 2051 6 406.8 ls tº 77 49 256 1314 1850 19 34.92 2nd 77 31 194 1601 1268 18 3.11.7 . 1st '78 28 137 786 1217 20 2195 TABLE 3 COMPARISUN AMONG SELECTED PRIMARY DRUGS The most interesting aspect of Drug Arrests presented in Table 4 is the numerical relationship between the 12 months of '77 and the first 6 months of '78 under the column for Synthetic Narcotics. Nearly 3/4 of the arrests for the previous year have already been recorded in '78. The absence of similar changes in the other categories, each maintains an antici- pated relationship of approximately 50%, suggests that the data for Synthetic Narcotics is not a function of a policy change within the Department and may reflect a real in- crease in activity of trafficking (and arrests). Dangerous Opium- Cocaine Marijuana Synthetic Narcotics Non-Narcotics Manufacture/ Possession Manufacture/ Possession. Manufacture/ Possession |Manufacture/ Possession Delivery Delivery Delivery Delivery 1974 614 , 836 504 ' 2650 123 I 45 186 169 1975 1155 ' 1 035 6 4.5 2573 85 l 49 215 , 183 1976 1993 , 1179 740 ' 2804 68 | 65 2 3 4 * 151 1977 99.5 ' 764 1063 , 2742 96 I 58 291 , 245 6/30 l º ! t 1978 528 , 260 581 ' 1214 70 t 38 123 102 ! ! t TABLE 4 DRUG ARRESTS* 74 – 0, 1 *Numbers indicate persons arrested. Property related crime arrests show a continued decline - which started in '75 and continues through the first 6 months 171 of '78. While the number for robbery suggest continued stability, (50% of the '77 figure), a continued decline may be anticipated for larceny, auto theft, and burglary. These figures may be reflective of a change in the means of pro- Curing abused drugs. Emphasis on ready cash for illicit pur- chase may be shifting to accessing legitimate distribution pathways, for instance, forged prescriptions, interrupted delivery and pharmacy theft. These procurement methods would support the demand for "heroin substitutes" (Tables 1A & B). ROBBERY BURG LARY LARCENY AUTO THE FT 1973 8,481 18, 790 21,490 17,395 1974 10, 069 21, 295 27,061 10, 804 - 1975 10,405 22,480 29, 656 15,728 1976 7, 786 20,048 30, 242 15, 608 1977 6,999 19, 108 28, 301 12, 371 6/30/78 3,357 8,884 l2, 706 5,507 TABLE 5 ROBBERY, BURGLARY, LARCENY, AUTO THEFT 1973 - JUNE 30, 1978 There is a slight, and probably inconsequential de- crease in the number of Emergency Room DAWN mentions during the first 6 months of '78. Diazepam continues to be the major cause of ER episodes and is joined by marked increases in other sedative/hypnotic drugs, especially Ethchlorvynol (Table 6). Pentazocine is reported twice as frequently whereas Propoxyphene is somewhat decreased. Heroin mentions are essentially stable whereas Meperdine and Morphine mentions are increased. PCP and Methylphenidate continue to be popular and show moderate increases. 1st Half '77 1 St Ha 1 f '78 Hero in 88 º Hydromorphone 14 Meperdine 5 11 Morphine 3 9 Code ine 16 11 Methadone 34 49 Pentazocine 17 34 Propoxyphene 111 95 Diazepam 4 14 502 Chlor diazepoxide 80 59 Flurazepam 105 ll l Seco/Amo 93 90 Ethchlorvynol 44 11 l Amphetamine 30 47 Methylphenidate 26 S 0 Cocaine 11 16 PCP 21 36 Glues 10 10 TABLE 6 COMPARISON SELECTED DAWN ER EPISODES.” *Total ER episodes for 1st Half '77 is 3568, 1st Half '78 is $218. 172 The last three Tables prepared for this report are con- Cerned with mortality data taken from the Medical Examiner's records. It should be understood that this data is incomplete and, for this report only, presents six month information for the previous six years. Further analyses, to be prepared for the next CCG Report, will provide annual information for these six years as well as extending the reporting period from the present to 1971, the first year in which data of sufficient detail is available in a routine and accessible summary form. Table 7A compares totals for Narcotic and Dangerous Drug. Related Deaths by race and sex differences. The marked decrease, observed in the previous report, more or less continues for black males and black females, but mostly in comparison with whites. Figures for both race/sex groups show an increase, however, in this most recent report period. The most signi- ficant source of increasing mortality is among Puerto Rican males. MALE FEMALE TOTAL White Black Sub - Total White Black Sub - Total 1973 34 72 106 7 16 23 129* 1974 25 66 91 4 12 16 107* 1975 | 24 54 78 10 7 17 95 1976 26 58 84 5 7 12 96.8 1977 21 27 48 6 2 8 S6 & 1978 29 32 61 4 6 10 71 & TABLE 7 - A COMPARISON OF NARCOTIC & DANGEROUS DRUG RELATED DEATHS FURTAT5-MONTH-pſ:FTUD UAN-JUNE)-OVER-5-YEARS * 1973 PR: 1974 PR . male - Total 130 males - ! ? 109 male - * , 97 male - ! { 57 males - " 75 1976 PR: 1977 PR: 1978 PR: | Table 7B reports death in which morphine or quinine was found on toxicology. This is not to say that these figures represent only heroin-related mortality, because, there are certain deaths reported for which toxicologic findings are not available. The purpose here is to demon- Strate that most of the mortality reported in Table 7A is , in fact, a function of heroin use. These figures represent two-thirds of the male deaths and approximately half of the female deaths reported in Table 7A. The differences in 173 totals of 64%, is significantly higher than totals compared between Tables 7A and 7B for previous years. In '73, '74 and '77 the heroin/quinine positive toxicology deaths were approximately 40% of the narcotic and dangerous drug deaths, and, in '75 and '76 these figures amounted to the low 50's. It is apparent that in the six month period of '78 there is a marked increase, within the opulation of all deaths at- tributed to dangerous drugs in the Medical Examiner's Office, of deaths specifically related to heroin use. COMPARISON OF DEATHS WITH HEROIN/QUININE POSITIVE TOXICOLOGY | MALE FEMALE TOTAL White Black Sub - Total White Black Sub - Total 1973 10 36 46 0 8 8 54 * 1974 5 32 37 2 5 7 44 1975 12 32 44 2 3 5 49 1976 10 35 45 l 5 6 51 1977 9 13 22 2 1 3 25 1978 17 2 3 40 2 3 5 4 S 8 TABLE 7 - B * 1973 PR: 1 male - Total 55 1978 PR: 3 males - * : 48 In 10 oking for where this increase might be found demographically, data from Table 7C is helpful. The figures in each ce11 are small, a function of the limited reporting period. Nevertheless, certain directions are suggested. Mortality among the under 20 black and white males is sharply decreased as it is most dramatically for the over 40 black males and somewhat less so for the black males aged 20- 29 years. The rates for white males in this age group, as well as in the 30-39 year age group, seem to be holding. White famles are showing no marked changes over the last three observed time periods. Black females, however, of the 20- 29 year age group, can be seen to be less represented. <20 White Males 7 l 2 3 3 l 20 – 29 '' tº r 19 22 15 17 12 21 30 - 39 '' 5 2 5 5 6 6 40 + i i 3 0 2 l 0 1 <20 White Females l 20 – 29 '' ! I 3 * * * I K20 Black Males 6 7 3 1 l l 20 - 29 '' ! I 37 31 27 37 18 19 30 - 39 '' ! : 1 7 20 15 16 6 11 40 + ºt I t 12 8 9 4 2 l 17|| =- - -ºs- - - - <20 Black Females 0 20 – 29 '' 1 * 12 30-39 '' ! { 2 40 + 2 16 12 7 7 2 6 : i i i : TABLE 7 – C DEMOGRAPHIC COMPARISONS OF NARCOTIC & DANGEROUS -DRUCTRELATED DEATHS FORTATETMONTH perTOD (JAN.-JUNE), OWER 6, YEARS Before the next meeting of the CCG the City of Phila- delphia anticipates being able to initiate a major study in- Vestigating Correlates of drug use, sought among data contri- buting to CCG (heroin indicators), census information, other archival sources, and an ethnographic survey. It is hoped that one of the more significant results of this project will be to permit the development of actual rates for drug use, by particular geographic location within the City, either cen- sus tract or neighborhood. We should, in any event, be able to develop overall city rates. The ultimate intent is to de- Vise a methodology for analyzing (anticipating?) drug use trends in urban centers. We anticipate collaborating with members of the CCG in the development of the proposal subsequent to the initial period of work in Philadelphia. * *: * HEROIN USE TRENDS IN PHOENIX: UPDATING OLD INDICATORS MS Sandi MacConnell Phoenix, Arizona Traditionally, NIDA has used four main indicators for predicting preva- lence of heroin abuse: 1), emergency room mentions, 2) crisis center records, 3) Overdose deaths, and 4) hepatitis B cases. While these indicators may have been appropriate in the past, recent data clearly suggests that their usefulness may be decreasing. The fallacy inherent in continued use of these indicators is that they are assumed to represent an invariate proportion of the drug-abusing popula- tion. That is, if the number of people who are represented by these indica- torS decreases from One year to the next, it is assumed that the entire heroin abusing population has decreased. In fact, estimates derived from these in- dicators have shown a consistent decline in prevalence of heroin abuse since 1976. If, however, these indicators are combined with information on heroin purity and frequency of heroin use, a different picture emerges. As is shown in Figure 1, heroin purity has steadily decreased from 26.4% in 1976 to 1.5% in September, 1978. Concurrently, price (Fig. 2) has in- creased from $10.00 in 1976 to a range of $17.00 to $25.00 in September, 1978. So, the heroin user is not only getting less heroin in each purchase but is also having to pay more for it. 175 An investigation of the frequency of use -as reported to CODAP completes the picture. Figures 3 & 4 present frequency of use reported by Terros detox and methadone maintenance clients. In 1976, the highest category available was "once a day" and the majority of admissions were in this category. How- ever, there is no way of knowing how many persons used heroin more frequently but were placed in this category by default. When new categories were made available in 1977, a more accurate picture emerges. Here begins a very clear pattern of drug use shifting to high frequency (three or more times daily) by 1978. In addition, it is apparent that the increase in reported cases of hepatitis B supports the contention that heroin users are injecting the drug more frequently. What all of this information points to is the idea that heroin use is not decreasing but rather that the proportion of the heroin abusing population which requires emergency or crisis treatment is declining. In other words, it is quite feasible that the decreased purity of the available heroin has re- duced the likelihood that an individual Will inadvertently overdose and require emergency services. So, it is possible that the prevalence of heroin use has not declined at all. This notion is supported by admissions data to CODAMA treatment programs which indicate that the number of persons going into treat- ment dropped from 1976 to 1977 and has since remained relatively stable (Figure 6). Also, the percentage of clients which are new admissions has shown no significant change. There has been one change in admissions data which is of interest: the appearance of a trend toward younger persons going into 176 treatment (Fig. 8). It is unclear if this trend is related to the decreased purity. i A serious implication of this data is that any sudden increase in the purity of available heroin may catch many users unawares and result in a rash of overdose crises. Drug abuse agencies should not be lulled into a false sense of Security by a rosy picture painted with data which may be hiding a time bomb. Fig. l HEROIN PURITY > *— 2 T} CA- tº- > Li J (-) &Y Lil CA. 1976 1977 June–0ct. 1978 Source: Drug Enforcement Administration, Oct. 1978 Phoenix Police Department, Oct. 1978 Fig. 2 . HEROIN PRICE PER PAPER 2 30 'ſ 25 *; __ 17 0 * ºr . . . 1976 1977 June–0ct. 1978 Source: Drug Enforcement Administration, Oct. 1978 Phoenix Police Department, Oct. 1978 FREQUENCY OF USE AS REPORTED BY CODAMA DETOX CLIENTS §§ººººC×Q×OD×C×OD×C×O）O）O）C C ∞∞∞∞©®©×××× CC??S?Q=&&&&&&&&&&& ©Qº&ſº�ŒXOXOXOXOXOXO CXCXC×C×C) &&&&&8，8&&&&&&&№ºººººº · C ŽŽŽ .* NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN NNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNNN C×C×C×C) §§§§ 2233 }$$%$&& Ø|- Fig. 3 ©©©© ſºs��MY^-}5-3 }$$$$< №,§§ -• • •|-• • • •*（š- •~~~ș****-****ær ^ ^,… “ŚŃ N Ņ Jan-June 1973 Fig. 4 100 C)O ſºs\© À80031\!0 ÅQN30ò383 HOVB NI IN3033d OC)OC)o© L©, ON •••• • 3 --> G.) C ~, t< r» tº， * CIY ∞ → ry «-» Q.} C. " CD QC ， & tº）, >~, ON • • T3 •- » © : CT T^ <-Q •-> t） I CYN gC • ºſº •-> Once Daily % - § = Twice C2 i ly - Three or More D3 ily 178 Fig ... 5 REPORTED CASES OF HEPAT IT IS B 150 - - 143 |25 || || 20* Projected from 3rd Quarter 100 . 10 75 : 50 - 39 25 . 1975 1976 1977 1978 The number of resorted cases for serum hepatitis has increased a total of 266 percent from 1975 through 1977. The increase may be attributable to the location of the national hepatitis laboratory in Phoenix during 1976. Source: CDC Hepatitis Laboratory, Phoenix, Arizona Fig. 6 PERCENT NEW ADMISSIONS TO CODAMA 50 - || 46% 43%.” Projected from 3rd Quarter T--— |- 40 º- 44% tº 30 5. C-2 § 20 !. Cº- 10 : O 1976 l 977 1978 The percent new admissions to CODAMA (Multimodality Drug Treatment) remained relatively stable at 44-46 percent. The percentage new admissions is high compared to similar programs in other cities. Source: CODAMA Services, Inc., Phoenix, Arizona Fig. 7 TERROS DETOX ADMISSIONS 9, 2000 fl- 2. S. |620 C/") 3 1500+ | 465 as º 5 1000+ fº 880* Projected from 2nd Quarter £2 #5 500+ 2. 1976 1977 1978 The number of heroin detox admissions decreased steadily 1976-1978. Detox admissions were used rather than total admissions to all programs because increased slots influenced changes in the total number of admissions. Source: CODAMA Services, Inc., Phoenix, Arizona Fig. 8 TERROS DETOX CLIENTS, 19 AND UNDER AGE GROUP 10 :- 9% 10% = Projected from 2nd Quarter : 8 ºf § 6 - ſº- §: 4 ! 4% 2 Ji-º-º: N. lºſ -º- 0 | 976 | 9// | 3 / 3 {}, i le the muſ...}, ºr of do tº x adri (, ; ; on 6 ('ecreated, the fiercent admissions in the youngest throug) (, ; e ] 9 and under) intreased. Source: C0ſ)}\}{A Services, Inc., Phoenix, Arizona Fig. 9 HEROIN EMERGENCY ROON MENTIONS.--DAWN (V) 2. S. 600 + O- ; 43] 2E * J 400 + C É 2 248 230 ; 00 - - l67* Projected from 3rd Quarter 2. 1975 1976 1977 1978 Source: Drug Abuse Warning Network Fig. 10 HEROIN RELATED OVERDOSE DEATHS 2 90 + 85 ; 75 + O 60 - 5 45 : § 30 25 25* Projected from 2nd Quarter £2 - #5 15 ** = 2. 0 - . 179 1975 1976 1977 1973 The number of heroin-related deaths has been decreasing steadily from 1976. The number of deaths is conymonly thought to be associated with the purity of heroin and the number of users. Source: Arizona Department of Health Services Fig. ll ALCOHOL IN COMBINATION--DAVIN ºf) - à 600 + º: 500 + 514* Projected from 2nd Quarter # 400 + 485 *s 300 419 : 353 g 200 : = 100 + 0 1975 1976 1977 1978 Source: Drug Abuse Warning Network 180 TRANQUILIZERS Chlorpromazine Despramine Diazepam Doxepin Impramine Meprobamate Phenothiazine Thioridazine BARBITURATE SEDATIVES Amobarbital Belladonna Phenobarbital Pentobarbital (Nembutal) Secobarbital NON-BARBITURATE SEDATIVES Chloral Hydrate Doriden Flurazepam Glutethimide Methaqualone NARCOTIC ANALGESICS Cocaine Codeine Dil audid Meperidine Methapyrilene Percodan NON-NARCOTIC ANALGESICS Phenactin Pentazocine Propoxphene (Darvon) Salicylamide PSYCHOSTIMULANTS Amitriptylene (Elavil) HALLUCINOGENS Peyote Psl locybin Water Hemlock INHALANTS Chloroform Glue Paint Pam POISON Cyanide Strychnine HEROIN ALCOHOL ALCOHOL IN COMBINATION WITH OTHER DRUGS *Projected from August OVERDOSE DEATHS IN MARICOPA COUNTY 1975 1976 1977 1978% 3 l 2 2 3 7 l 2 5 8 3 - 2 2 l l l l 2 l 5 l 4 5 2 2 l 17 14 ll 14 9 10 8 6 3 l l T 2 2 2 - 2 2 3 4 3 l 2 l l I l I l l l T l | 24 20 25 26 1 6 3 2 5 6 8 12 l l i l 3 l 2 3 l l l 2 l 2 85 85 25 26 I8 17 9 5 28 19 24 17 Arizona Department of Health Services TRANQUILIZERS Diazepam ūthers BARBITURATE SEDATIVES Phenobarbital Others - NON-BARBITURATE SEDATIVES Flurazepam Others NARCOTIC ANALGESICS Heroin/Morphine 0thers NON-NARCOTIC ANALGESICS Aspirin Propoxyphene Others AMPHETAMINES Amphetamine Others COCAINE PSYCHOSTIMULANTS Amitriptyline Others CAN}}{ABIS Marijuana HAL}_UCINOGENS Phencyclidene Others INHALANTS ALCOHOL IN COMBINATION WITH OTHER DRUGS OVERDOSE INDICATORS 18. DAWN DATA 1977 TERROS CRISIS 1977 CODAMA DATA 1977 E. R. M. E. (Not reported to DAWN) M. E. - - 558 l 75 l 555 l& 45 17 TT3 15 i20 T5 127 3 |0 3 157 12. _54. 19. 284 15 64 22 172 3 13 3 _315 3. 31. 3. 487 6 44 6 260 5 i08 24 200 2. 71. 7. 460 7 79 3} 270 2 22 2 159 #7 2] 20 183 _l 4. - 1. 6] 2 20 47 23 107 3] _48. 6. 155 37 30 T 3 T 133 6 8 _50 —l 17. l 183 7 17 9 37 4 35 36 32 26. T 67 62 -T 57 6 2 648 15 226 CODAMA Data Compiled by Planning and Research Division Arizona Department of Health Services E. R. = Emergency Room fi. E. = Medical Examiner 27 182 FOREWORD The Indicators of Heroin and Other Drug Use is a tech- nical report prepared for the County of San Diego, Depart- ment of Substance Abuse, Division of Drug Programs. Data included in this report were contributed by the County of San Diego, Department of Public Health, the County of San Diego Coroner's Office, the County of San Diego Sheriff's Office, the City of San Diego Police Department, the County of San Diego Integrated Narcotic Task Force and the Narcotic Abuse Treatment Program. Written by: Ann C. Lampkin, Research Analyst John O. Green, Research Analyst Department of Substance Abuse Division of Drug Programs 2870 Fourth Avenue San Diego, CA 92103 (714) 236–2734 The correspondent from this city is Howard DeYoung FINDINGS Treatment Data Since data for the full calendar year, 1978, are not yet available, compari- Sons are being made using data from the first two quarters of the three years under consideration. Table I depicts new admissions to treatment programs for clients whose primary drug problem is heroin. The data is separated into two classifications of programs: 1) methadone maintenance and residen- tial drug-free, and 2) other outpatient programs. From the table, it can be seen that new admissions, overall for clients with a primary heroin problem, have decreased by 15 percent from 1976-1978. The decrease is all accounted for in the outpatient programs; not specifically heroin oriented, which have shown a decrease of 34 percent. Meanwhile, those programs speci- fically oriented toward heroin have shown a 12 percent increase in admissions. TABLE I New Treatment Admissions (Heroin Primary) Jan. - June Jan. - June Jan. - June % Change 1976 1977 1978 1976-1978 Methadone Maintenance and O Residential Drug-Free 197 217 220 +12% Regional Outpatient 282 236 | 85 –34% 183 TOTAL 479 453 405 -15% SOurce: CODAP Admissions Within the San Diego area, predictions based on these trends are impossible at this time. The San Diego County Board of Supervisors has directed the termi- nation of County funding for methadone services. There have been no new admissions to this Program since September, 1978. Serum Hepatitis The serum hepatitis data used in this report was based upon civilian Cases re- ported to the San Diego County Public Health Department. The major limitation of the data was that only an estimated 10 percent (Department of Health) of the clinically identified serum hepatitis cases were actually reported to the Public Health Department. Studies suggest that serum hepatitis (hepatitis B) incidence reflects that rate at which new intravenous (primarily heroin) users are being created. Needle- sharing among drug users can be, and often is, the principal mode of trans- mission of serum hepatitis. 18|| 40 30 20 } 0 Figure l. NUMBER OF SERUM HEPATITIS CASES REPORTED Total cases = 110 — 1978 (Jan - June) Total cases – 92 1977 (Jan - June) Total cases – 76 1976 (Jan - June) (35) . (35) \ . *\ /\ \ *º / \ / \ (25) / \ \ _ — N / \ e--T N ^ N. º N / N / \ / N / N / N - Z N _ -- T. —l T l TI I T] Jan Feb Mar Apr May June Month Reported Source: Department of Public Health, County of San Diego. As indicated in Figure 1, the total number of reported serum hepatitis cases increased by 45 percent when comparing the first half of 1978 with the same period of 1976. This has been, roughly, a 20 percent annual increase. From the data entered on the Uniform Drug Use Indicators Report, Tabular Presentation (See Appendix A), one can note that since 1975, semi-annual total S have been somewhat higher for the second half of each year than for the first half. Thus, the first half data cannot simply be doubled to Obtain yearly totals. This is particularly evident in 1976, where the second half total is twice that of the first half of the year. Heroin and Other Drug-Related Overdose Deaths From the Uniform Drug Use Indicators Report it can be seen that, at least in recent years, 1976 was the worst year for heroin-related overdose deaths in San Diego County. Table II shows half year (January - June) data from 1976-1978 for all narcotic/drug-related deaths. From this table, one can see that heroin (morphine) related deaths have decreased substantially (-67%) from 1976 to 1978. Other drug-related deaths increased 22 percent from 1976 to 1977, but then decreased in 1978 producing an overally increase of 8 percent from 1976- 1978. TABLE II Narcotic/Drug-Related Overdose Deaths 185 Jan. - June Jan. - June 1 Jan. - June % Change 1976 1977 1978 1976-1978 Heroin (Morphine) only 22 7 7 -68% Heroin in COmbination and Other Narcotics 36 27 12 -67% TOTAL Heroin-Related 58 34 19 -67% Barbituates and Other Sedatives, Hypnotics, Analgesics and Tranquil- o/ izers 60 73 65 +8% TOTAL Narcotic/Drug - Related Deaths TT 8 107 84 –29% Source: San Diego County Coroner's Office Emergency Room Data The number of drug-related emergency room mentions is based on data reported to the Drug Abuse Warning Network (DAWN), a nationwide program established and co-sponsored by the National Institute on Drug Abuse (NIDA) and the Drug Enforcement Administration (DEA). In San Diego County, 20 emergency rooms located in non-federal, short-term hospitals submit information on drug abuse mentions, monthly to the DAWN system. The number and percent of heroin-related emergency room episodes declined significantly from the first half of 1976 to the first half of 1977, then remained constant for the first half of 1978 (See Chart 1, 2 and 3), repre- senting a 1976 to 1978 decrease of 59 percent. The leading drug of abuse for 1977 and 1978, in terms of emergency room mentions, was diazepam (valium), with heroin running a close second. This is a reversal of 1976, where Walium was second to heroin. From Figure 2, it can be seen that of the seven leading narcotics/drugs in emergency room mentions all except PCP (phencycledine) have shown decreases from 1976 to 1978. Over this three-year period total narcotic/drug mentions decreased 25 percent from 3,051 to 2,275. Combined with this overall decrease was a proportional decrease in most of the more frequently mentioned categories (See Charts 1, 2, 3). The "all other drugs" class, which has shown a proportional increase of 16 percent, is a proliferation of 40 miscell aneous drugs and other combinations. - It has been suggested that the significant decrease in heroin-related deaths 186 and emergency room episodes is a result of decreased purity of street level heroin. CHART 1 CHART 2 Emergency Room Mentions Emergency Room Mentions (Jan - June 1976) (Jan – June 1977) PCP 19 PCP 22 Heroin 449 Heroin 188 Diazepam (Valium) 353 Diazepam (Valium) 279 Secobarbital (Seconal) 95 Secobarbital (Seconal) 52 Methaqualone (Quaalude) 76 Methaqualone (Quaalude) 59 187 Aspirin 87 Aspirin 62 Amitriptyline (Elavil) 79 Amitriptyline (Elavil) 68 All other drugs l, 912 All other drugs 1,576 TOTAL MENTIONS 3,070 TOTAL MENTIONS 2,306 CHART 3 Emergency Room Mentions (Jan – June 1978) PCP 59 Heroin 186 Diazepam (Valium) 232 8.0% Secobarbital (Seconal) 38 Methaqualone (Quaalude) 45 Aspirin 70 Amitriptyline (Elavil) 51 All other drugs 1,653 TOTAL MENTIONS 2,334 Source: Drug Abuse Warning Network (DAWN) Source: Drug Abuse Warning Network (DAWN) § i : i : . | : i i Figure 2 San Diego County Emergency Room Mentions f of Seven Commonly Used Narcotics/Drugs — 1978 Half-year Data (January–June) for 1976–1978 1977 leſs L. 1978 1977 1976 1978 1977 1976 1978 1977 1976 1978 1977 1976 1978 1977 1976 1978 1977 1976 1bo 2bo 360 400 DAWN data Number of Emergency Room Mentions DAWN data Law Enforcement Data Heroin-related drug arrests reached their high point in 1976. By 1977, a decrease of roughly two-thirds (2/3) was noted (See Table III). 1978 has experienced yet another decrease. Marijuana arrests peaked in 1977, with over twice the numbers of either the preceding or subsequent years. Arrests in the "dangerous drugs" category took a three-fold jump from 1976 to 1977, and have remained relatively constant since that time. Drug-Related Arrests By Year And Drug Type 1976 1977 1978 January – June January – June January - June HerO in 1,002 3] 3 220 Marijuana/Hashish l,735 3,770 1,593 Cocaine 55% 243 206 Dangerous Drugs 474 1,436 1,473 *Only San Diego Narcotics Task Force 189 Source: Drug law violations involving persons 18 years of age and older San Diego Police Department San Diego County Integrated Narcotics Task Force San Diego County Sheriff The above table depicts data from only four of the law enforcement jurisdictions in San Diego county, and includes all felony and misdemeanor arrest within these drug classifications. Table IV, while not broken down by individual narcotic/ drug classifications, is probably more indicative of arrests of hard Core drug users since it reflects only non-marijuana, felony drug arrests. These are region-wide data for the years depicted. It is generally agreed that other criminal behavior increases with increased drug use (non-marijuana), and it has been hypothesized that crimes of theft (income-generating crimes) are committed in high proportions by drug abusers attempting to support their expensive habits. Little substantial data is available to support this hypothesis, but from Table IV, one can see that the rate of change for crimes of theft, over a three-year period, has been roughly equivalent to the rate of change of felong drug arrests for the same period. TABLE IV San Diego County Reported Theft Crimes & Non-Marijuana Felony Drug Arrests - 1975-1977 Reported Non-Marijuana Felony Drug Arrests Year Crimes * Total | Adult Juvenile 1975 49,339 1,59] 1,356 235 1976 53,090 1,738 1,532 - 206 1977 58,298 1,846 1,706 º 40 % Change - - - 1975-1977 15.4% 16% 26% -40% | - - *Crimes include: Robbery, Burglary, Grand Theft and Vehicle Theft Source: Bureau of Criminal Statistics Heroin Street Level Price and Purity The street level price of small (2 gram) quantities of heroin increased for the first half of 1978, resulting in an overall increase of approximately seven percent (See Table V). At the same time, purity experienced a dramatic decrease from 18 percent (1976) to 6.3 percent (1977) and has not shown much change for the first half of 1978 (6.6%) (See Table V and Uniform Drug Indicators Report). TABLE W Heroin Street Level Price and Purity 1975 1976 1977 1978 (Jan.-June) Price/2 Gram $70-80 $70-80 $85-100 $70-90 Purity 17–23% 9.23% 1 - 12% 3-1 i Ż Average Purity Unknown 18% 6.3% 6.6% # Samples 100 52 35 |0 Source: San Diego County Integrated Narcotic Task Force DISCUSSION The analysis of treatment data suggested that heroin availability was inversely related to the increased admissions to drug treatment programs. Furthermore, factors such as client acceptability of the ºnent program Were assumed highly related to increased treatment emand. Experience has shown that as the Supply of a certain commodity decreases, that the demand for a substitute or alternative commodity usually increases. An examination of other drug-related overdose death statis- tics revealed that this indicator was, in fact, inversely related to heroin availability. Implicit to such findings was: as the supply of heroin decreased, the demand for an alternative or substitute drug for heroin increased. Indicators of incidence (i.e., new heroin use) did not clearly indicate that incidence was increasing. On the other hand, one cannot conclude that new use of heroin is on the decline. The quantitative relation- ships of the incidence data are still not fully understood. The availability of "indicator" statistics from a variety of sources provided an opportunity to further examine the extent of drug use. The review of findings support the salient fact of Widespread heroin 191 and other drug use in San Diego County. - BIBLIOGRAPHY Minichiello, Lee and Retka, Robert, "Trends in Intravenous Drug Abuse as Reflected in National Hepatitis Reporting." American Journal of Public Health, September 1976; 66:872-877. Hunt, L. Gibson, Drug Incidence Analysis, Special Action Office for Drug Abuse Prevention, Washington, D.C. : Monograph Series A, No. 3, 1974. Greene, Mark H. , Estimating the Prevalence of Heroin Use in a Community, Special Action Office for Drug Abuse Prevention, Washington, D.C.: Monograph Series A, No. 4, 1974. Heroin Indicators Trend Report. A publication of the Fore- casting Branch, Division of Resource Development, National Institute on Drug Abuse, Washington, D.C. : U.S. Department of Health, Education and Welfare Publication No. (ADM) 76-315. Crider, R. and Green, J.0. , Drug Use Indicators Report — San Diego County. San Diego County Department of Substance Abuse, Division of Drug Programs, May 1977. - 192 INDICATOR'S OF HEROIN USE IN SAN FRANCISCO : DECEMBER 1978 John A. Newmeyer, Ph.D. Haight-Ashbury Free Medical Clinic To make an analysis of the trends in prevalence of heroin use in the City and County of San Francisco, nine different "indicators" were used. This analysis, conducted in early December of 1978, disclosed the following: 1) Overdose Death. Data. During the first six months of 1978, the San Francisco Coroner's Office recorded a total of seventeen deaths attributable to morphine-type alkaloids as a primary or major contributing cause. At this rate, a total of thirty-four such deaths would be observed during all of 1978. This would represent a significant increase from the low incidence of such deaths observed during 1977: 1970 57 deaths 1971 60 ! } 1972 66 | | 1973 37 " 1974 72 1 | 1975 74 " 1976 76 " (revised figure) 1977 22 " (revised figure) 1978 34 " (projected) 193 The seventeen decedents recorded during the first half of 1978 were unusually young, in comparison to recent past years: their median age was 25, and fully 13 were under the age of 30. Fourteen were White (including Latino whites) and sixteen were male. There is a hint, in these figures, of a revived vigor of the heroin-use "epidemic" of the early 1970's-– an "epidemic" notable for its high proportion of youthful, White victims. 2) Property Crimes Data. Burglary has been considered the single crime most likely to reflect the efforts of heroin-dependent persons to finance their "habits". However, in a study of the twenty-six largest California counties, the author found that the rate of reported robberies correlated rather more tightly with other heroin-prevalence indicators than did the rate of reported burglaries. The 1970–1978 statistics for San Francisco County for these two types of crime were as follows: Year Burglaries Robberies 1970 18,900 5,930 1971 18, 300 6,640 1972 14,600 4,630 1973 15,500 4,850 1974 14,400 4,450 1975 17,500 5,690 1976 22,000 6,630 1977 19,500 5,420 1978 (projected) 16, 100 6,010 19|| The incidence-rates of these two types of crime both reached a peak in the early Summer of 1976, then dropped sharply until the early Winter of 1978, after which the rates began rising again. During the Summer of 1978, the rate for robbery levelled off, while the rate for burglary once again began falling sharply. It would be incautious to say that these property-crime cycles reflect a similar cycle in the prevalence of heroin addicts. Only about one addict in five supports his habit primarily through property crimes, and only about one property crime in three is reported to the police. These ratios may themselves change from year to year as a result of new police policies, a new municipal "atmosphere", a changed addict demography, changed public attitudes, or other secular changes. 3) Incidence of Serum Hepatitis. The incidence of new cases of serum (type B) hepatitis has traditionally been considered a reflection of the number of persons self-injecting themselves with drugs. However, in San Francisco, a large proportion-- perhaps a majority--- of the transmission of serum hepatitis occurs through sexual contact rather than through the use of unsterilized hypodermic needles. The unorthodox sexual practices of many San Franciscans (specifically, oral-anal contact) account for this unusual transmission-pattern. As the victims of either transmission-vector tend to be males aged 21 to 35, it is not possible to distinguish the two victim-groups through simple demographic techniques . There is evidence that other vectors, in addition to needles and sexual contact, may play an important role in the spread of type-B hepatitis. Nevertheless, the incidence of serum hepatitis, in large California counties, correlates highly with other heroin-use indicators. The monthly incidence of new cases of serum hepatitis in San Francisco has been as follows: July–December 1974 12 January–June 1975 17 July–December 1975 24 January–March 1976 38 April–June 1976 30 July–September 1976 24 October–December 1976 16 January–March 1977 23 April–June 1977 32 July–September 1977 32 October–December 1977 26 January–March 1978 33 April–June 1978 26 July–September 1978 22 It is seen that three "peaks" of serum-hepatitis incidence have occurred recently, one in early 1976, one in mid-1977, and one in early 1978. Although each of these may reflect a peaking in the rate of use of unsterilized hypo- dermic needles, they may also simply be a reflection of epidemic factors independent of needle use or of sexual activity. 4) Year-of-First-Addiction Data. Figures 1 and 2 present data from the Haight-Ashbury Free Medical Clinic on the claimed year of first continuous use of heroin, of its newly-admitted heroin-abusing clients. Figure 1 deals with January–June admittees for 1974, 1975, 1976, 1977, and 1978, and Figure 2 deals with the July–December admittees for those years. The data are presented with "years since first continuous use" as the X- coordinate-- e.g., "Y-1" for the 1974 admittees refers to the proportion of persons who claimed first addiction in 1973, "Y-2" refers to first addiction in 1972, and so en. The analysis of these graphs is complicated, but in essence we look at the "shifting" of the peaks in the 1977- or 1978–admittee data as compared to the 1974–admittee data: a shift to the left would indicate that the rate of incidence of new addicts was declining, while a shift to the right would suggest that the incidence rate was still rising. The two Figures clearly indicate that 1970 witnessed a peak in heroin- addiction incidence, followed by a sharp decline, followed by a new peak in 1973 and 1974. After a slight decline in 1975, another peak appears to have been reached in 1976, with 1977 and 1978 witnessing a small decline therefrom. These trends are summarized in Figure 3, which represents a "best fit" of incidence estimates to the observed data. Although the shape of the incidence curve of Figure 3 is well-established—– the 1970 "peak", for example, can be seen neatly retreating to the left in Figure 1, as we 195 progress from 1974's admittees to 1978's-- the scaling of the Y-coordinate must be considered uncertain, because our incidence—estimation technique is directed at relative changes in incidence rather than at the absolute Size of the new-addict population. Also, it must be kept in mind that these estimates are based only upon admittees to the Haight-Ashbury Free Medical Clinic, and may therefore reflect a biased sample of the total treatment population of San Francisco. There is a remarkable aspect to the shape of the incidence curve in Figure 3: it strongly resembles the attenuation curve of a spring upon which a heavier load has suddenly been put: Incidence Year Perhaps the "heavier load" is the massive social and economic change that befell San Francisco in the mid-1960's, and the "attenuation" is toward a newly-enlarged number of "entry slots" into the alternative world of heroin addiction! 22 2 : 20 17 I 3 | 2 I 5 4. 2 • *-** - - -, ------- + ------→ ------ 2 -- - - - - - --- - - -t- t—-- - - --- - - - - - - -e- - - - - - -, . t + -- - - - - --------------- - - - - -- 4 - - - - - - - --- i. . . . . . - - -H t I w -------, --, - + --------------- - -------- + --------- - -- +-- - ----------. . –––. --------- +--- 4 - --—----- +---- ------ ------- ~~. . . . ;---. - - - - - -— — —-. — — . -- - - - +----------- * n - - * -------------- + -----4------4---4---------—t - +------- . ------ t-------—!------------. - - - - - ------- * * * ~ * =-º----4---- ~4 - - - - ----- --- - - - - +------. - -- * . --A- --~~~~- + - - - -- + --—i-----. — +--—- --4--------------. --- - - - - - --------, ----> . * -- a-- * -- i - first. During: •º- - - - - ------ - - - - ---- --------- - - •----, * - - - - - - - --- -- +-------. . H 4 (N=558) ſ ------------ - -- ~~e I - - - ------ - I - **º - ºr -----|-} july-Dec. 197 § 4. - - | - - i t •- --- ~~~~~~~ -- ~ *-*-. ----- - l - • -- ~ *-------4----- " - - - - - - - - 44) =No . 1978 (N ----- - --4----> -- +---------- + -- -- * - - - - - - - - ----- - - - - +------- 1- Y-4 jºy. —a - -4-------- †975 (NH608) 6 (NH353) (NH330). -z-Hº- -*- - -, -, 5) Caseload of Treatment Programs. The Haight-Ashbury Free Medical Clinic has been fairly consistent in its admission criteria for drug- dependent persons, in recent years. Thus, the admission figures for the past two-and-a-half years may reflect the heroin-use prevalence situation of the County as a whole: July–September 1976 214 October–December 1976 214 January–March 1977 259 April–June 1977 201 July–September 1977 207 October–December 1977 192 January–March 1978 216 April–June 1978 236 July–September 1978 227 - October–December 1978 258 (projected) It is seen that there are two peaks in the admission data: one in the Winter of 1977 and the second in the Fall of 1978. These peaks, of course, may reflect the incidence-of-new-addiction trends of two or three years previously, since it is a common observation that the typical addict will have a "lag" of two or three years between first becoming addicted and first showing up at a treatment agency. The shape of the curve of Figure 3, then, would account for the cyclical nature of Our recent caseload-sizes. 199 The H. A. F.M.C. admittees were noteworthy for their increase in age: from 1971 to 1978, the median age of heroin-problem admittees rose from 23.0 to 28.3 years. 6) Emergency—Room Data. The Drug Abuse Warning Network (DAWN) data from emergency rooms in the San Francisco–Oakland SMSA showed the following trend: July–September 1975 324 mentions of heroin/morphine October–December 1975 307 ! 7 W January–March 1976 294 7 : - April–June 1976 254 ! ? - W I July–September 1976 174 f : 7 : October–December 1976 156 m 7 January–March 1977 133 § 7 11 April–June 1977 109 7 : 7 July–September 1977 86 ! ? 1 October–December 1977 81 | W ! ? January–March 1978 74 ! I | | April–June 1978 116 The trend was steadily and steeply downward from Summer 1975 to Winter 1978, with a drop of 77%; the Spring of 1978, however, witnessed a sharp rise. 200 7) Public Survey Data. Only one 1977-vintage survey of heroin use was available for the Bay Area: this was the comprehensive survey of drug use among junior- and senior-high-school students in San Mateo County. This survey (N=22,077) showed that the reported use of heroin levelled off in 1977, after having declined steadily during the 1974–1976 period: the proportion of students reporting using heroin "fifty or more times during the past year" was 1.0% in 1974, 0.9% in 1975, 0.7% in 1976, and 0.8% in 1977. Of course, these data refer to the 12-18 age group, and thus have limited generality. However, treatment-program data in San Francisco show a steady rise in the median age of the heroin-abusing client. If the number of heroin abusers is to be maintained at or near current 1evels, there must be substantial recruitment of new addicts among the younger age-groups-- something which the San Mateo study shows not to be happening nearly so much now as in the early 1970's. 8) Analysis of Heroin Samples. The Drug Enforcement Administration prepares monthly reports on the price and quality of heroin samples seized in the Southwest Region (California, Nevada, and Hawaii). For samples of "brown" heroin, the median statistics for three-month periods in 1977–1978 were as follows: Price per milligram Quarter Purity. of pure heroin Janaury–March 1977 12.4% $.46 April–June 1977 10.6 .45 July–September 1977 9. 3 .45 October–December 1977 9. 1 . 57 January–March 1978 5. 5 . 48 April–June 1978 ** sº sºm . 72 The trend in purity is decisively downward, while the trend in cost per unit of pure heroin is, for Spring 1978 at least, sharply upward. 9) Street Wisdom. Thirteen clients of the Haight-Ashbury Free Medical Clinic, each with extensive recent experience in making "street" buys of heroin, were queried during November 1978. The consensus was that the heroin being sold on the streets of San Francisco was of very low quality, and that it was distinctly poorer even in comparison to the already-low quality observed during 1977. Many spoke of the difficulty of acquiring enough heroin to get "off". * * * * * * * * * In general, the indicators cited in this paper-- and particularly the overdose-death and emergency-room data-- point clearly to a sharp decline in heroin-use prevalence during 1977. The most recent indications, however, suggest that prevalence stopped declining during the Winter of 1977–78, and may have risen somewhat during the Spring and Summer of 1978. The author used a regression formula, based upon the indicators, to make numerical estimates of the prevalence of heroin addicts in San Francisco during 1973 through 1978; he used the precise prevalence estimate of the exhaustive study of Newmeyer and Johnson (1) as his base-line. This estimate derived from several independent applications of the capture-recapture method, plus the use of some survey-research data from the 1973 period. Their estimate was that some 5,500 + 500 addicts were active in San Francisco at any one point in time during mid-1973. Similar point-prevalence estimates for 1974, 1975, 1976, 1977, and 1978, and a best-fit curve for these points, are displayed in Figure 4. This Figure suggests that the number of San Francisco heroin addicts reached a peak of just under 10,000 in early Spring, 1976, and thereupon declined sharply to a low of 7,000 in late Fall, 1977; a modest increase has apparently occurred during the first months of 1978. The prevalence trends cited in the 1ast paragraph have had a tendency to disagree with N. I.D.A. and newspaper reports on the prevalence of heroin use in San Francisco. For example, during June 1977, these sources spoke of San Francisco as being "Number 1" in the nation in regard to the per capita population of heroin addicts-- this at a time when the actual prevalence curve was bottoming out. The reason for these discrepancies is that N. I.D.A. and the media tend to use "stale" San Francisco data (in the example just cited, two-year-old data) and hence are liable to be neatly out of phase with the cyclical prevalence curve of Figure 4. A few notes on recent trends in use of other drugs in the Bay Area. At rock concerts, alcohol continues to be the dominant drug problem (66% of total mentions), followed by cannabis (11%, mostly in combinatinn with other drugs or alcohol), LSD (8%), and PCP (6%). Abuse of Ritalin and of Dilaudid have both increased, especially among Whites. Butyl nitrite (Brand "B"; amyl nitrite, Brand "A", is much rarer) has become immensely 201 popular; its raunchy, phallic-imagery-resonant, short-term effect is highly consonant with the sensibility of Disco dancing, as well as with the sensi- bility of gay male lovemaking. "Guys were practically drinking the stuff, from those little brown bottles" was once observation of butyl nitrite use at a Memorial Day gay Disco bacchanalia. REFERENCE 1. Newmeyer, J.A. and Johnson, G. L., Estimating Opiate Use Prevalence in San Francisco: Feasibility Studies. 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: w - - - --------- *. - - ** *** **, * ~ * * * * * * - - - * - - * -a-see-sºare-vº • * t - - - ; - { - - . . . . -- - - - 4 — r. - ----------- “... -------- * * * * - - - - - l i ! - t ---- --------4-------- - ... --- + ... - - -- - - - ~4----------. . . y -, -... - - - - - - --- - - - - - - - - -- . . . . ... r > . . . . . . . . . . . --- - - - - - - - - . . - ... . . . - - 4 i - - -------4------ ------ - - - - - - -- k ----------, -, -, ---e. . $ ----- - - - - - • --- -4...- ~~--- - - -t.--------- - - - - - - ------------------ ~~~~~ *- - - - - - - - - - - - - - - l ! | I - k - - - * - - - -ee-- *** * : *-*. º. --------> -- -- - - - - - - l i -- ... ... - . 4. ------- . . . ---, - . . . . . . .----------- . . . . -- # - - + . . . . . -- - - i ! - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -4 - - - - - - - - - : i t - * - w - - - -* . . . . - - - - w - ... --- *** * * * * * **w wºr-- - - - - - - - - - f - - * - - --- ~~...~------------- ~~~~ : - - -- - • * -- - - -- ------- —r-- - - - - - - - * . – --- - - | - - - - - - - -- * * -------- - **. - - - -- " " ------- - - - - -t-...--4-- - ------ . +--------, -------- - - -------- - ----- • ---------------------------- " -- - - - { - - - - 4 * ~ *-*. - - - - - - - - - - - - 4 - -----... • * **- +-- • *-* -- 4 - - - - * * * - - - --- -- - - - --- - - --- . . Iſº ---------------- - - - - - - - -- - - - - - - - - - 4- 4 - - - - - - - - - - - - - - - - - - - - - - - - * - - - - - - - - - - ! h - r - –4– —l- 4- **- - -----...-- --- **-* --- - - - - Michael Emby Seattle, Washington PHENCYCLINIDINE – The following data are presented due to the interest expressed at the June 1978 C. C. G. meeting. l. Indicators Deaths - the King County Medical Examiner has attributed one death in 1977 and one death in 1978 (as of 10/31/78) to P. C. P. Emergency Room Mentions - Figure 10 depicts P. C. P. related emergency room mentions as reported in the DAWN Quarterly Report series. ſiquro 1(). P. C. P., Related Emergency Room Montions |}} 16| | / Mentions º / 203 2nd 3rd 4th l St 2nd 3rd, 4th 1st 2nd 3rd 4th l St 2nd 1975 1976 1977 1978 . Years DAWN also reports that 69% of the mentions are for persons aged 10–19, 85% are for whites, and 77% are for males. Local School Survey - Preliminary results of a survey conducted by Kent Valley Youth Services in four junior high schools and one high school in the south county area indicate that 4.2% of the persons surveyed (N=332) have experimented with P.C.P., 1.5% use P. C. P. occasionally, and .6% use P.C. P. regularly. In support of the DAWN data it was found that P. C. P. use is heavily weighted toward males with 7.7% of the males reporting experimentation with P. C. P. while only 1.6% of the females reported such behavior. 20|| An additional section of the survey required respondents to indicate the degree of risk of physical or other harm inherent in the use of specific substances. On this item the respondents indicated risk of physical harm to users of P. C. P. as shown in Table 2. Table 2. Risk of Harm to P. C. P. Users Experimental Use Regular Use No Risk - 3.3% .7% Slight Risk | 9.7% .7% Moderate Risk 13.4% 4.6% Great Risk 22. 1 % 52.3% Unknown 41.5% 4].7% Points of interest regarding this item are: . The high percentage of respondents who indicated that they did not know enough about the drug to rate its degree of risk. In fact, the population surveyed was far less informed about the risk potential of P. C. P. than any of the other substances included in the Survey. . Of the persons who were informed as to the risk potential , the vast majority indicated a risk for great harm associated with regular use and at least slight risk associated with experimentation. For informed respondents, P.C.P. was one of the most dangerous drugs. Other Sources – Schuckit and Morrissey reported on interviews with 335 adolescents referred by courts to alcohol counseling and education centers in King County. Among other things, respondents were asked about their use of propoxyphene (Darvon) and P. C. P. They found that 4% of their sample used propoxyphene alone, 16% used P. C. P. alone, and 6% used both substances. No note of frequency of use was made. The authors conclude; "... individuals who used these substances were distinct from non-users. If one of the two Substances was taken in, individuals reported more antisocial , alcohol, and drug problems than for those who used neither--a pattern more obvious for P. C. P. than the propoxyphene takers. Use of both drugs together outlined a group with the highest rate of serious problems. . . ." Comparison between the Kent Valley Youth Services (KWYS) school survey and the Schuckit and Morrissey Survey is difficult due to the extreme difference in populations sampled. The KWYS Survey is probably more representative of the general adolescent population as it Sampled a cross section of public School students as opposed to a Selected sample of court referrals. Prevalence It is difficult to project a trend given only one overtime indicator. The only one-time indicator presented for P. C. P. emergency room mentions suggests a trend toward more use of P. C. P., although increased medical personnel familiarity with a new substance might also be an explanation of the increase in mentions. We have not located any previous attempts to establish a preva- lence rate for P. C. P. use. The federally funded Surveys, which are updated annually, have not named P. C. P. as a Specific Sub- stance of interest. Thus, the KWYS survey is the only basis for a countywide estimate. Application of the rates found by KWYS to the total King County population aged 10–19 result in an estimate of 1300 regular users of P. C. P. The reader is cautioned against use of this estimate for all but the most general planning purposes due to the limitations of sample size and geographic location of the KWYS study. 205 206 HEROIN INDICATORS WASHINGTON, D.C. George E. Powell, Jr. Central Intake Division Substance Abuse Administration Washington, D.C. Heroin indicators in the City of Washington, D.C. suggest heroin use may have declined from 1975 to 1977, 1eve1 off the first half of 1978 with a very slight increase during the second half of 1978. Heroin indicators that suggest this slight increase are: 1) number of persons in treatment; 2) urine results of persons going through D. C. Courts; and 3) number of new persons seeking treatment. I must mention the patterns of substances abused have changed significantly. The heroin user with occasional use of stimulants such as cocaine or one of the amphetamines has changed to a pattern of abuse which includes alcohol, cannabis (marijuana), other narcotics (dilaudid), phenmetrazine (preludin), PCP, tranquilizers (valium) etc.. These substances are being used singularly and in combina- tions, in addition to the fact that the substance are being abused with or without heroin. UNIFORM DRUG USE INDICATORS REPORT w)--kºsław TD C * Cºmmunity - Heroin Use Substance iDece, ber *} , | ? 7 % Date 2 I. TABULAR PRESENTATION INDICATOR SOURCE TIME PERIOD (semi-annual data) --> r- "C r- |-|-> CNJ "C CNJ --> CO FC or |-|-> <- |vºj CO ITC, UC 4–2 fºe -c, ſº- || 4–3 CO Heroin-Related Deaths ---|--____________22-33 || 6 || 2 | | |4|+|14- /5 || 7 ||25 |/3 | #|ſ/ | 3 |_|_|_ _ _ _ _ Heroin-Related ER. Cases ~ | . | – ||5||145 ||27||55 || T &ºi= &ºm= ′ = * — — — — — — — — — — — — — — –2-7 ––––7. T T TITT Tºll, 31.Al KSTLâlºlºl SW, An-TNo|S|Nº|SS|Nºo TTTTTT restºn; Admissions:IIIſ Žº sº) III ºf &\|&lºsºkº Š & cºlºlº Tºlº"|_|_|_ _ _ _ _ Yaar of list Heroin Use - 1970 - _l 1971 1972 - t º + - . 1973 . - - 1974 f 1975 1976 - 1977 - 1978 - R+-3 AT: Retail Price of Heroin — — — — — — — — — — — — — — — — — — — — — — — — — sº wº sºlºs' *ASsºlº wº sºlº *sº sº. ºs ºmº º sº º Retail Purity of Heroin – Ai (2.7%0 |33 ||37 ||37 || 3 ||3:22, 2-3% & º sº sº. — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — * : * * * * | * * * * * * *ms: sm- * * Hepatitis. Type B — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — e- — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — gº tº ºº &ºm= ºr :- ºr — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — - - - - - - - - - - - - - - - - - GL) •r- - -E O § 3. s- - - - - - - - - - - - - - - - - - - - — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — — S^. ... NO - * Primary Heroin Use - * ' . 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Į į Į į Į į Į į Ķ ķ Ļ ļ ; ; ; ; ; ; ; ; ;│ │ │ │ │ │ │ │ │ │ │| } } } } } { { { { {# # # # #.+ +|-i ++ § { } } } {i« ; i j : -|; ; ; ; ）! ! !:; ; ; ; ; ; ; ; ;;} } {; ; ; ;{ { # $ %:į š , !' ; ; ,| } ;; ; ; ; ; ; ;| + |- | + } } } +…}， }#--#-- !--#--# !！ # … :-） ! ！ ！! !!|-+-+-+i.- 4. §. - ;---&· · · · } } , + · · · · }†+ ）; ， ; ， ; ; … }- i- {，} + }; } ;; ;}4.- * : į å·}}†į #1-#--# # # # # # # !· ſ · * # : ;-） ; i ++） {į+4-4-4 +---+-i-i-i-i|----+---+---+---- - ---|---------', - ） ！！!--"…4---1--1--1---*{--~~~~ ~~~~）---&---------+--------! __i - i ） {#i-i-i-i-i-i-iº |į - # …ſi –-t----+---+---+-------X. PRELIMINARY ANALYSIS OF DRUG ABUSE TRENDS IN WASHTENAW COUNTY Reverand Richard P. Gilmore Ronald G. Amos Octagon House, Incorporated Ann Arbor, Michigan Any discussion of drug abuse trends in Washtenaw County, Michigan will invariably focus on Such drug scene patterns as are evident in the adjacent cities of Ann Arbor and Ypsilanti. These two cities together comprise the urban population center of the County, and many of the social indices asso- ciated with a growing, if not thriving, drug culture have existed within them for more than a decade. For example, a growing number of current initial admissions to treatment indicate that many of them began using nar- Cotics during the late fifties and mid-sixties while residents of Ann Arbor Or Ypsilanti, although a variety of drug abuse treatment facilities were not established in Washtenaw County until the early seventies. The crime rate in the two cities since 1970, as exemplified by the number of felony arrests and criminal prosecutions, has by far consistently surpassed that of the rest of the County. In particular, the two main categories of Cri- minal activity have been larceny and narcotic drug law offenses. On the 209 average, 57 percent of the County-wide larceny arrests and 70 percent of - the County-wide narcotics law arrests occurred in Ann Arbor and Ypsilanti." Additionally, the diverse drug treatment facilities located in the County have primarily been established in Ann Arbor and Ypsi, although their clientele is seldom limited to the residents of these two cities. There- fore, it is anticipated that an analysis of the indicators of drug abuse reported in Ann Arbor/Ypsilanti is sufficiently close to a County-wide sur- vey to warrant little additional information. Octagon House, Inc. is the narcotic abuse treatment facility Serving Washtenaw County and the surrounding area, having a clinic established in both Ypsilanti (Octagon II) and Ann Arbor (Octagon I). The clinics provide multi-modality assistance to hard drug abusers, including methadone mainte- nance, methadone detoxification, and a drug free regimen. These clinics provide the basic source of data for the analysis of the two drug abuse in- dicators reported in this paper, namely treatment admissions for narcotic drug abuse and treatment slot (modality) utilization. The methodology employed involves a rather detailed look at CODAP re- ported first admissions to treatment over a 35-month period from January 1, 1976 through November 31, 1978. Data for December, 1978 were not yet available at the time of this report's preparation. In addition, the pro- gram maintained CODAP files were accessed rather than the NIDA published clinic CODAP reports because it was felt that a hands-on approach to the data processing would facilitate a more complete and consistent analysis. Except for the latter half of 1978, each calendar year has been divided 210 into Semi-annual periods ending June 31 and December 31, respectively, for most of the analyses presented. The semi-annual analysis framework is very facilitative of monitoring trends ecause of the more ready discernability of period changes. The six month interval generally Safeguards against changes over time being smaller or larger than is Significantly plausible, given the context of this investigation. Mathe- matical analyses will be limited to percentage distributions when cumula- tive variables (i.e., age, number of admissions, and so on) are under discussion, and percent differences to underscore change (increases and decreases). . Where appropriate, rates of change are presented to high- light specific issues. By way of further analysis, data on the percen- tage utilization of treatment modality slots across ethnic and sexual grouping will be described for two consecutive years, beginning June 1, 1976 through May 31, 1978. It is expected that changes occurring in admission rates will be similarly reflected in the stability, decrease, or increase of treatment modality utilization. The different annual comparison period in this case will be more fully explained in the Sec- tion dealing with that discussion. Additionally, other selected drug use indicator data will be discussed with the intent of exploring the usefulness of available data on the abuse of drugs other than heroin, emergency room episodes, reported hepatitis cases, drug seizures, drug price and purity levels, and drug related deaths. Tentative considera- tion will be given to some solutions to the problems which are current- ly hindering the collection, management, and interpretation of more definitive data in each of these areas. Treatment Admissions Treatment admissions in the Octagon House program are comprised of three mutually exclusive groups: first admissions, readmissions, and transfer admissions. Persons who have never been treated at Octagon constitute the group of first or initial admissions, while persons who have had previous treatment experiences in either Octagon House clinic are considered as readmissions. The transfer admission Status is re- served only for those individuals within one Octagon House clinic who continue their treatment at the other Octagon clinic site without interruption. Therefore, by definition, a person admitting to either Octagon I or II will be automatically assigned to One of these three categories, and can have Only one status at any given point in time. These admission status categories are in no way used by the Octagon professional staff as if they represent experimental research design groups. No special intervention approaches are reserved for any parti- cular group of clients based on admission status. At present, all admitting clients are afforded the same opportunity to avail themselves of the diverse social, psychological, vocational, and educational exper- iences Octagon has to offer them. Since transfer admissions between the two Octagon House clinics do not effect the overall number of clients being treated, those admission changes brought about by movements within the transfer category are not considered in the discussion which follows. Throughout this paper, any reference to "total" admissions will mean the combined number of first admissions and readmissions to the Octagon House Clinics. Thus, an indirect measure of both relative incidence (first admissions) and rela- tive prevalence (combined admissions) is easily observed. Although the admissions under discussion have been further delimited in some cases by primary drug (s) of abuse, admissions to treatment at Octagon House generally result from heroin abuse. Between January, 1976 and November, 1978 the total admissions to treatment for any narcotic and hard drug abuse declined from 394 to 173, a decrease of 56 percent. The major decline (54%) occurred between 1976 and 1977 when admissions to treatment dropped to 179, as shown in Figure 1. The difference between the 1977 total admission (179) and the 1978 Figure 1. Total Annual Treatment Admissions in Washtenaw County, 1975-1978 400 -- 394 ( 380 —- 360 -- 340 520 —l— 211 300 305 280 —l— 260 —l— 240 —l– 220 —- 200 –– 180 —l— \ 179 —e 173 160 —- - | l— | | 77 78 YEARS i f Source: TClient Oriented Data Acquisition Process (CODAP) 212 total admission (173) accounted for only 3 percent of the change. The general picture as presented by Figure 1 is, then, that drug use pre- valence has decreased in Washtenaw County and is leveling off. In contrast, Figure 2 depicts a closer look at this phenomenon by comparing six month intervals over the three year span. This compari- son shows that a continuous incremental decrease did in fact occur in total treatment admissions from January, 1977 through June, 1978. missions remained high and consistent during 1976. However, the most notable event observed in this comparison is the 120 percent increase in admissions over the preceding six month interval during the latter half of 1978. Total treatment admissions from July through November, 1978 increased at the rate of 55 percent. | 180 160. 140 120 100 Figure 2. Semi-Annual Comparison of Total Treatment Admissions vs. First Treatment Admissions for Primary Narcotic Use, 76-78 200 —H· •–• Total Admissions First Admissions Osmº ºne O 80 . 60 40 20 wv- l | | | b al 1976 1977 1978 SIX-MONTH INTERVALS/YEAR al Source: Client Oriented Data Acquisition Process (CODAP) Ad- Figure 2 also illustrates the relationship of all admissions to the initial admissions of persons abusing heroin and Other narcotic drugs. The shapes of the curvilinear relationships described by these two in- dices are essentially similar, with only a slight variation between the total admissions and first admissions occurring between July and December of 1976. While total admissions held constant during that period, first admissions exhibited an 11 percent increase over the first half of 1976. The difference between all admissions and first admissions (the area be- tween the two lines) is equal to the number of readmissions to treatment. Of the 746 treatment admissions beginning 1976 and ending 1978, 48 per- cent were readmissions. - There appears to be an inverse predictive relationship between first admissions and readmissions, although this hypothesis has not been tested out thoroughly. For example, the percentage of readmissions Was highest during the period of declining overall admissions beginning early in 1977 and ending in mid-1978. Readmissions reached a maximun level of 65 per- cent between January and June of 1978 when decreases were observed in total admissions (-3.1%) and first admissions (-39%) over the preceding months, as summarized in Table 1. Conversely, periods of Stable Or 1976 1977 1978 1st 2nd - 1st 2nd - 1st 2nd Treatment readmissions 47%. 42% 51%. 58% 65%, 4.2% 213 First admissions 53%. 58% 49%. 42% * 58% . . . . 35 Table 1. Admissions Levels of TWO Treatment Statuses increased admission activity have had notable increases occur in the first admissions category and decreases occur in the readmissions category. This fact of observable increases in first admissions being accompanied by decreases in readmissions appears to support the inference that measures of the prevalence of narcotic drug abuse in Washtenaw County are predicated primarily on the rate of treatment entry for persons who have never been in treatment before. Summary. 746 narcotic and other hard drug abusing clients admitted to treatment at Octagon House from 1976 through 1978. 390 or 52 percent were first-time admissions. Overall, treatment admissions declined for an 18 month period between 1977 and mid-1978. An apex appears to have been reached during 1976, when a high of 197 clients admitted during each six month interval of that year. Despite this stability in overall admissions, an 11 percent increase in first admissions during the second half of 1976 was observed. Additionally, initial admissions to treatment increased more than twofold during the latter half of 1978, even though fewer clients admitted in 1978 than in either 1976 or 1977. The general impression of stable or waning incidence during periods of apparent stability or decline in relative prevalence is not supported. However, these treatment admission 21. data do support the notion that an inverse relationship exists between first admissions and readmissions. The implication of this finding is that first admissions are likely to be more significant in the global determination of narcotic abuse prevalence 1evels in Washtenaw County. Client Demography The significance of treatment admissions in the determination of drug abuse trends in the community, especially narcotics drug abuse, is enhanced by the further discovery of who is entering treatment as a consequence of drug abuse. The specific characteristics of client populations, such as age, sex, ethnic background, and so forth, pro- vide a general view of how drug abuse is effecting a community in terms of the loss of its human resources. Such information becomes extremely instructive when compared to more global assessments of a community's population, such as census data and projections of popu- lation growth. The usefulness of the specifics of a drug culture's make-up to planning and carrying out intervention and prevention strategies is unquestioned. The discussion which follows in this section is concerned with extrapolating a profile of the characteris- tics of first-time admissions to Octagon House. Sex and Ethnicity Males consistently constitute the majority of persons entering treatment for the first time in the three years 1976 through 1978. Overall, males comprised 72 percent of all first treatment entries for these years, being two to three times more likely than females to admit. Table 2 shows that black males generally average more first admissions than all other groups. However, the average number of black males and white males admitting for the first time does not appear to be vastly different ( 39% and 32%, respectively). Similarly, no enormous difference is evident when black and white females are compared on the average number of first-time treatment admissions (11% and 16%, respectively). Yet, a consistently greater frequency 1976. 1977 1978. M F M F M F Black . 39 . 10 . 40 . 10 . 36 . 16 White . 34 .15 . 29 . 20 . 32 . 13 Nat. Amer. --- .05 --- .01 .01 --- Mex. Amer. , 09 . 05 - - - --- --- --- Spanish - - - * “º - - - E= --- .02 --- Percentage Total . 74 . 26 . 69 . 31 . 71, . 29 First Admissions 163 56 57 25 63 26 Table 2. Percentage Distribution of First Admissions by Sex/Ethnicity Source: Client Oriented Data Acquisition Process (CODAP) of White female admissions compared to black female admissions is noted. Given the fact that blacks have a slight edge in the admission pools (193 or 49.5% of the 390 first admissions), it might be expected that this admission level would be similarly distributed with respect to sex. The raw variations indicated by Figure 3 do not confirm this assumption. Figure 3. Semi-Annual Comparison of First Treatment Admissions by Sex and Ethnic Background, 1976–1978 o—o black females 45 -l- X— —X white females O , black males %--->4. White males 40 – 35 30 25 20 — 215 +-H– d b al b !, 76 77 78 SIX-MONTH INTERVALS/YEAR Source: Client Oriented Data Acquisition Process (CODAP) In fact, the general trends outlined in Table 2 above are made more expli- cit as a consequence of the greater analytical detail of Figure 3. It should be noted that although the graph's slope is essentially the same as that of the lower portion of Figure 1, several notable developments con- tributed to the final shape of that slope. For example, the decrease in 1977 of the average number of white male admissions, the increase in the average number of white female admissions that same year, and the 75 per- cent increase experienced by black females in 1978 are each shown to have had some concrete impact on the overall picture of first treatment entries. 216 For the most part, black male and female admissions data form the graph's respective upper and lower boundaries. Except for the latter half of 1978, a general decline is observed in the absolute number of admissions in each ethnic and sexual group during each successive six month period after December, 1976. However, white female admissions actually increased above white male admissions during the latter half of 1977, while all other groups continued to decrease. The increases in first admissions July – December, 1976 appear to be principally accounted for by the large numbers of white males and females admitting. The July – November, 1978 first admission upsurge resulted from signi- ficantly increased entries for all groups, except white females. Black females contributed very little to the increase or decrease of drug abuse relative incidence levels during most of the three year period due to the generally depressed character of admissions for this group. However, black female admissions increased beyond white female admissions during July – November, 1978. White male admissions have exactly paralleled black male admissions during all three years at a lower level of incidence. It is surprising to note, therefore, that the admission of white males surpassed that of black males during July – November, 1978, even though black males re- mained the most admitted group during 1978. Summary. Basically, a variety of ethnic and sexual combinations have been found to be significant in the indirect measurement of drug abuse incidence. Treatment admission data indicates that the incidence of narcotic drug abuse in Washtenaw County is extremely sensitive to sex, rather than ethnic background. Overall first admissions for blacks and whites are not substantially different. This observation is primarily the result of black females entering treatment at a much lower rate than all whites, while black males maintain a consistently high admission rate. However, without additional information, such as the drug use patterns of clients enrolled in other area treatment/intervention facilities, it is difficult to determine whether the appearance that Washtenaw County males are more 1ikely to use narcotic drugs and to Subsequently enter treatment at a faster pace than females is merely reflective of a more general characteristic pattern of client populations admitting to treat- ment and rehabilitation programs offering methadone as a treatment choice.” In other words, the question of whether females choose other types of treatment models over methadone treatment, and therefore exhibit artificially low entry levels in Octagon's client population, is not definitively addressed by the presented data. Further study is certainly indicated in order to answer that question. Age and Heroin Use Onset For persons entering treatment for the first time during 1976 through 1978, the mean age at admission was 23.6 years, and the age at which they began using hard drugs was 19 years. On the average, a little over 4 years elapsed before most of these individuals presented themselves for treatment. Although Hispanic males (average age of 15.6 years) and Native Ameri- can females (average age of 17.5 years) are the youngest groups when they begin using narcotics and Other hard drugs, their impact on age of first use as a relative incidence measure is negligible because of their extreme- ly low admission to treatment rates. This is also true for Hispanic fe- males (average age of 20 years) in the case of age at first admission. As indirect measures of the incidence of narcotic and hard drug abuse in Washtenaw. County, neither age at first use nor age at admission are very powerful predictors of either ethnic or sexual group admissions. There is a great overall comparative similarity in age across both ethnic and sex grouping for first-time treatment admissions. About the best that can be expected from observing group differences of age at first use and age at admission is the establishment of ranges most adequately descriptive of an entering client population for both of these indices. It is probably most appropriate, then, to describe Washtenaw County first admissions to treat- ment for narcotic use as generally ranging in age from 18 to 20 at first drug use and from 21 to 25 at admission (Table 3). ALL FIRST ADMISSIONS -- JANUARY, 1976 - NOVEMBER, 1978 Average Age Average Age Years Admission First Use Between Black 26.7 20.8 5.9 217 White 25.0 18.9 6.1 Nat. Aſner. 21.8 19, 8 2. 0 Hispanic 20. 7 17.3 3.4 Males 23.9 19. 0 4.9 Females 23.2 19.4 3. 8 Table 3. Average Age and Years of Drug Use Source: Client Oriented Data Acquisition Process (CODAP) On the other hand, what is probably significant about the differences between age at first use and age at admission is that females, by far, enter treatment sooner after initial use than males. Although this fact seems contrary to the 10w entry levels of females, thus apparently suppor- ting low female incidence levels in the County, it is unclear whether fewer female admissions to treatment are an artifact of the unavailability of treatment regimens other than methadone. Between 1976 and 1978, blacks, as a group, tended to be 26+ years old at treatment admission, and also tended to have a long history of drug abuse (6 years), although they seldom began using drugs before the age of 20 or 21. By comparison, other ethnic groups tended to be only slightly 2 younger at the onset of heroin use, a little younger at the time of treatment entry, and, except for whites, tended to have used drugs for shorter periods of time before admitting for treatment. These data sug- gest, then, that year of first drug use, rather than age, may be criti- cal to the more complete analysis and understanding of several expecta- tions which seem to be associated with the Washtenaw County treatment admissions data presented up to this point, including the following: i), heroin use onset cohorts enter treatment as first admissions at dissimilar rates by year of admis- Sion - ii) treatment admissions for each onset cohort are likely to be differentially distributed across ethnic groups iii) post-1970 onset cohorts generally furnish the major- ity of first treatment admissions to the 1976 - 1978 admission pools; a decreasing number of pre-1970 co- horts are admitting iv) levels of treatment admissions are very closely re- lated to entry levels for particular onset cohorts. In order to observe the relationship that year of first drug use has to the level of treatment admissions previously discussed, all first ad- missions for which heroin was the primary drug of abuse were analyzed. Of the 390 first admissions, 203 (52%) began using heroin since 1970 and 40 percent began using heroin between 3938 and 1969. Of the remaining 8 percent of first admissions during the three study years, 23 (6%) be- gan using a variety of other narcotic and hard drugs since 1970, and 2 percent used these drugs between 1958 and 1969 (cf. Figure 5, below). Total * win * wºn Amm Admits Admits Admits Admits. Admits Admits. 1938 25 is - ºn - * *** - --- tº gº ºf 1947 . 25 . 45 - Rºs - *- -ºs - as ºse ºxº -** - Gº 1948 • * * . tº ºr sº tims º- º ---- .25 1.1 1950 .51 . 91 - sº- ---- º- *** - * twº gº 1956 . 25. . 45 .25 1.2 --- --- 1961 . 25 .45 -- ---- --- gºs ºse tº 1962 tº -ºs º- -- ºn E- . 25 1.2 — — — --- 1976 1977 1978 O O O O O % % % % % TOtal Annual Total Annual Total Annual Admits Admits Admits Admits Admits Admits O. 1963 .25 .45 tº º ºst &= * * .25 1.1 1964 tº º tº * * * .25 1.2 .25 1.1 1965 .51 .91 * sº tºº tº º ºs .25 1.1 1966 1.5 2. 7 . 76 3. 6 .51 2.2 1967 4.1 7.3 1.8 8.5 .25 1.1 1968 7. 9 14.2 1.5 7.3 2.3 10.1 1969 8.9 16.0 2.8 13.4 3.6 15. 7 1970 7.2 12.8 2.6 12.2 . 25 1.1 1971 5.1 9.1 1.5 7.3 1.5. 6.7 1972 4.4 7.8 2.6 12.2 1.5 6. 7 1973 3.1 5.5 1.5 7.3 .51 2.3 1974 3. 6 6.4 2.1 9.8 2.6 11.2 219 1975 5.1 9. 1 1. 3 6.1 1.5 6. 7 1976 1.5 2. 7 .51 2.4 1. 3 5.6 1977 sº as sº * * * .25 1.2 .51 2.3 % Totals 54.6 97.9 19.9 95.0 17.3 76.2 Table 4. Percentage Distribution of Heroin Use Onset Cohorts in 1976-1978 Annual Admission Pools Source: Client Oriented Data Acquisition Process (CODAP) Table 4 shows the percentage representation of heroin use onset co- horts in each enrollment year. The majority of entrants appear to have begun heroin use between 1968 - 1972 (53.9%) and 1974 - 1975 (16.1%) for all first enrollees between 1976 and 1978. It is quite evident that pre- 1970 onset cohorts are admitting less and less over the three year period. It is also evident that 1969 cohort members admit more often than any other cohort, as indicated by the extremely high consistency of this group's representation in each year's admission pools. This is all the more sur- prising given the fact that all other onset cohorts exhibit more extreme Variability in their annual admissions rates. The invariant representa- tion of the 1969 cohort probably attests to the high number of beginning 20 users for that year still extant in the general population. This con- tention would support the observation that a heroin use epidemic occur- red in Washtenaw County at the same time as in the rest of the Detroit SMSA. If this is true, then treatment admissions for the 1968-69 on- set cohorts may continue to be noted for some time yet. The plausibi- lity of such an occurrence is indicated by the behavior these cohorts exhibited over the three study years. Between 1976 and 1978 140 treat- ment admissions were from the 1966–69 first use cohorts. Seventy-six percent of these were 1968 and 1969 onset cohort members. As treat- ment admissions declined during 1977, treatment entries for members of the 1968 and 1969 onset cohorts also decreased. When overall admissions rose again during 1978 for first entries, so did the admission 1evels of the two cohorts. The 1974, 1975, and 1976 onset cohorts behaved in a similar fashion to the fluctuations of 1976–1978 admission 1evels. Post-1970 first-time heroin users average 51.5 percent of all first ad- missions over the three year period, and pre-1970 users average 38.2 percent. At this time, it appears that the magnitude of heroin abuse inci- dence in Washtenaw County has not necessarily ceased with the passing of the sixties. Even though all first-use years show relatively high entry rates in the 1976 admissions being drastically effected by the admission declines of 1977 and 1978, both periods between 1968–72 and 1974–75 in- clusive have consistently provided enough treatment enrollees to be con- sidered as probably having experienced very heavy first-time heroin use. The 1976 enrollees appear to represent the majority of different onset cohort admissions. However, the overall decline shown in the 1978 ad- missions for all onset cohorts -- 76.2%, as compared with 97.9% in 1976 and 95% in 1977 -- does not conclusively reflect decreased drug use in- cidence levels. In all likelihood, this data merely implies that per- Sons admitting to treatment specifically or primarily for heroin addic- tion are not doing so rapidly. Especially supportive of this notion are the apparently discrepant increases in admissions observed for cer- tain herion use onset cohorts, as in the case of 1968 first-users enter- ing treatment in 1978. - Thus, the data presented in Table 4 does indicate somewhat cursorily that critical heroin use onset years are observable across different points in time. At present, it is not possible for these figures to ade- quately forecast future admission or incidence 1evels. However, these data are being used along with previous years’ admissions information to construct an average cumulative entry curve. Such a model would be used for estimating future treatment admissions for heroin abusers, and also for estimating relative incidence levels of heroin abuse in Washtenaw County based on the actual historical treatment admissions data. Although ethnicity does not appear to be a guiding criterion for determining who is likely to show up in the treatment admissions, it may nonetheless be instructive to consider whether the general variability and decline of heroin use onset cohorts over the three year period holds with respect to ethnic groups entering treatment. Figure 4 presents data for first heroin use cohorts since 1970. The graph is a modified version of the tabular format suggested by the Community Correspondents Group. The lower boundaries of the graph (i.e., years of first heroin use prior to 1970) are not shown because it was assumed those data would be negligible. Indeed, it was expected that ethnic group admission data 75 Figure 4. Distribution of Selected Year of 70 First Heroin Use Cohorts by Ethnicity, 1976-78 65 60 55 - - E 1974 50 1975 45 | 1976 40 N 1977 35 30 221 25 20 15 10 *:::: #: * 3: 5 *:::: *::::::: * * * * *k * * NA |* * * * * :k X: Sº I k ºr 1976 1977 1978 YEARS/ETHNICITY Source: Client Oriented Data Acquisition Process (CODAP) would conform to the differential admissions model outlined above and il- lustrated in Tables 3 and 4. Under this process, it was anticipated that the majority of individuals who began using heroin prior to 1970 would have more likely been involved in treatment before 1976, the starting point of Our general analysis. In addition, it was further expected that the attrition process associated with drug use would have claimed some percentage 222 of pre-1970 first users. This process would result in some users drop- ping out of the drug scene altogether as a consequence of death or suc- cessful detoxification and abstinence via Some other method, Such as "cold turkey" or imprisonment. The data contained in Figure 4 support two observations regarding the general model of differential treatment admissions over the three years observed. The first is that each heroin use onset cohort is dif- ferentially distributed across ethnic groups. That is, different ethnic groups are shown to enter treatment at different rates with respect to their years of first use and year of admission. In 1976, each year since 1970 inclusive was represented in both black and white treatment admissions. However, more first heroin use cohorts from 1970 and 1972 were among the black admissions, while more cohorts from 1970–71 and 1974-75 were among white admissions. Mexican American enrollees were from the 1970 and 1975 Cohort, and Native Ameri- can entrants belonged to the 1972 cohort. No black 1977 cohorts admit- ted in 1977, and 1970 cohort members admitted more for this ethnic group in 1977. All years since 1970 inclusive were again represented among white admissions for 1977, although a considerable decrease occur- red in all but the 1972 cohort. In fact, the 1972 cohort actually in- creased slightly (14%) over the 1976 level to gain the majority repre- sentation among white admissions in 1977. Native Americans entered from the 1973 cohort in 1977. Again, 1978 black admissions had no 1977 cohorts, and the declines that are very evident in the 1970 and 1973 cohorts are not offset by the increases over the 1977 levels noted in both the 1971 and 1974 Cohorts. White admissions in 1978 had no 1970 cohorts among them, both 1972 and 1976 were the leading cohort groups, and an increase is shown in the 1977 cohort. Neither black nor white drug abusers who began using heroin in 1978 admitted to treatment. In general, each year of first heroin use cohort decreased in re- presentation from 1976 through 1978 for each ethnic group. The most extreme cases of decline were the white 1970 cohort and the black 1976 cohort, each of which completely disappeared by 1978. No explicitly predictable ratio of cohort admissions can be discerned when comparing ethnic groups along the year of first use index, although particular post-1970 Onset cohorts variably figure in the overall annual admission levels. The only notable deviations occurred in the 1968 cohort ad- missions (30% more black than white members admitting) and in the 1971 cohort admissions (38% more white than black members admitting). Fur- ther analyses must be performed to learn whether drug use onset cohort admissions necessarily predict treatment entry levels, to determine how reliable such estimates are, and to discover whether sex is a more in- fluencing factor than ethnicity in such estimations. The second observation regarding differential treatment admissions supported by Figure 4 concerns the distribution of pre- and post-1970 heroin use Onset Cohorts among the admitting clients. It is fairly Obvious that more Whites than any other group who began using heroin since 1970 entered treatment between 1976 and 1978. However, the expec- tation that all persons who first began using heroin prior to 1970 more likely than not account for a minority of treatment admissions in 1976– 1978 is not readily Substantiated for all ethnic groups entering treat- ment during those years. For example, Figure 4 shows that all Native and Hispanic Americans entering treatment in 1976 and 1977 began using heroin between 1970 and 1975. In addition, the percentage of whites entering treatment during the three study years who began using heroin Since 1970 increased each successive year: 1976 - 63%, 1977 – 66%, and 1978 - 67%. By comparison, except for the 1970 and 1974 onset cohorts, each of the post-1970 onset cohorts come up substantially short on black admissions. Particularly notable are treatment admission years 1976 and 1978. In both years, over 50 percent of the black first admissions had heroin use histories beginning prior to 1970. In fact, of the 140 first admissions between 1976 and 1978 representing the 1966-69 onset cohorts, 57.8 percent were black, with 1968 and 1969 cohort members accounting for over seventy-four percent of those admissions. Thus, as pointed out in the earlier discussion on age at admission vis-a-vis age at first use, black heroin addicts appear to be admitting to treatment slower and over more protracted time periods than other ethnic groups. Summary. Neither age at first use nor age at admission seem to be highly predictive of ethnic or sex admission characteristics when taken separately. However, when taken together and used to calculate the number of lag years intervening between first use and treatment admission, age differences become meaningful. It appears that the number of years elapsing prior to treatment entry after first drug use is probably sig- 223 nificantly less for females than for males and somewhat more for blacks than other ethnic groups. Blacks also appear to be older when they begin drug use, and therefore enter treatment older than other groups. Analysis of year of heroin use onset indicates a highly variable admis- Sion pattern for all ethnic groups entering treatment between 1976 and 1978. Except for the deviations of 1968 and 1971, no single use onset Cohort is predictably more likely to have more representatives than any Other in a given admission pool or ethnic group. Post-1970 cohorts. generally comprise the major part of the total treatment entries for the years Studied. The high percentage of blacks admitting to treatment who began heroin use prior to 1970 is likely a consequence of their generally lengthy drug use careers. Yet, the pre-1970 first use cohort representation noted in connection with black admissions is declining. For example, use Onset cohorts for 1966–69 decreased from 24 percent of the total black admissions in 1976 to 17 percent in 1977 and 1978. For all ethnic groups, the critical onset years were 1968–72 and 1974-75. The former time span Corresponds to the general epidemic period experi- enced by the total Detroit SMSA. However, it must be pointed out that the patterns of decline noted in connection with admission of on- set Cohorts do not necessarily mean the problem of heroin abuse is re- Solved or has gone away in Washtenaw County. The drug abuse scenario has simply had a different turn of events. Not only should we expect future admissions to continue for heroin abuse, as indicated by the bud- ding levels of 1974 and 1975 onset cohorts and the invariant 1969 on- Set Cohort, we should probably also expect that future admissions will contain more and more abusers of other drugs. 22|| Primary Drugs of Abuse Heroin addiction was the primary drug problem for 360 (92%) of the treatment admissions during 1976, 1977, and 1978. The highest percentage of primary heroin users in an entering treatment popula- tion was 97.9 in 1976, declining to 95% in 1977, and subsequently decreasing to 76.2% by November, 1978. The remaining admissions to treatment during those years were made up of persons whose pri- mary drug of abuse ran the gamut from amphetamines to psychedelics. Additionally, some heroin addicts exhibited secondary and Some ter- tiary use of these drugs. Polydrug abusers comprised a total of 37.7 percent (131) of the 390 first admissions between 1976 and 1978. One hundred and seven- teen (89%) of them used heroin as their primary drug of choice, but reported supplemental use of a number of other drugs. Among the most frequently mentioned secondary choice drugs are barbiturates (23.9%), cocaine (24.8%), and other narcotic drugs (codeine, demer- ol, percodan, and dilaudid - 18.8%). Among the most frequently mentioned tertiary drug choices are ampehtamines (16.7%), marijuana (20%), barbiturates (13.3%), and cocaine (13.3%). Consistent with Overall treatment admissions data, males con- stitute the majority of secondary (75%) and tertiary (70%) drug users. Whites outnumber blacks approximately two to One in either supplemen- tary drug use category. While all groups show a penchant for barbs and cocaine, white males also lean heavily towards the use of other narcotics, marijuana, alcohol, and amphetamines as Secondary drugs of abuse, as well as alcohol, tranquilizers, and psychedelics (LSD, DMT, mescaline) as tertiary drugs of choice. Black males favor ex- tremely sporadic use of marijuana, tranquilizers, alcohol, other narcotics, or amphetamines as additional drugs of abuse, but general- ly favor amphetamines and marijuana as third drug choices. Addition- al Secondary drug choices among white females include illegal metha- done and marijuana, with marijuana also being a favored third choice. Black females are only 5.1 percent of the heroin-plus-other-drug using population, and, therefore, exhibit only very sporadic patterns of additional drug use besides heroin. In general, treatment admis- Sions for heroin polydrug abusers have declined from a 1976 high of 53 (13.6% of total first admissions) to 31 (7.9%) in 1978 (Figure 5). The remaining 30 polydrug abusers admitting for the first time indicated no heroin use history at the point of admission, but showed a rather consistently high use of other narcotics, including opium and morphine, amphetamines, barbiturates, and tranquilizers as pri- mary drugs of abuse. This group of drug abusers is similar to the "heroin-plus" abuser group in that it is primarily composed of men (63%) and whites (57%). However, in contrast to the heroin polydrug abusers, these non-heroin polydrug users appear to be rapidly increas- ing in number. - Figure 5. Comparison of Levels of Heroin Poly- drug Abuse and Post-1970 Non-Heroin Polydrug Abuse in 1976-1978 First Treatment Admissions 35 —H· W 30 -- W/1971 25 —— 20 —l— W 1973 W [] ºug 15 -- 10 a-- l 9 7 2 NA | |- FZZA Eğ 1 7 6 1977 YEARS/ETHNICITY 225 Source: Client Oriented Data Acquisition Process (CODAP) Figure 5 illustrates the annual distribution of 77 percent of the non-heroin polydrug abuser admissions by post-1970 onset cohort years in comparison with the total heroin polydrug abuser first-time entrants to treatment for 1976 through 1978. It was felt that these particular on- set cohorts would be sufficient evidence of the general increase observed in the number of non-heroin polydrug abusers currently admitting to treat- ment. Since four of the remaining seven pre-1970 onset cases admitted during 1978, no significant evidence is lost by not showing pre-1970 co- horts for any of the three study years. Admissions for other narcotic and hard drug abusers remained fairly stable from 1976 through 1977. Between 1977 and 1978, admissions by this group increased over fourfold, representing onset cohorts from 1970 through 1976 inclusive and four ethnic groups. In the three admission years, 78.3 percent of the enrollees in this category were 1971-74 cohort members. Based on the frequency of drug mentions at intake, a variety of nar- Cotic drugs are known to be the most frequently used, at 31.1 percent of all mentions. More specific drug use references favor codeine, barbitu- rates, and anphetamines (40.5% all mentions), followed by cocaine (12.2%), marijuana (9.5%), alcohol (8.1%), tranquilizers (6.8%), psychedelics (5.4%), demero1 (5.4%), morphine/opium (4.1%), percodan (4.1%), dilaudid (2.7%), and illegal methadone (1.4%). Codeine use was mentioned more by whites, especially males, While blacks, particularly females, indicated heavy amphetamine use. Cocaine, alcohol, and barbiturate use are fairly evenly distributed across sex and ethnic group. Except for One mention each of demerol and codeine use, no mention was made by blacks in this admissions group of any other narcotic or tranquilizer use. Since this observation is supported by the extremely low level incidence of these same drugs being used among black heroin polydrug abusers, it is felt that the Small number of blacks in this sample does not adversely impact the general notion that these drugs tend to be primarily abused by whites. No black females mentioned marijuana use, and all psychedelic use was confined to the Native American enrollee. Summary. Non-heroin polydrug abusers are appearing for treatment admission more frequently at a time when heroin polydrug abusers don't appear to be increasing as rapidly in the admissions pools. However, the declines observed in the latter group are presumed to be artificial- ly associated with the overall treatment admission decreases. Fewer heroin abusers entered treatment for the first time in 1977 and 1978 combined than in 1976. However, this phenomenon is not expected to last, 226 as more post-1970 onset cohorts near the end of their "normal" (average) lag period preceding treatment entry. It also appears to be a fact that heroin users are switching over to or supplementing their primary drug diet with other kinds of drugs in large numbers. This situation may in- dicate something about the quality and availability of heroin in Wash- tenaw County as a drug of abuse. Treatment Slot Utilization In order to corroborate the general picture presented by the treat- ment admissions data in the last section, it was determined that the analysis of utilization rates for treatment modalities would provide a sensitive assessment of at 1east one issue bearing on treatment admis- sions levels --- the availability of an adequate treatment capacity. This issue become important when it is considered that Octagon House Operates under a fixed Static treatment capacity, and is the only hard drug treatment facility in the County. The implication is, then, that substantial increases in dynamic client capacity extending over long periods of time may seriously effect a program's optimal functioning level, especially if adequate Operational resources do not similarly become available. Extreme overutilization of treatment capacity would seem to directly impact treatment admissions in a negative fashion, if quality of Service provision is believed to be an expectation and con- cern of the entering drug abuser. Certainly an implied relationship exists between treatment capacity availability and the concept of quality service provision, even though this analysis does not presume that any directly measurable relation is operating between the two. Data conducive to an analysis of modality utilization rates was previously prepared for an on-going in-house Study Similar to the pre- sent study. The two-year period (June, 1976 - May, 1978) covered by the data provides enough overlap of the admission data presented ear- lier that its interpretability within the context of this report should not strain the analytical perspective already set up. Table 5 presents monthly distributions of treatment modality utilization for 722 total program admissions. As mentioned earlier in this Section, the static treatment capacity is fixed and distributed across treatment modalities such that the following configuration results: methadone maintenance - 64% (125), methadone detoxification - 3% (6), and drug free - 33% (64). Table 5 indicates that overall admission levels were very high in 1976–1977. The 441 admissions that year were 226.2% of the funded ca- pacity. Except for the June, 1976 drug free slots and the February through April, 1977 detoxification slots, all treatment slots were filled well above their limit during the year. Females admitted less than half as much as males (131/42.2%). No real ethnic group differen- ces can be deciphered with respect to admissions and treatment modality utilization, although black males admitted slightly more than white males (respectively, 43% and 27% of admissions). Males in general dominate the admissions pools, and, therefore, the available treatment 227 slots. Also, both black and white males chose the same treatment modalities in the same proportions. Forty-seven percent of them entered the maintenance regimen and thirty-two percent admitted to the drug-free aspect of the program. - The 1977–78 half of Table 5 is quite the reverse of the 76–77 half. Comparing the two years, it is noted that more treatment slots are avail- able for use, especially detoxification (short-term chemotherapy) and drug-free (no chemotherapy). These were the two most used modalities in the previous year. The decreases drop sharply from July, 1977 on. The average dynamic capacity for the year declined to 84.2%, as compared to 117.2% for 1976–77. Since the maintenance treatment slots continued to be utilized at near capacity level during 1977-78, much of the status of the detoxifi- cation and drug-free treatment modalities appear to have been bound to the influences of factors other than ethnicity or sex of the admitting clients. One explanation which comes highly recommended in this regard by program clinical Staff is that a very intensive detoxification and counseling program for Washtenaw County Jail inmates was gradually phased out over the latter part of 1977 and early 1978, after having Served incarcerated drug abusers for approximately two years. However, the increased treatment slot utilization during 1976 should probably not be solely attributed to the program's extremely progressive relationship With the jail administration during that period. Although new client JUN/76 – MAY/77 JUN/77 – MAY/78 4–9 Modality Utilization § v. ãºf Modality Utilization § v. #. E (% of Norm) T; % . E 9 (% of Norm) T; ; . E 9 Month M D DF $ 3 Efee M D DF 43 EPs June 111.2 433.3 98.4 228 116.9 97. 33. 3. 109. 194 99.5 July | 100.0 300.0 123.4 222 113.8 94. 33, 3 89. 176 90.3 Aug. 106.4 533.3 118.8 241 123.6 | 103. 133. 3 50. 169 86. 7 Sept. | 101.6 350.0 162.5 252 129.2 | 104. 116.7 48. 168 86. 2 Oct. 100.0 350.0 168.8 254 130, 3 || 108. 83.3 53. 174 89. 2 Nov. 108.0 133. 3 143. 8 235 120. 5 # 106. 150. 0. 54. 178 91 .. 3 Dec. 107.2 116.7 140.6 231 118.5 102 150. 0 53. 170 87.2 Jan. 100.8 150. 0 139. 1 224 114.9 101. 66.7 50. 163 83. 6 Feb. 100. 0 33. 3 142. 2 218 111.8 || 101. 66. 7 35. 154 78.9 Mar. 105. 6 83.3 142.2 228 116.9 97. 0. 0 39. 147 75. 4. Apr. 100.0 83. 3 120. 3 207 106.2 90. 50. 0 40. 142 72.8 May 103.2 116.7 103.1 202 103. 6 || 92. 16. 7 31. 135 69. 2 Admissions - - Subtotal 225 91 124 441 XXXXX 181 12 88 281 XXXX * | *—º 226.2 195 | 125 6 64 144. 1 195 X XXXXX XXXXX XXXXX 228.5 117.2% 164. 2 84.2% XXXXX XXXXX XXXXX Drug Treatment Modalities: Table 5. Modality Utilization Rates Source: Client Oriented Data Acquisition Process (CODAP) DF = Drug Free M = Maintenance D = DetOx intake referrals were constantly made by the jail personnel, and any number of Octagon clients were incarcerated during 1976 and 1977, it is doubtful that the total population being serviced at the jail accounted for more than approximately 40% of the detoxification and drug free clients in treatment during those years. In addition, incarcerated clients on detox schedules tend to become drug-free or are released in relatively short periods of time and would not necessarily remain in either modality. Thus, it is difficult to validate the notion that a direct, crugial relationship exists between Octagon's treatment capacity utilization rates and a Single community Outreach program. Even so, it is fairly evident that detoxification and drug free treatment slot utilization levels appear to be decisively associated with overall pro- gram admission 1evels. Together these slots accounted for 48.9 percent of the 1976-77 admissions and 35.6 percent of the 1977-78 admissions. Other Washtenaw County Drug Abuse Indicator Data Crime Three separate sets of data on criminal activity in Washtenaw County have been reviewed. These include Ann Arbor Police Department arrest totals for fiscal years 1976-77 and 1977-78, Michigan State Police arrest totals (narcotic law only) for January – December, 1977, and the Washte- naw County Prosecuting Attorney's Office warrant arrest and prosecution totals for each year 1975 through 1977. City of Ypsilanti PD data were unobtainable. In all quarters, data for 1978 was generally in the pro- 229 cess of being pulled together and interpreted, and unavailable at the time of this report's data collection procedure. Some attempt was made at reconciling each data set with the others, as well as to separate out any overlap in reported figures. This effort proved to be thoroughly impractical for several reasons. Since the Ann Arbor Polic Department data was obtained for fiscal years (July 1 - June 30) of only two consecutive periods, it was difficult to manipulate and extrapolate from. Aside from the fact that only one year's data was ob- tained from the State Police, both Ann Arbor PD and State Police arrest data are significantly different from the County Prosecuting Attorney's data. Major problems with the comparability of differing definitions and methodologies for data collection are clearly felt to be impediments to reliable interpretation. However, cautiously, the data are nonethe- less presented, with the hope that supportive trends may be observed. The largest data set, State Police 1977 data, indicates that 542 arrests occurred in the County for narcotic law violations, which in- cludes sales and use. Since it is not clear what "use" means in the context of the report, it is presumed that the term refers to "posses- sion" of quantities of drugs generally too small to be other than for personal consumption, rather than for selling. The categories of * drugs included in the report are opium-cocaine, marijuana, synthetic, and other. Eighty-seven percent of the arrests noted were for drug use (382 males/87 females), and 13 percent (69 males, 4 females) resulted from drug sales. Marijuana use constituted the largest number of drug 230 specific arrests, with 294 males and 66 females arrested. No arrests were recorded for the sale of synthetics, and only . 7% of the arrests were for synthetic use. Opium-cocaine accounted for 7 sales arrests (a11 male) and 11 use arrests (55% male). Other use arrests totaled 94 (17%), with 15 females involved. Other sales resulted, in 43% of the arrests made by the Michigan State Police Department.* Since the general jurisdiction of the State Police in Washtenaw County is upon the highway, it is highly probable that these arrests were made in connection.with some other traffic law violation. Ann Arbor PD data indicates a general" decline in all arrest cate- gories except narcotic drug law offenses over fiscal years 1976-77 and 1977-78. Of the 730 larceny arrests recorded for fiscal 1976, 49.7 percent were males; similarly, males were arrested less (48.8%) during fiscal 1977 for larceny. Shoplifting appears to be the most signifi- cant type of activity accounting for the high larceny activity among women. Females were only arrested for 20 percent of the 173 narcotic 1aw arrests in 1976, and even less (11%) out of 210 narcotic law ar- rests in 1977." The substantive increase in narcotic drug law arrests includes an unknown number of persons fined $5 for marijuana posses- Sion. The exact percentage of those arrests accounted for by the fines is indeterminable at this time. The Washtenaw County Prosecuting Attorney's Office publishes an annual report of its activity in the area of warrant arrests and crimi- nal prosecutions.6 This data is substantially different from the data reported by the Ann Arbor Police Department and the State Police. It reflects the level of cases authorized for trial for the various re- ported offenses. The data presented in Table 6 attests to the rather comprehensive nature of the drug related offenses handled by this judicial unit. ARRESTS 75. 76. 77 Delivery of Heroin . . . . . . . . . . 165 71 72 Delivery of LSD . . . . . . . . . . 11 - «- 6 Delivery of Marijuana . . . . . . . 26 7 5 Delivery of Hashish . . . . . . . . 5 •º ºr 4 Delivery of Other Hallucinogens . . --- *- tº- 2 Delivery of Demerol . . . . . . . . --- * = 1. Delivery of Cocaine . . . . . . . . 15 12 17 Delivery of Methamphetamines . . . . 1 tº gº 10 Delivery of Barbiturates . . . . . . --- tº º 2 Delivery of Phencyclidine . . . . . 29 16 23 Possession of Heroin . . . . . . . . --- 1. l Possession of Cocaine . . . . . . . 1 2 4- tº Possession of Hashish . . . . . . . 2 ºn tº * - 255 109 143 Table 6. Comparison of Drug Law Arrests/Prosecutions for 1975 to 1977 Source: Report of Criminal Authorization, 1975-1977 The data in Table 6 show a decline over the three years in the number of criminal prosecutions handled by the Prosecuting Attorney's Office for drug law violations. The significantly high number of arrests in 1975 for heroin delivery were the result of concentrated investigations during that year by the specialized narcotics team operating in the County. Not much traffic is noted in marijuana sales during 1976 and 1977, and an amphetamine trafficking problem appears to be on the increase, in 1977. Consistent arrests occurred during all three years for the sale of cocaine and PCP. Judging from the data presented, it is not likely that locating various drugs of choice would be much of a problem for Washtenaw County drug users. Although 1978 data is not yet released, it seems likely that the general increase in drug trafficking arrests noted during 1977 will continue for the wide variety of drugs indicated. It is noteworthy that 48% of the criminal prosecutions involving drug law violations were for the sale or possession of non-narcotic drugs The relationship of criminal activity and drug abuse is not always as clear cut as it would need to be for optimal usefulness of crime statistics as supportive evidence in community drug abuse assessments. The data presented here are not meant to provide any direct measure of drug abuse levels in Washtenaw County. Rather, they are intended to illustrate the variety of criminal involvements occurring in the com- munity, from which can be observed the levels of particular crimes generally believed to be associated with high levels of drug abuse in 231 a given community. The major flaw in the data, of course, is the fact - that drug abusers are not specifically identified within the arrested populations and reported on separately. Thus, while the data reviewed speaks to some measure of the level of drug related criminal activity, the most complete analysis of the relationship between crime and drug using behavior will necessarily focus on the criminal careers of known drug abusers. Hospital and Emergency Room Visitations for Drug Related Emergencies There are seven hospitals in the immediate vicinity of Ann Arbor and Ypsilanti. Each of these hospitals have varying degrees of drug abuse oriented programs, ranging in Sophistication from One person thera- peutic intervention/data gathering Operations to full-fledged teaching and research units devoted to the understanding and amelioration of drug abuse related medical problems. One of the hospitals in the area is a member of the DAWN reporting network. Requests for input from these institutions proved very unsatisfactory. Only one set of data was re- turned for drug related emergencies treated or seen by the hospital medical personnel. The data is obviously limited in what it can contri- bute to the overall assessment of drug abuse levels in Washtenaw County. For our purposes, this data will be considered as representing little more than a glimmer of the problem of medical emergencies resulting from the misuse and abuse of various drugs. Table 7 shows both inpatient and outpatient levels of opiate induced medical emergencies for 1975-78. Outpatient Visits – November 1978; Number of Patients – 11 Inpatient Hospitalizations – July 1975 to present’ Total Through ER July – December 1975 13 O January – June 1976 4 O July – December 1976 9 4 January – June 1977 9 2 July – December 1977 8 3 January – June 1978 6 3 July to Present 1978 2 l Patient seen in Emergency Room. 2 Data for these patients based on H-ICDA-2 diagnosis code 965.0 which is specifically "Adverse Effects, opiates and synthetic analogs including codeine, methadone, morphine, opium, Deinerol and Delaudid." 3 Total includes those through Emergency Room. Table 7. Opiate Induced Medical Emergencies Treated in One Clinical Setting, 1975 - 1978 232 Source: Anonymity requested pending institutional review of this report. These data reflect rather consistent numbers of emergency room and hospitalization episodes for Opiate induced medical emergencies. A total of 52 such episodes were seen between July, 1975 and Novem- ber, 1978. Twenty-five percent of the emergencies occurred in the latter half of 1975. Admissions to an inpatient status for drug induced emergencies after having been diagnosed in the emergency room does not appear critically until the latter half of 1976 on- ward. Such emergencies appear to be tapering off at present, al- though all the data is not in for the 1978 period. This data reports more inpatient than outpatient visitations for drug induced emergencies as a consequence of the idiosyncratic nature of the data collection and reporting procedures of the clinic. It seems that only the most current outpatient information is retrievable from the data system because it is not coded into the system for per- manency. In fact, outpatient demographics are not maintained in file at a11, and Summary contact information is kept only in log books. The more permanent and detailed data banks are reserved for the more chronic inpatient cases. The rationale behind this record keeping Scheme is that outpatient files would be too voluminous to maintain, considering the sheer numbers of outpatient visits per week. Addi- tionally, Outpatient visits, especially emergency room cases, tend to be one-time situations in which a detailed record would quickly become useless, except, perhaps, to some epidemiologist who is looking particularly at outpatients for specific disease occurrences. According to the data obtained, opiate induced medical emergencies have remained at consistently moderate levels for some time since the latter half of 1975. The decline noted in the 1978 levels may be due to the general unavailability of opiate drugs in the area (not a very likely situation), or a general decline in the quality of the available drugs. It remains to be seen which is the most plausible explanation for the observed re- duction in emergencies requiring medical attention. Hepatitis and Deáth Data Both of these indicators pose some problems of interpretation. He- patitis information is only available from the State Department of Pub- lic Health. Both infectious and serum hepatitis cases are reported together for each county in the state. However, the total number of serum hepatitis cases reported in the entire state are footnoted in the annual report of communicable diseases. The percentage equivalent of the total number of state reported serum hepatitis cases was used to ar- rive at an estimation of serum hepatitis cases occurring in Washtenaw County for the three years 1975 through 1977. Accordingly, it was es- timated that 14 serum hepatitis cases occurred in Washtenaw County in both 1975 and 1976. Thirty serum hepatitis cases are estimated to have occurred in the County in 1977, an increase of 114 percent. The ac- tual reported combined cases of infectious and serum hepatitis are as follows for Washtenaw County: 1975 -- 62; 1976 -- 45; 1977 -- 95.7 The conversion factors, based on State-1evel reported cases, were: 233 1975 -- 22%; 1976 -- 31%; 1977 -- 32%. The incidence of the type of hepatitis generally associated with intravenously consumed narcotic abuse appears to be on the increase. However, it is difficult to qua- lify this data much further since the age ranges for the source data are not published with it. According to Department of Public Health Statistics, substance abuse was the underlying cause of death in 22 Washtenaw County deaths reported in 1976 and 20 deaths reported in 1977.8 The classification "substance abuse" does not include alcoholism for these reports. The Washtenaw County Health Department - Medical Examiner's Office reports only 8 drug related deaths for 19779 No previous year's report is available because the current report was initiated as a special project by one of the office clerks, who also plans to compile future reports of this nature. Some 1978 drug related deaths have already been analyzed for this report. The County Health Department death report is comprehensive in that dates of death, age, race, Sex, and drug (s) abused are indicated along With the cause of death. All eight of the confirmed drug related or induced deaths in 1977 were white, seven were females, four were sui- cides, two were natural, one was accidental (overdosed on morphine), and One resulted from Overdose-induced pneumonia on an unknown drug. Al- though only three of this group were over 40 years old, the mean age for the group was 41 years. The drugs used in the suicides included a 23|| combination of dalmane, phenobarbital, and mySoline in One case, and aspirin, scopalamine, and mySoline respectively in the other cases. There were levels of salicylates, propoxyphene, and imipramine found in the case of the natural male death. The two drug related deaths reported through March, 1978 by the County Medical Examiner's Office indicated methapyrilene, quinine, alcohol, and morphine in One case and triavil in the other. The non-specificity of the Department of Public Health data makes it rather difficult to interpret. It may be necessary to re- quest special reports from this office in order to be able to ob- tain the required data. Heroin Purity The Drug Enforcement Administration reports that the retail purity level of Detroit PD samples declined steadily from 1976 through the first quarter of 1978. 1976 purity levels were, for the first through the fourth quarter respectively, 9.6%, 7.4%, 7.4%, and 7.7%; 1977 purity levels were 4.3%, 2.7%, l; Q%, and 2.0%; 1978 purity level for the first quarter only was 1.7%. An inquiry into the community found that some law enforcement officials believe the current 1978 purity level in Washtenaw County to be somehere between 3% and 7% for heroin. However, other ethnographic sources disclaim all of the above estimates of heroin purity levels. Most users are seeing brown heroin at this time, which is believed by them to be less than 0.5% pure. Some white heroin is again being reported on the Streets. It is esti- mated by the knowledgable that any increase in purity levels for her- Oin is a consequence of the very high quality of the intermittently available white Turkish heroin. The current going price for the white heroin is approximately $80.00 for an eighth teaspoon ( 2 "mac" spoons). The purity level of this heroin is estimated to be in the neighborhood of 12 "macs" of brown for each "mac" of white, or 6%. Data on confiscated drug purity levels for Washtenaw County are generally not available. The analyses of such drugs are done by the State Police Crime Lab located less than fifty miles from Ann Arbor. However, these analyses are done upon request of an arresting officer, rather than routinely. Also, no codified report is maintained by the chemists at the Crime Lab of individual analyses. The Lab files do contain the disjointed, individual reports requested by arresting officers, however. And, the manpower presumed to be necessary in order to put this information into any kind of meaningful whole is considerable. However, volunteers for the job must go through several clearances and Still may be denied access to the files because of the very sensitive nature of the information contained in them. Yet, it should be worth Wrestling with the anticipated problems in Order that the jurisdiction of Washtenaw County can begin to approach at least One of its problems in an informed, precise, constructive fashion. Conclusion A thorough analysis of the drug abuse problem in Washtenaw County Will necessitate the very close coordination of several key agencies in the County and at the State level, and will also demand the very Open and free exchange of all information vital to the completion of the tasks of initial assessment and continued monitoring. A major problem is a lack of a common reporting format that can be used by agencies in which information must be gathered. If the design of treat- ment strategies is to be based upon the data collected, it is crucial that a common language be in operation with respect to the behaviors related to drug use and abuse. This language might do much to educate the community, not only about the nature of the addict, but also about what types of intervention are necessary to redirect that nature. For example, the term "drug use" might mean one thing to the criminal jus- tice system, and quite another in the hospital setting. Data indicators for drug use and abuse are largely non-Specific, and must be extrapolated from the data of agencies whose primary popula- tions may not be drug abusers. As such, these data are tentative with respect to presenting a true picture of trends in drug use and abuse. The variables which indicate drug use and abuse must be isolated with- in the community at all cost, however. It is in this regard that the data such as that presented in this paper become useful. Yet, there seems to be a general unwillingness on the part of other community agencies to provide treatment agencies with this kind of information. 235 Whether this situation is a consequence of the nature of the bureau- cracy within institutions, or results from the general political na- ture of drug treatment facilities is not known. It seems obvious that the nature of the drug user/abuser has changed in Washtenaw County in the last ten years, if treatment admis- sions are the established Criteria indicating this. The reasons are not clear, in view of the kind of data available at the time of this report. However, it would seem that a great deal of attention is not given to treatment variables for the drug abusing population. For instance, hospitals do not seem to make the separation of attending drug problems in the emergency room versus those admitting to the hospital for drug related illnesses. The general trend seems to see the drug abuser within the normal admissions. This phenomenon may be related to the Sophistication of the drug abuser within the County, and his/her ability to hide within the system due to his/her knowledge of the agency recordkeeping requirements, and how to avoid them. In fact, such knowledge may be a variable concerning the existing indicator measures for heroin and other drug abuse. Persons who have previously admitted to treatment are aware of the types of demands placed upon the client, and have been willing to provide this informa- tion for the sake of treatment. Since the data shows that 48 percent of all admissions for treatment are readmissions, and since the format of the primary data Collection instruments has not changed significantly, 236 the interpretation of the data may not truly reflect the type of client seen in treatment. As such, true data may not be available which re- flects drug use/abuse trends, and, therefore, treatment needs. It would seem appropriate to obtain further data from the Prosecu- tor's Office in order to determine the direct correlation between drug use and the associated criminal behaviors of addicts. While it is often assumed that the drug user/abuser must commit crime in order to support a habit, hard data concerning actual convictions is needed to verify the criminal behavior of the addict being seen in treatment at the pre- sent time. The Prosecutor's Office is singled out for this type of data analysis since it appears to have the most comprehensively collected and reported data regarding the interface of drug abuse incidence and the judicial System. The measurement of drug abuse as a disease is likewise limited with- in Washtenaw County, in that mortality rates for the County seem to con- flict with State reports of a similar index. Again, this may indicate a general lack of knowledge about the variables of drug abuse, or it may reflect a lack of a common reporting format for drug related incidents. Morbidity rates are also difficult to determine, in that there is no reporting differentiation with regard to the types of hepatitis being reported. Both serum and infectious types are simply reported as hepati- tis. - Obtaining accurate, complete data is not realistic within the pre- sent record keeping systems in Washtenaw County for all variables indi- cating levels of drug abuse. Therefore, the profiles of the drug abusers are in question in terms of making definitive Statements about the drug abuser most likely to seek treatment. Even less accurate is the profile of the user/abuser hidden in the community and not approaching treatment as an alternative. It is hoped that a constructive, Consistent System can be developed in order that the drug abuser may be served in his/her specific need. The state of the art and science of drug abuse assessment has recognized these issues as common problems. - REFERENCES 1. Washtenaw County Prosecutor's Office, Report of Criminal Authori- zation, 1970 - 1977. 2. Hunt, Leon Gibson, "Prevalence of Active Heroin Use in the United States", in The Epidemiology of Heroin and Other Narcotics, DHEW, 1977, pp. 61-86. 3. Greene, Mark H. ; Kozel, Nicholas J. ; Hunt, Leon G. ; and Appletree, Roy L., An Assessment of the Diffusion of Heroin Abuse to Medium-Sized American Cities, SAODAP, Washington, D.C., 1974. 4. Michigan State Police Department, Print-out Report of Offense 18- 19 (Narcotic and Gambling Law Offenses) for Washtenaw County, 1977. 5. Ann Arbor Observer, "Arrests are Down City-Wide; Sex Differences in Crimes Remain'', Vol. 3, No. 4, December, 1978, p. 9. 6. Washtenaw County Prosecutor's Office, Report of Criminal Authori- zation, 1975, 1976, and 1977. 7. Michigan Health Statistics (Annual Report), Table 4.13, Reported Cases of Certain Communicable Disease by County, Michigan Residents, 1975 – 1977. 8. Michigan Department of Public Health, Underlying Cause of Death: Substance Abuse, County of Residence, Michigan 1976-1977 (Unpublished Office of Vital Health Statistics printouts). 9. Lewis, Irene, Report of Alcohol and Other Drug Related Deaths - 1977 to 1978 (Washtenaw County Health Department - Medical Examiner Office mimeo). 10. Drug Enforcement Administration, DEA Retail Level Heroin Program - Quarterly Report, 1973 - 1978. 237 Aſpp.B.NDIX A SCHOOL REPORT AND QUESTIONNAIRE PAUL S, UPPAL SUBSTANCE USE AMONG NEW YORK STATE PUBLIC AND PAROCHIAL SCHOOL STUDENTS IN GRADES 7 THROUGH 12 New York State Division of Substance AbuSe Services November 1978 The Division of Substance Abuse Services conducted a major survey of secondary school students throughout New York State in March and April 1978. A stratified random sample of 146 public and 48 parochial schools participated. Over 35,000 students in grades 7 through 12 completed a five-page drug use questionnaire that maintained the anonymity and confidentiality of the respondents. The sample was projected to reflect drug use among the 1,817,000 students enrolled in public and parochial Schools. Major Findings Substance use is widespread among secondary school students in New York State. © Over 960,000 students –- more than 54 percent -- have used marijuana in their lifetime. At least 220,000 -- almost 13 percent -- have used hashish, inhalants such as glue or solvents, or used tranquilizers nonmedically. & At least 275,000 students -- about 16 percent -- have used PCP (Angel Dust). - & At least 155,000 -- almost nine percent -- have used cocaine or hallucinogens or have used cough medicine with codeine, other narcotics, or "downs" (depressants) nonmedically. . Heroin and illicit methadone are least apt to be used; fewer than 50,000 students -- about three percent -- have ever done SO, - © Among those students who have used cocaine, PCP, heroin and "ups" (stimulants) at least once, particularly large proportions began their use since January 1977. Alcohol has been used in combination with other substances by 568,000 students -- almost 32 percent -- since September 1977; alcohol has been used in combination with marijuana by 466,000 -- more than 26 percent -- in the same time period. A-1 A-2 The majority of students -- 51 percent -- used at least one substance (other than alcohol) since School began in September 1977. 882,000 -- 49 percent -- used no substances; 387,000 -- 22 percent -- used one substance; 358,000 -- 20 percent -- used two to four Other substances; and ... 167,000 students -- nine percent -- used five or more Substances. Comparisons with Previous New York State Surveys Comparisons with similar statewide surveys of public high school Students conducted in 1971 and 1975 reveal substantial increases in the lifetime and current use (in past 30 days) of several substances: Marijuana and tranquilizer use has doubled between 1971 and 1978. Lifetime use of cocaine and inhalants has almost trip led since 1971. Lifetime use of hallucinogens and stimulants has increased by about four percent since 1971. Use of heroin and depressants has remained the same since 1971. Substance Use by Grade Substance use generally increases with grade level. Students in 11th and 12th grades are generally two to four times more likely to be substance users than 7th and 8th graders; levels of use by 9th and 10th graders generally fall somewhere in between. sº Heroin and illicit methadone use, however, are not related to grade level; use of inhalants and cough medicine with codeine declines with increasing grade level. Substance Multiple substance use increases with grade level and the proportion of students who have used no substances declines. Use by Health Service Area (HSA) Substance use is proportionally highest in the Buffalo Health Service Area followed by the Long Island Health Service Area. Substance use is proportionally lowest in the Rochester Health Service Area. The New York City HSA has levels of use that are generally similar to the statewide figures; however, for certain substances this HSA has the highest proportion of users in the State. The proportion of substance users in the Syracuse, Binghamton, Albany and White Plains Health Service Areas is about the same as the statewide figures. A-l; Substance Use Among New York State Public and Parochial School Students in Grades 7 through 12 A. Introduction Youth in secondary schools (grades 7 through 12) have traditionally been identified as a population at high risk of drug abuse. As a result the New York State Division of Substance Abuse Services periodically surveys this population to assess the patterns and magnitude of drug use. The previous statewide survey was conducted in the Winter of 1974/75. Since then some of the substances of choice have changed; others have remained the Same. The primary objective of the new survey was to assess drug use among public and parochial secondary school students in New York State. This report contains findings for the state as a whole and for its eight individual Health Service Areas (map on page 26) regarding the prevalence, frequency, and recency of use, as well as the incidence of first use among students for the following substances: PCP, hallucinogens, cocaine, inhalants such as airplane glue or solvents, heroin, methadone, marijuana, hashish, Stimulants, depressants, tranquilizers, cough medicine with codeine and other narcotics. Other objectives of the survey were: to determine student awareness of and participation in school-based drug programs, to measure the need for services among the student population, and to examine behaviors that may be related to drug abuse, such as truancy and classroom disruption. Future reports will focus on each of these objectives. 1. Sampling Design The Survey was based on a sample of 35,317 students randomly selected from public and parochial schools throughout the state. The Selection procedure involved a series of steps. First, each of the State's eight health service areas was stratified into central city, suburban, and rural regions; one or more school districts were randomly selected from each of these regional types. Then, a number of schools within each sampled school district were randomly selected. As the final Step, approximately four classes per grade (7 through 12) in each of the Schools were randomly chosen. The survey was then administered to all Students present in these classes on the date of the survey. The Sampling design was such that every student enrolled in grades 7 through 12 in New York State public and parochial schools had an equal chance of being in the Survey. In presenting the findings, the sample of 35,317 was statistically projected to reflect drug use among the 1,817,000 students enrolled in public and parochial schools. In short, each student in the survey was representing a number of his or her peers in the particular school, school district and region of the state. 2. Questionnaire A five-page questionnaire was developed by agency staff. It was printed in a format suitable for machine optical scanning so that processing could be easily accomplished. A research consulting firm outside the state was subcontracted to print and process the questionnaires. The questionnaire was designed for self-administration; pretesting in a number of schools showed that it could be completed in one class period. The questions covered personal data, drug use behavior, maladaptive behavior and awareness of and participation in school-based prevention programs. Internal consistency checks were built in to permit elimination of frivolous and inappropriate responses. A-5 3. Procedures In order to implement this survey, permission was secured from the selected School district and diocesan superintendents who in turn designated representatives to work with the agency's survey teams. The representatives attended a training session and then provided the agency with a list of all scheduled English classes at each sampled school from which the classes were selected. They then made arrangements with appropriate school personnel and supervised the survey in the schools. Proctoring was done by teachers from the sampled school and/or the representatives and their staff. A Spanish translation of the questionnaire was read by the proctors in classes where Hispanic students had limited English comprehension. The cover letter of the questionnaire assured students of the confidential nature of the survey; students were carefully instructed not to write their names anywhere on the booklet. Participation was voluntary; Students were instructed to leave blank any questions they could not answer honestly. After completing the questionnaires, students inserted them into sealed boxes which were returned to the agency and then shipped to the consulting firm for optical scanning. The resulting computer tape is the basis for the findings that follow. The original questionnaire booklets were destroyed by the consulting firm to assure confidentiality. After receiving the data tape, the Division of Substance Abuse Services carefully analyzed student responses for indications of frivolous answers (e.g., marking all substances as having been used at the maximum level, giving an age of first use of several substances that was older than current age, etc.), for inconsistent answers (e.g., giving a positive response to the aver use question, but responding "never" on the age of first use question, etc.), and for incomplete answers (leaving one or more drug use questions blank). Thus, the data presented below are based upon a careful classification of each respondent as a user or Il Gn USer. Students who could not be so classified are excluded statistically from the findings. Statistical adjustments were made based on truancy and chronic absenteeism from School. The responses of students who indicated skipping classes many times during the school year and in the past 30 days were statistically increased to represent enrolled students not in class on the day of administration. A-7 B. Findings for Each Substance (Table 1) Substance use is widespread among secondary school students throughout New York State. In this section, the statewide results are presented separately for each substance. In the remainder of this report, drug use rates at lifetime, recent, current, and heavy levels are presented; these nonmedical use levels are defined as: lifetime use – used at least once in lifetime; © recent use - used at least once since School began in September, 1977 (about 6 months prior to participation in the Survey); current use - used at least once in the past 30 days; heavy use – used 10 or more times in the past 30 days. PCP (Angel Dust) Of the 1.8 million* New York State public and parochial school students in grades 7 through 12: © 276,000 -- 15.5 percent -- have used PCP; © 172,000 -- 9.6 percent -- are recent users; © 90,000 -- five percent -- are current users; © 12,000 -- 0.6 percent -- are heavy users. *For each substance and level of use the percentages are based upon somewhat less than 1.8 million students; the no response column indicates the number of students who gave frivolous, inconsistent, or incomplete answers. These have been excluded from the statistical results. DIW l Sl Ol' OF SUBSTANCE AIRUSE Sſ.RVICES TMI’l.E. l. SUBSTANCE ABUSE Al101ſt; tıEW YORK STATE SIU[][HIS 1,017,000 Students Enrolled in Grades 7 through 12, Spring 1978 sº- - - - --- - - d Ilever Used Lifetime Use ||O Récent Use Curr Grºt U.Sc Curſe 1, t lic : , , U : “Type of Substance ſtes punse || (12cd since school (U&cd in past (Lºt d i (, , t if & S (Used at least once) Legan in Sept. '77) 30 days) in a St 3 (; ; ; , ; } - Il #. Il 3. il il % II 3. -- PCP (Angel Dust) l,510,000 84.5 276,000 15,5 31,000 - || 172,900 9.6 – 90,000 5.0 12,000 0.6 Ilallucinogens l,621,000 91.3 l 55,000 8.7 4l,000 | 109,000 5.8 63,000 3.5 5,000 * { | Cocaine l,596,000 89.2 194,000 l 0.8 27,000 l 36,000 7.6 66,000 - 3.7 6,000 * { Inhalants l, 48l ,000 84.0 282,000 l6.0 54,000 l 49,000 8.3 _84,000 4.7 9,000. a . *---- - - | Heroin |1,745,000 97.4 47,000 2.6 25,000 3] ,000 l .. 7 20,000 l. l 3,000 **____ Mc thadone (Illicit) l,742,000 97.5 44,000 2.5 3] ,000 28,000 l. 6 17,000 l.0 l,000 * . - Marijuana - - 8] 3,000 45.8 964,000 54.2 40,000 833,000 46.4 652,000 36.9 293,000 l 6.6 insisi 1,325,000 74.8 ºf,000 25.2 45,000 34l,000 19.0 --- 314,000 l l .9 36,000 2.0 stimulants --- l, 495,000 84.9 206,000 15. I 56,000 200,000 ll . . | 121,000 6.7 16,000 0.9 Depressants lºgº,000 89.3 l69,000 10. 7 44,000 l 28,000 7, 1 - 73,000 4. 7,000 * { Tranquilizers i,514,000 07.3 220,000 || 2.7 83,000 150,000 8.8 100,000 5.9 9,000 0.9 ºf lºw 89.0 l 95,000 l l .0 $2,000 || 118,000 6.6 __77.000 4.3 9,000 0.5 Other Harcotics l, 560,000 88.7 199,000 ll. 3 58,000 l 34,000 7.5 49,000 2.7 6,000 * . Example of How to Read the Table: NOTE: *% less than 0.5%. à methaqualone; # * tranquilizers such as Walium and Librium; Date of Preparation: September 25, 1978 Among responding students, 276,000, or 15.5%, The number of users in the table are underestimates since they do less than 500, Hallucinogens such as I.SD, Inescaline, and psilocybin; have used PCP (angel dust) at least once. not include the nonrespondents. ſ stimulants such as amphetamines and diet pills; other narcotics such as opium, inorphine, and codeine. depressants such as barbi turates and A-10 Hallucinogens Of the 1.8 million New York State public and parochial school students in grades 7 through 12: © 155,000 -- 8.7 percent -- have used hallucinogens; § 105,000 -- 5.8 percent -- are recent users; . • 63,000 -- 3.5 percent -- are current users; 5,000 -- less than 0.5 percent -- are heavy users. Cocaine Of the 1.8 million New York State public and parochial school students in grades 7 through 12: © 194,000 -- 10.8 percent -- have used cocaine; tº 136,000 -- 7.6 percent -- are recent users; 66,000 -- 3.7 percent -- are current users; 6,000 -- less than 0.5 percent -- are heavy users. Inhalants Of the 1.8 million New York State public and parochial School students in grades 7 through 12: © 282,000 -- 16.0 percent -- have used inhalants; 69 149,000 -- 8.3 percent -- are recent users; º 84,000 -- 4.7 percent -- are current users; § 8,000 -- less than 0.5 percent -- are heavy users. Hero in Of the 1.8 million New York State public and parochial students in grades 7 through 12: 47,000 -- 2.6 percent -- have used heroin; 31,000 -- 1.7 percent -- are recent users; Q 20,000 -- l. l percent -- are current users; 3,000 -- less than 0.5 percent -- are heavy users. [ ] { i cit Methadone Of the l.8 million New York State public and parochial students in grades 7 through 12: 44,000 -- 2.5 percent -- have used illicit methadone; 28,000 -- 1.6 percent -- are recent users; 17,000 -- 1.0 percent -- are current users; l,000 -- less than 0.5 percent -- are heavy users. Marijuana and Hashish Of the 1.8 million New York State public and parochial students in grades 7 through 12: & 964,000 -- 54.2 § 833,000 -- 46.4 Ç 652,000 -- 36.9 percent -- are current users; 293,000 -- 16.6 percent -- have used marijuana; percent -- are recent users; percent -- are heavy users. 447,000 -- 25.2 percent -- have used hashish; 341,000 -- 19.0 percent -- are recent users; 214,000 -- 11.9 percent -- are current users; 36,000 -- two percent -- are heavy users. School School School A-ll A-12 Nonmedical Use of Stimulants (mainly amphetamines) Of the 1.8 million New York State public and parochial school students in grades 7 through 12: Q 266,000 -- 15. l percent © 200,000 -- ll. l percent O 121,000 -- 6.7 percent tº 16,000 -- 0.9 percent have used stimulants nonmedically; are recent users; are current users; are heavy users. Nonmedical Use of Depressants Of the 1.8 million New York State public and parochial school students in grades 7 through 12: © 189,000 -- 10.7 percent -- have used depressants nonmedically; © 128,000 -- 7.1 percent -- are recent users; O 73,000 -- 4.1 percent -- are current users; 7,000 -- less than 0.5 percent -- are heavy users. Nonmedical Use of Tranquilizers Of the 1.8 million New York State public and parochial school students in grades 7 through 12: © 220,000 -- 12.7 percent -- have used tranquilizers nonmedically; O 158,000 -- 8.8 percent -- are recent users; º 106,000 -- 5.9 percent -- are current users; § 9,000 -- 0.5 percent -- are heavy users. Monſmedical Use of Jough "ædicine With codeine Of the 1.3 million New York State public and parochial school students in grades 7 through 12: 195,000 -- 11.0 percent -- have used cough medicine with codeine nonmedically; l 18,000 -- 6.6 percent -- are recent users; º 77,000 -- 4.3 percent -- are current users; 9,000 -- 0.5 percent -- are heavy users. Other Marcotics (morphine, Oil audid, opium, etc.) Of the 1.8 million New York State public and parochial school students in grades 7 through 12: 199,000 -- 11.3 percent -- have used other narcotics; A-13 134,000 -- 7.5 percent are recent users; 49,000 -- 2.7 percent -- are current users; 6,000 -- less than 0.5 percent -- are heavy users. -1|| Comparisons Among Substances (Table 1) The five most popular substances used by New York State's secondary school students are marijuana, hashish, inhalants such as glue or solvents, PCP and stimulants. Marijuana has been used by over half -- 54 percent or 964,000 -- of the students. A quarter, or 447,000, of the state's students have tried hashish. At least 266,000 students -- more than 15 percent -- have used inhalants, PCP or stimulants. - - At least 155,000 students -- more than 8 percent -- have tried other narcotics, cough medicine with codeine, cocaine, depressants, or hallucinogens. Heroin and illicit methadone are the two substances least apt to be used; each of these drugs has been used by slightly fewer than 50,000 students. Marijuana is the substance most apt to be used currently (in past month) and on a heavy basis (10 or more times in the past month). One secondary school student out of every three -- or 652,000 -- has used marijuana in the past month; one secondary school student out of every six -- or 293,000 -- now uses it twice a week or more. Alcohol has been used in combination with other substances by almost one-third of the students -- 568,000 -- since school began in September, 1977; more than one-quarter have used alcohol in combination with marijuana. - Less than one percent of the state's secondary school students are heavy users of any substance other than marijuana and hashish. Stimulants are the substances most likely to be used recently, currently and heavily after marijuana and hashish. Illicit methadone, followed by heroin, are the substances least apt to be used recently, currently and heavily. D. Trands in Substance Use Since 1971 A central finding of this study is that substance use among New York State secondary school students has increased dramatically since the early 1970s. For most substances, this increase in use has not only been consistent over time, but has been especially sharp during the past three years. Figure l displays the changes in lifetime and current use of various substances among public school students in grades 9 through 12. Earlier statewide surveys, conducted in 1971* and 1974/75, * sarve as the bases for comparisons with the present study. In order to have comparability across the three studies, the 1978 data are limited to public schools and are not adjusted for chronic absenteeism. The following trends are clearly evident: - Lifetime use and current (in the past 30 days) use of marijuana have more than doubled since 1971. Almost 65 percent of the 9 through 12 graders in the 1978 survey report having used marijuana, compared to 30 percent in 1971 and 42 percent in 1975. Current marijuana use increased from 19 percent in 1971 to 23 percent in 1975 and to 46 percent in 1973. @ The use of cocaine among 9 through 12 graders has tripled. Lifetime use was reported by 12 percent of the 9 through 12 graders in 1978, compared to only four percent in 1971. Current cocaine use also increased, although not by the same magnitude. - A surprising increase has occurred in the use of inhalants. Lifetime use of these drugs increased from five percent in 1975 to 14 percent in 1978; current inhalant use also showed an increase, from two percent in 1975 to three percent in 1978. These findings are a reversal of earlier trends showing that both lifetime and current use had decreased from 1971 to 1975. *D. Kandel, E. Single, R. Kessler, "The Epidemiology of Drug Use Among New York State High School Students: Distribution, Trends, and Change in Rates of Use," American Journal of Public Health, 1976, Vol. 66, pp. 43- 53. **New York State Office of Drug Abuse Services, "A Survey of Substance Use Among Junior and Senior High School Students in New York State, Winter 1974/75. " - 60 - 20 - A-16 15- 10 - 5– DIVISION OF SUBSTANCE ABUSE SERVICE FIGURE 1. THE TREND IR LIFETIME USE AND CURREIT USE" OF SELECTED SU3STANCES AMONG NEW YORK STATE STUDENTS IN PUSLIC HIGH SCHOOLS (Grades 9-12) 1971,b iſ HH Till | ||||| 1975, c 1978d Lifetime Use Current Use 42.1°. T 29-52. 3. º * { * F-7 | t |* | 7 - ...—amº '71 e '75 *††: ###–#-F#–F#–His hallucin- cocaine inhalants heroin ogens *Defined as use at least once within the 50 days prior to the survey. For the 1975 data, current use is defined as use at least once in the past six months. - b D. Kandel, E. Single, R. Kessler, "The Epidemiology of Drug Use Among New York State High School Students: Distribution, Trends, and Change in Rates of Use, "American Journal of Public Health," 1976, Vol. 66, pp. 45-55. '71 s '78 ‘71 75-78 stimulants depressants. tran- ſmarijuana quilizers “New York State Office of Drug Abuse Services, "A Survey of Substance Use Among Junior and Senior High School Students in New York State, Winter 1974/75." d . • * g. New York State Division of Substance Abuse Services, Periodic Assessment of Drug Use Among Youth, 1978. *Comparable data were not available in the 1975 survey. ‘cata for 1975 include both marijuana and hashish. © Use of hallucinogens has increased only slightly since 1971, while heroin use has remained virtually the same. About one percent of the 9 through 12 graders in both the 1971 and 1973 surveys reported current use of heroin. O Among the pills, nonmedical use of tranquilizers shows the sharpest increase at both lifetime and current use levels . The percentage of students in grades 9 through 12 who ever used tranquilizers nearly doubled between 1971 -- 3 percent -- and 1973 -- 15 percent. Current use also doubled during this period, from three percent to seven percent. The use of stimulants has only slightly increased since 1971. Lifetime use increased from 14 percent to lº percent and current use increased from six percent in 1971 to eight percent in 1973. Lifetime and current use of depressants has remained fairly uniform since 1971. The 1973 data show that about 12 percent of the 9 through 12 graders have used depressants and five percent have used them in the past month. The trends in drug use among students in grades 7 and 8 (not shown) are similar to those for high school students summarized above. The use A-17 of most drugs among secondary School students has been increasing since the early 1970s. A-18 E. Substance Use by Grade (Tables 2 through 5) For grades 7 and 8, 9 and 10, and 11 and 12, data are presented on lifetime use in Table 2, recent use in Table 3, current use in Table 4, * and heavy use in Table 5. With the exceptions noted below, the data in these tables show that: © substance use generally increases with grade level; © students in the llth and 12th grades are generally two to four tº les more likely to be substance users than the 7th and 8th graders; and substance use among 9th and 10th graders, while intermediary, is generally closer to the levels of use of llth and 12th graders than those of 7th and 8th graders. The above generalizations, however, do not apply to four Substances: gº the use of heroin and illicit methadone does not seeil to be related to grade level; 7th and 8th graders are generally as likely as the older students to be lifetime, recent, current, and heavy users of these Substances. the use of inhalants and cough medicine with codeine declines as grade level increases; 7th and 8th graders are about twice as likely as 11th and 12th graders to be recent, current, and heavy users of these Substances. An important finding in Tables 2 through 5 is the dramatic increase in the level and intensity of marijuana use by students in the two lower grade categories. Recent and current marijuana use among 9th and 10th graders is more than twice the use level among 7th and 8th graders: 54 percent compared to 26 percent for recent use and 43 percent compared to 19 percent for current use. Marijuana use among students in the 11th and 12th grades is less than 10 percent greater than in the 9th and 10th grades. ſ) [W ISION OF SUBSTAf:CE AſitySE SERVICES TABLE 2. 1,817,000 Students Enrolled in firades 7 through 12, Spring 1978 SUBSTA}|CE USE IN 1...] FET IME AMONG f{E!! YORK STATE STUDENT$ 13Y GRAi)}: Type of Substance” 7 – 8 i. IHz———— H 3. N % Il * ... PCP (Angel Dust) . 46,000 7.6 - ll 7,000 | 7.9 }l 3,000 21.5 Hallucinogens 21,000 3.5 55,000 8.5 79,000 15.0. Cocaine 34,000 5.6 75,000 l i .4 85,000 _10-0 Inhalants 110,000 18.4 l 05,000 l 6.3 67,000 12. Heroin ... 19,000 3.2 16,000 2.5 12,000 *—— Methadone (Illicit) l3,000 2.2 18,000 2.8 l 3,000 2.4 Marijuana l90,000 31.9 400,000 6 : .. 3 374,000 10.0 flashish 60,000 | 0.0 178,000 27.5 209,000 39.9 Stifliulants 43,000 7.2 l'O5,000 l 6. 3 l 18,000 *.9 Depressants 29,000 4.8 77,000 | }. 9 83, 000 15.9. Tranquilizers 37,000 6.3 92,000 | 4.5 91,000 | 7.9 , cough Medicine with Codeine 80,000 *—— 72,000 ll l 43,000 8. I Other Harcotics. 39,000 6.6 83,000 l 2.8 77,000 l 4.9 Example of How to Read the Table: Among the responding students in Grades 7–8, 46,000, or 7.6%, have used PCP (angel dust) at least once in their ifetime. THITETTISTUDEFSTFEported in the table are underestimates since they do not include nonrespondents. * Hallucinogens such as LSD, iſ escaline, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as barbiturates and methaqualone; tranquilizers such as Walium and Librium; other narcotics such as opium, morphine, and codeine. Date of Preparation: September 25, 1978 º TABLE 3. g Division OF SULSIAHCE ABUSE SERVICES l,817,000 Students Enrolled in Grades 7 through 12, Soring 1978 SUBSTANCE USE AMONG NEW YORK STATE STUDENIS SINCE SC1400L BEGAN IN SEPTEMBER 1977 BY GRADE Type of Substance” Grade 7 – 8 §Tiſ) | | – 12 {{ f{ # fl PCP (Angel Dust) 33,000 5.4 76,000 ll. 6 63,000 ll .. 8 Hallucinogens 15,000 2. A 39,000 6.0 51,000 10-0 Cocaine 25,000 4. 55,000 8.3 56,000 10.5 Inhalants 72,000 m.9 5\ ,000 7.7 26,000 5.0 |leroin 13,000 2. ll ,000 l. 6 7,000 1.4 *mº Hathadone (Illicit) 10,000 ! .. 6 10,000 l. 6 8,000_ 1.5 Marijuana 158,000 26.2 354,000 53.9 321,000 60. Hashish 49,000 8.0 139,000 2] .. 2 153,000 28.7 Stimulants 34,000 5.6 8 l ,000 12.2 85,000 ! 6.0 Depressants 2l,000 3.4 58,000 8.9 49,000 9.2 Tranquilizers 29,000 4.7 71,000 l 0.8 58,000 |0. 9 Cough Medicine with Codeine 53,000 8.7 **º-sºº “ 42,000 6.4 23,000 4.3 0 ther flarcotics 27,000 4.5 60,000 9. 1 47,000 8.8 Hallucinogens such as LSD, mescal ine, and psilocybin; stiãulants such as amphetailines and diet pills; ºxample of Hou to Read the Table: Among responding students in Grades 7–8, 33,000, or 5.4%, have used PCP (angel dust) since eptember 1977.THOTE: The numbers reported in the table are underestimates since they do not include nonrespondents. % less than 0.5%. * * Less than 500. methaqualone; tranquilizers such as Walium and libriuli; other narcotics such as opium, morphine, and code ine. late of Preparation: September 25, 1978 school began in depressants such as barbiturates and Division of $UBSTANCE ALUSE SERVICES SUBSTANCE USE AHONG HDu YORK STATE STUDEHIS IN THE PAST 30 DAYS BY GRADE l,817,000 Students Enrolled in Grades 7 through 12, Spring 1978 Grade Type of Substance" 7 – 8 9 – 10 l 1 – 12 N. % N. % tl Ž PCP (Angel Dust) 18,000 3.0 43,000 6.5 29,000 5.5 Hallucinogens 10,000 l. 7 25,000 3.7 28,000 5.2 Coca iſle 13,000 2. l 25,000 3.9 28,000 5.2 In lial ants 41,000 6.8 29,000 4.3 14,000 2.7 Heroin 8,000 } .3 7,000 l .0 5,000 0.9 Methadone (Illicit) 6,000 0.9 7,000 l. 1 4,000 0.8 Marijuana ll 3, ( )0 18.9 277,000 43.0 262,000 50.0 Hashi Sh 30,000 4.9 88,000 l 3.5 96,000 - l £3.2 Stimulants 20,000 3.3 50,000 7.5 51,000 9.7 Depressants ll,000 l .8 34,000 5.3 28,000 5.2 Tranquilizers l 9,000 3.2 50,000 7.6 37,000 6.9 Cough fledicine with Codeine 32,000 5.3 30,000 4.6 l 5,000 2.8 10,000 • 1.6 23,000 3.5 l6,000 3. 1 Example of How to Read the Table: 30 days. NOTE: The nullibers reported in the table are undere * Hallucinogens such as LSD, mescaline, and psilocybin; stimulants such as amphetamines and diet pills; Along responding students in Grades 7-8, methaqual one; tranquilizers such as Walium and Librium; other narcotics such as opium, inorphine, and codeine. TABLE 4. Other Harcotics *% less than 0.5%. ** Less than 500. Date of Prepar’ tidn: September 25, 1978 § 18,000, or 3:0%; have used PCP (angel dust) at least once in the past Stillates since they do not include nonrespondents. depressants such as barbi turates and § DIVISION OF SUBSTAHCE ADUSE SERVICES TABLE 5. CURRENT HEAVY SUBSTANCE USE* AMONG NEW YORK STATE STUDENTS BY GRADE l,017,000 Students Enrolled in Grades 7 through 12, Spring 1978 b Grade fype of Substance 7 – 8 - 9 – l () - ll – l 2 N. % - Il 2. t! 3. PCP (Angel Dust) - 3,000 0.5 5,000 0.8 4,000 0.7 Hal lucinogens I,000 * , 2,000 *% 2,000 * ºf Cocaine l,000 *% 2,000 * . 3,000 0.5 Inhal ants 4,000 0.7 2,000 *% 2,000 * { !!eroin l,000 * †. l,000 *% l,000 * . Methadone (Illicit) – 'A #: *% l,000 * † - * * * { - Harijuana . - 3},000 5.2 - l 29,000 19.9 l33,000 29.4 Hashi Sh 5,000 0.8 16,000 2.5 l 5,000 —“— Stimulants 3,000 *% 5,000 0.8 8,000 l. 4 Depressants —l 2,000 *% 2,000 *% - 3,000 0.5 l ranquilizers 2,000 -º 4,000 - 0.7, 3,000 I 0.6 - Cough Medicinc with Codeine 4,000 0.6 3,000 0.5 2,000 **. Other Narcotics l,000 *% 4,000 0.7 l,000 * { Example of ſlow to Read the Table: Among responding students in Grades 7-8, 3,000, or 0.5% have used PCP (angel dust) at least 10 times in past 30 days. HOTE: The nulliber of users, in the table are underestimates since they do not include the nonrespondents. *% less than 0.5%. ** less than 500. * Defined for all substances as use 10 times or more in the past 30 days. b Hallucinogens such as LSD, mescal ine, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as barbi turates and Iſlethaqual one; tranquilizers such as Walium and Librium; other narcotics such as opium, morphine, and codeine. Date of Preparation: September 25, 1978 In Table 5, neavy marijuana users in the 9th and 10th grades far exceed the number in 7th and 3th grades: 20 percent -- 129,000 -- compared to five percent -- 31,000. The number of heavy users in the 11th and 12th grades -- 25 percent or 133,000 -- somewhat exceeds the number in 9th and 10th grades. Persistence of heavy use among lifetime users in the four upper grades is: 32 percent -- 129,000 of 400,000 -- for 9th and 10th graders and 36 percent -- 133,000 of 374,000 -- for lith and 12th graders. For most of the other substances, lifetime use seldom persists as heavy use. At each grade level, generally less than three percent of the lifetime users of a given substance are classified as heavy users. A–23 F. New Substance Use by Grade (Table 6) Many students across the State began using a variety of substances during 1977 and early 1978. About 255,000 -- 15 percent or more -- of the responding students began use of marijuana. qº Over 100,000 -- six percent -- of the responding students began use during 1977 (in descending order) of: PCP, hashish, cocaine and stimulants. For the following substances, a large proportion of those who have ever used them began their use in 1977: cocaine (61 percent), PCP (46 percent), heroin (43 percent), stimulants (39 percent) and hallucinogens (37 percent). For the other substances, less than a third of lifetime users began their use in 1977. The following major patterns of new substance use by grade emerge: gº For PCP, hashish, stimulants, depressants, tranquilizers and other A–2|| narcotics, the percent of new users is lowest in grades 7 and 8 and highest in grades 9 and 10. For hallucinogens and cocaine, the percent of new users increases with grade level, suggesting that students initiate use of these Substances at an older age. © For marijuana the percent of new users declines with increasing grade level. Thus, most students initiate marijuana use in grades 7 and 8 or earlier, so that new use rates are lower in higher grades. For inhalants and cough medicine with codeine, the percent of students beginning use declines with increasing grade level, suggesting that these are particularly popular substances with younger students but not with older students. © Initiation to heroin use also appears to decline with increasing grade level. DIVISION OF SUBSTANCE ABUSE SEſ&WICES TABLE 6. NEW SUBSTANCE USE SINCE JANUARY 19779 A140tlG NEW YORK STATE STUDEIIIS BY GRAſ)E l,817,000 Students Enrolled In ºrales 7 through 12, Soring 1978. º * * ſype of Sutstance" I () l ;\l. -- ;H---- * º in-- I--— H. * li * - 1: i. # 7. PCP (Angel Dust) 127,000 7.2 29,000 tº 6l ,000 9.4 37,000 7.1 e Hallucinogens. 50,000 3.3 ll,000 l.9 25,000 3.9 22,000 4.2 Cocaine mº,000 6.6 20,000 3.4 50,000 7.7 48,000 9-0 Inhalants 79,000 2. 3 * * 36,000 25,000 3.9 * 13,000 3.4 Heroin 20,000 l. 1 10,000 l. 6 6,000 0.9 __4,999___0.9 Methadone (Illicit), ll,000 0.6 3,000 0.6 __4,000 0.6 4,000 0.7 Marijuana 265,000 | 4.7 99,000 | 7.0 106,000 l 6.6 50,000 9.9 Hashi sh ll 8,000 6.7 31,000 5. l 58,000 9.2 29,000 —“–– stments |- 105,000 . 6. I 21,000 3.6 * 47,000 7.4 gºsºsºsºsºs 37,000 7.3 Depressants 61,000 3.5 12,000 2.0 3 l ,000 4.7 l 8, 000 3.6 Tranquilizers 65,000 3.9 sº-ºs- 12,000 2. l 34,000 5.5 * ** won 3.9 town ºne with tolene 44,000 2.5 21,000 *—— l6,000 *— 7,000 1.3 Other flarcotics 52,000 3.0 l4,000 2.4 22,000 3.5 16,000 3.2 Example of ſlow to Read the Table: Nilong responding students in Grades 7–8, 29.000 , or 4.9 7, have used PCP (angel dust) for the first time since January 1, 1977. * . NOTE: The numbers reported in the table are underestimates since they do not include nonrespondents. *% less than 0.5%. ** LeSS than 500. d Persons who used the substance for the first time since January 1, 1977. b * - Hallucinogen; such as LSD: mescaline, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as barbiturates and methaqualone; tranquilizers such as Waliull and Librium; other narcotics such as opium, illorphine, and codeine. Date of Preparation: September 25, 1978 == Nº) Vi G. Multiple Substance JS2 by Grade (Table 7) Secondary school students in New York State do not confine their use to one or two substances. A sizable proportion use several substances during a given period of time. The data in Table 7 show the number of substances a student has recently used. The total column shows that since school began in September, 1977: © 882,000 students -- 49 percent -- did not misuse prescription drugs nor use illegal substances; 387,000 -- 22 percent -- used one substance (mainly marijuana users); 358,000 -- 20 percent -- used two to four substances; and 167,000 -- nine percent -- used five or more substances. Multiple substance use also increases with grade level. Since school A-26 began in September, 1977: 393,000 students -- almost 66 percent -- in grades 7 and 8 did not use any Substances; 287,000 -- 44 percent -- in grades 9 and 10 and 202,000 -- 38 percent -- in grades l l and 12 used no substances. comparing 7th and 8th graders with 11th and 12th graders shows that the percent using one substance is 17 percent compared to to 25 percent, two to four substances is 13 percent compared to 26 percent, and five or more substances is five percent compared to 12 percent, respectively. TABLE 7. MULTIPLE SUBSTANCE USE* SINCE SCHOOL BEGAn in SEPTEMBER 1977 AHOTIG NEW YORK STATE STUDENTS by GRADE 1,817,000 Students Enrolled in Grades 7 through 12, Spring 1978 Grade ſlumber of Substances - Total 7 - 8 - 9 - 10 ll – 12 No Prescription Misuse Nor N j. illegal Substance Use Since N % H 3. N 3. sºsºs * School Began in September 1977 882,000 49.2 393,000 65. 5 287,000 43.5 202,000 37.8 Number of Substances Used: l 387,000 21.6 100,000 l 6.7 156,000 23.7 131,000 24.5 2 196,000 # 0.9 41,000 6.8 81,000 12.3 74,000 13.8 3 101,000 5.6 21,000 3.5 42,000 6.4 38,000 7. I '4 61,000 3.4 13,000 2.2 2] ,000 3.2 27,000 5.0 5+ l 67,000 9.3 32,000 5.3 72,000 l().9 63,000 ll.8 Example of How to Read the Table: - - Among the responding students in Grades 7 through 12, 100,000, or 16.7% used one substance since school began in September 1977. HOTE: The numbers reported in the table are underestimates since they do not include nonrespondents. DIW ISI ()?! 0f Stjit STAſ CE Ai:USE SERVICES *% less than 0.5%. ** Less than 500. - d Included are all substances mentioned in the previous tables. Date of Preparation: September 25, 1978 § A-28 H. Regional Comparisons (Tables 3 through 17 and attached map) * Neº York State has aight health service areas (nencefºrth HSA) which include at least one major central city, the surrounding suburbs and adjacent rural areas (except for New York City and Long Island). In Tables 3 and 9, data are presented on new substance use and multiple use for the eight HSAs. Tables 10 through 17 present findings on lifetime, recent, current and heavy substance use in each HSA in a style parallel to the one used for New York State as a whole (Table 1). The following general findings emerge from these regional comparisons: Substance use is proportionately highest in the Buffalo HSA, followed by the Long Island HSA. In these HSAs, almost every substance has as high or a substantially” higher proportion of users than the statewide average. For almost no substance or lavel of use is either HSA substantially below the statewide average. Substance use is proportionately lowest in the Rochester HSA. In this HSA, almost every substance is lower or substantially below the proportion of users in the state. º The New York City HSA has levels of use that are generally similar to the statewide figures; however, for certain substances this HSA has the highest proportion of users in the state. © . In other HSAs, the findings are more mixed. For most substances and levels of use, the proportions of users in the Syracuse, Binghamton, Albany and White Plains HSAs are not substantially different from the state figures. *In this report the name of a major central city (except for Long Island) is assigned to the entire health service area (HSA). For example, in the tables and text, the term "Buffalo HSA" refers to the Western New York HSA and includes the counties of Allegany, Cattaraugus, Chautauqua, Erie, Genesee, Niagara, Orleans and Wyoming. All of the counties located within each HSA appear in the attached map. The statistical findings apply to all counties in the HSA and not only to the major central city. **In this report, the term "substantial" means a difference that is considerably beyond statistical significance. With extremely large samples such as in this survey, a small difference of a fraction of a percent may be statistically significant but not particularly important. As a guide to determining a substantial difference in percentages of substºnce use and levels of use, the 95 percent confidence interval for a random sample of 1,000 respondents was used. See H. I. Abelson, P.M. Fishburne, and I. Cisin, "National Survey of Drug Abuse: 1977, " conducted for the National Institute on Drug Abuse by Response Analysis Corporation and The George Washington University, 1977, p. 138-139. \/ S H|---- O N \/ T S I 9 N O T Leºz-ſí? -K --\∞ \ [ [ O \/S H. 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NOTE: *Y" Less than 0.5%. d b # k TABLE 8. NEW SUBSTANCE USE SINCE JANUARY 1977* AMONG NEW YORK STATE STUDENTS BY HEALTH SERVICE AREA - 1,817,000 students Enrolled in Grades 7 through 12, Spring 1978 - Type of Substance” tºo Roºter Syºğuse Bºnton Allºy Whitfiftains New! º City toº island - - R 3. N. 2. N 3. tl 1. N 1. N 1. N % !! 7. _PCP (Angel Dust) 14,000 7.9 3,000 2, 1 10,000 6, 2 3,000 / .8 6,000 4.1 | 16.000 7.7 51,000 0.7 || 24.001) - 7.5 Hallucinogens 9,000 4.8 2,000 l. 2 9,000 5.6 # k 0.7 4,000 2.7 8,000 4.0 14,000 2-4 || |** ** _Cocaine ll,000 6.2 3,000 2.2 - 10,000 . 6.2 2,000 5.4 4.000 2.6 l 3,000 6.2 49,000 8.2 | 20,000 8. 3 Inhalants 9,000 5.3 4,000 3.4 10,000 6.3 3,000 7.0 1.ua 4.8 || 1 0, 000 4, 7 19,000 3.3—l ll,000 5-4 º –4,000–24–1–2 an–l- 3,000 l () k A. *% 1,000_0.5 2,000 0.9 5.000 — 0-8 * , ()()() l .4 Hathadone (Illicit) 3,000 l .5 * * *% l,000 *% ‘ſk A. *% * * *% 2,000 l.0 4,000 0.6 2, ()(){} 0.5 º 31,000 l 6.9 18,000 13.4 23,000 l 5.0 6,000 l 4, 8 19,000 13.6 3,000 15.2 79,000 l 3.8 49, ()(U 15.4 —lla Shish 23,000 12.7 8,000 6.2 12, ()00 7.7 3,000 7.7 13,000 8.9 || 14,000 7.2 23,000__3.9 22,000 7.0 Stimulants 20,000 l l . 2 . . . 4,000 3.3 10,000 6.6 l,000 3.0 5,000 3.9 3,000 6.4 26,000 A.4 | *6,000 *.* ſº 7,000 . . 2 2,000 l. 8 5,000 3.2 1,000 2.0 6,000 4.4 6,000 3.0 20,000 3.4 || ''." in Tranquilizers 8,000 4 .. 5 3,000 2.4 6,000 4.3 l,000 2.5 7,000 4.9 6,000 3.2 20,000 3.5 14, Ct)0 4./ ºne with 7,000 a., 3,000 a. 4,000 2.7 l,000 2.8 3,000 2.4 6,000 2.9 || 11,000 1.9 || 9,000 2-9 0 ther Harcotics 8,000 4.6 1,000 0.7 || 5,000 3.2 || 2,000 4.7 2,000 l .4 5,000 2.3 l 9,000 3.3 ll ,000 3.5 stimates since they do not include nonrespondents. stimulants such as amphetamines and diet pills; methaqualone; tranquilizers such as Waliun and librium; other nårcotics such as opium, morphine, and codeine. Date of Preparation: September 25, 1978 sº e ºs- Among responding students in the Buffalo IISA, 14,000, or 7.9%, used PCP (angel dust) for the first time since The nullibers reported in the table are undere less than 500. Persons who used the substance for the first time since January 1, 1977. Hallucinogens such as LSD, ſhe scaline, and psilocybin; depressants such as barbiturates and MULTIPLE SUBSTANCE use “since school BEGAN in sEPTEMBER 1977 Among stunfºrs, l,817,000 Students Enrolled in Grades 7 through 12, Spring 1978 DIVISION OF SUBSTANCE ADUSE SERVICES RY HEALTH SERV I ſº F A ſº EA Number of Substances Duffalo Rochester Syracuse Binghamton. Albany Whita Plains flew York City LCrış Island HSA |{SA HSA |ISA |SA ! ISA |*SA }ISA flo Prescription Mis- Il 2. N. * N # N. 3. H % N. 3. N % N & use for Illegal - tºº. - * Substance Use Since School Began in º September 1977 85,000 46.5 83,000 60.6 8] ,000 - 52.0 20,000 52.7 72,000 49.7 94,000 44.8 306,000 5l. 3 || 41,000 43. I Humber of Substances Used: l |30,000 16.4 22,000 16.1 27,000 7.3 7,000 l 8.4 26,000 l 7.9 || 46,000 21.9 151,000 25.3 78,000 23.9 2 24,000 l 3. ] 15,000 ‘l 0.9 17,000 |0.9 4,000 l 0.5 l6,000 l l . 0 || 30,000 14.3 52,000 8, 7 38,000 l l . 6 3 13,000 7. 1 || 6,000 4.4 8,000 5.1 | 2,000 5.3 9,000 6.2 l 2,000 5.7 25.000 A.7 | £2,000 0.7. 4. 9,000 4.9 4,000 2.9 5,000 3.2 l,000 2.6 7,000 4.8 8,000 3. 8 17.ſlſ)0 2.8 || 10.00ſ) 3. l 5+ 22,000 l 2.0 7,000 5.1 18,000 l l .5 4,000 10.5 15,000 l 0.4 20,000 9.5 43,000 7.2 || 38,000 ll. 6 Nong responding students in the Buffalo IISA, 30,000, or 16.4%, used one substance since school began in September 1977. TABLE 9. Example of How to Read the Table: *:0ſ E: * 2: Less than 0.5%. * Included are all substances mentioned on the previous tables. A tº Less than 500. Date of Preparation: September 25, 1978 g The numbers reported in the table are underestimates since they do not include nonrespondents. g DIVISION OF SUBSTANCE ABUSE SERVICES TABLE 10. substance use AMONG NEW YORK STATE STUDENTS ENROLLED IN THE BUFFAL0 HEALTH SERV I ce AREA 187,000 Students Enrolled in Grades 7 th! Pugh 12, Spring 19/8 flever Used Lifetime Use !C) Recent Use Current Use Current Heavy Use Type of Substance” Response (Used since school (Used in past (Used 10+ times (Used at least, once) begun in Sept. '77) 30 days) in past 30 days) !! 3. H. % H Il % H. * fl 3. PCP (Angel Dust) 156,000 85.2 27,000 | 4.8 4,000 19,000 ! (). 10,000 5.3 l,000 0.7 Hallucinogens 159,000 87.4 23,000 l 2.6 5,000 l 7,000 9 , ) l 0,000 5.5 l,000 * { Cocaine l68,000 91.8 15,000 8.2 4,000 ll ,000 6. 1 7,000 4. ) l,000 0.6 Inhalaſits l 47,000 82. 32,000 | 7.9 8,000 20,000 l 0. 6 l 2,000 6.4 fºr ſh _*1 leroin l 76,000 96.2 7,000 3. 8 4,000 5,000 2.9 4,000 2.3 l,000 0. 5 }|G thadone (Illicit) l 77,000 96.2 - 7,000 3.0 3,000 5,000 2.6 4,000 2. # tº * . Marijuana 79,000 43.2 104,000 56.8 4,000 89.000 48.5 74,000 40.4 33,000 18. Ha Shish l 23,000 67.6 59,000 32.4 5,000 52,000 28.0 38,000 20.8 10,000 b. 2 Stimulants ! 45,000 81.0 34,000 l 9 . () 8,000 28,000 | 6. l 7,000 9.4 2, ()()0 0.9 Depressents l 57,000 86.3 25,000 | 3.7 5,000 19,000 | G. 2 12,000 6.7 l,000 (). 83 Tranquilizers. ! 46,000 82.5 3] ,000 l 7.5 10,000 26,000 l 4.4 20,000 10.9 l,000 * 't Cough Fedicine with ! Ü0,000 88.4 21,000 l l .. 6 6,000 l 4,000 7.7 9,000 4.7 2,000 0.9 - Coºlging —— - - Q. ſ. Other Harcotics 154,000 85.6 26,000 l 4.4 7,000 10,000 0.2 7,000 4.0 l,000 0.8 £iºle Cf. tº to ſtead the Table: jºr; Fºciſ.j sidents, 27,000 , or 14.8 #, have used PCP (angel dust) at least once. t{U} f : The nº ſibër of users in the table are underestimates since they do not include the nonrespondents. * I ess than 0.5%. * * less than 500. d Hallucinogens such as LSD, ſilescal ine, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as Lārb turates and ſhe thadual one; tranquilizers such as Walium and Librium; other narcotics such as opium, morphine, and codeine. Date of Preparation: September 25, 1978 I. Substance Use Within 33& Health Service Area” (Tabi 2s 3 through 17) 1. Buffalo Health Service Area (Allegany, Cattārāugus, Chautauqua Erie, GeneSee, Niagara, Orleans, and Wyoming Counties) (Tables 3 through 10) © The Buffalo HSA has some of the highest proportions of substance use in the State. © This HSA has the highest proportion of students in the state using the following substances: during their lifetime: hallucinogens, heroin, illicit methadone, Stimulants, tranquilizers and other narcotics; in addition, lifetime use of hashish is substantially higher in this HSA than the statewide figure. since school began in September, 1977 (recently): hallucinogens, heroin, illicit methadone, hashish, stimulants, depressants, tranquilizers and other narcotics. ... in the past 30 days (currently): hallucinogens, heroin, illicit methadone, hashish, stimulants, depressants, tranquilizers and other narcotics. 10 or more times in the past 30 days (heavily): hashish, cocaine, heroin, cough medicine with codeine and other narcotics. - ... for the first time since January, 1977: heroin, illicit methadone, marijuana, hashish, stimulants and cough medicine with codeine (Table 8). This HSA has the highest proportion of students using five or more substances since school began in September, 1977 (Table 9). *In Tables 8 through 17, the percentages and numbers of students exclude those classified as "no response" (i.e. persons giving frivolous, inconsistent, or incomplete answers to a particular drug use question). Thus, the appropriate denominator for the percentages is not the number of enrolled students, but enrolled students minus those classified as no responses. For example, in the Buffalo HSA, there are 187,000 enrolled students. For marijuana, 4,000 students are classified as "no response." Thus, 183,000 (187,000-4,000) students are included in the percentage for lifetime marijuana use: 104,000 - # - 56.3% A–33 –s- & -ſº Division OF SUBSTANCE ABUSE SERVICES TABLE il. SUBSTANCE USF AM0NG NEW YORK STATE STUDENTS ENROLLEſ) I N THE ROCHESTER HEALTH S FRV I CE A PFA 136,000 Students Enrolled in Grades 7 through 12, Spring 1978 * Never Used - lifetime Use HO Recent Use Current Use Current ligavy Use Type of Substance" Response || (Used since school (Used in past (Used 10 t t ifies (Used at least ence) began in Sept. '77) 30 days) in past 30 days) N. Ž. N % N. il % H. 3. il 2. PCP (Angel Dust) 127,000 94.1 8,000 5.9 l,000 5,000 3. 8 2,000 1,8 # * wº. Hallucinogens 130,000 97.0 4,000 3.0 2,000 3,000 2. I 2,000 l, 1 : * { * †. Cocaine l 28,000 94.8 7,000 5.2 l,000 5,000 3. 6 2,000 | .2 A # A f_ Inhal ants ! l 4,000 86.4 l 8,000 13.6 4,000 - i i ,000 8 . . 7,000 º 5.0 $ ſº a; —lleroin ! 33,000 98.5 2,000 | .5 l,000 2,000 l. 3 l,000 }.0 # * - * ... -- Methadone (Illicit) 133,000 98.5 2,000 l. 5 l,000 l,000 l . . A 4 * †. • * * * : Marijuana 76,000 56.3 59,000 43.7 } ,000 48, CJO 35.5 38,000 27.8 || 5,000 * ! .. 3 ſlashish - 107,000 80.5 26,000 19.5 3,000 || 21,000 l 5.6 13,000 9.9 3,000 l, {{ Stimulants l 19,000 90, 8 | 2,000 9.2 - 5,000 8,000 5.8 5,000 3.5 l,000 () . 7 _ºpresents l 25,000 94.0 8,000 6.0 3,000 4,000 3. 2,000 ! .. 4 * * *. Tranquilizers - 118,000 90, 8 12,000 9.2 . 6,000 9,000 6.3 5,000 3.5 # is * { º º | 121,000 90.3 13,000 9. 7 2,000 7,000 5. 5,000 3. 8 * & P. f. ouer ºrcotics | 125,000 94. 0 8,000 6. 0 3,000 5,000 3.6 2,000 # .. 5 * & * †. £3.3 p. 3 of £3.1 to Read the Table: - - - Añº, responding students, T8,000 , or 5.9 ſ , have used PCP (angel dust) at least once. HCIE: The full-ber of users in the table are underestimates since they do not include the nonrespondents. º-º-º- a . le's S ihăn 0.5%. * † ŁęSS than 500. d Hallucinogens such as LSD, mescal ine, and psilocybin; stimulants such as amphetainines and diet pills; depressants such as bârbiturates and ſlethaqualone; tranquilizers such as Walium and librium; other narcotics such as opium, Horphine, and codeine. Pate of Preparation; seateabor 25, 1974. — Rochester Health Service Area (Cheºng, Livingston, Monroe, Ontario, Schuyler, Seneca, Stsiben, Wayne, and Yates Counties) (Tables 3,9, li) The Rochester HSA generally has the lowest levels of substance use in the State. This HSA has the lowest proportion of students in the state using the following substances: in their lifetime: PCP, hallucinogens, cocaine, heroin, illicit methadone, marijuana, stimulants, depressants, tranquilizers, cough medicine with codeine and other narcotics; in addition, lifetime use of hashish and tranquilizers is substantially lower in this HSA than the Statewide figure. since school began in September, 1977 (recently): PCP, hallucinogens, cocaine, marijuana, stimulants, depressants, tranquilizers, cough medicine with codeine and other narcotics; the use of hashish is substantially below the statewide figure. in the past 30 days (currently): PCP, cocaine, marijuana, stimulants, depressants, tranquilizers, cough medicine with codeine and other narcotics; use of hallucinogens is substantially below the statewide average. 10 or more times in the past 30 days (heavily): marijuana. for the first time since January, 1977: PCP, cocaine, depressants, tranquilizers and other narcotics; in addition, a substantially lower proportion of students in this HSA than in the state as a whole began using stimulants (Table 8). This HSA has the highest proportion of students in the state reporting no Substance use since school began in September, 1977 (Table 9). - For no substance is the proportion of students in the Rochester HSA substantially above the statewide average. A-35 g DIVISION OF SUBSTANCE ABUSE SERVICES TABLE 2. SUBSTANCE use AMONG NEW YORK STATE STUDENTS ENROLLED IN THE Syracuse HEALTH SERVICF AREA |59,000 Students farolled in Grades 7 through 12, Spring 1978 C & fiewer Used Lifetime Use N() Recent Use - Current Use Current lºcavy User Type of Substance Response || (Used since school (Used in past (Used l Or tires (Used at least once) began in Sept. '77) 30 days) in past 30 days) N. 3 : N. & N. H. % N. % tl 3. reſ (Angel Dust, 139,000 88.5 l{},000 l l .. 5 2,000 l 2,000 7.5 5,000 3, 3. ** a . Hallucino - llucinogens ł 38,000 88.5 18,000 | | . 6 3,000 13,000 8, 2 6,000 4 - 1 tº ºr *: Cocaine 143,000 9] . . l 4,000 8.9 2,000 9,000 5.9 3,000 i. 6 # tº: * { Inhalants l 26,000 8? .. 8 28,000 18, 2 5,000 14,000 8. A 6,000 4. l,000 * . łleroin - $53,000 97.5 4,000 2.5 2,000 - 3,000 * .. 6 1,000 (), 8 A tº: A $. Methadone (Illicit) || 151,000 96.8 5,000 3.2 3,000 3,000 * - / - l ,000 0.7 - * if: * : }larijuana 78,000 50.0 78,000 50.0 3,000 68,000 43.4 5l ,000 32.8 24,000 18.7 HaShish l l 3,000 72.9 42,000 27. 4,000 35,000 22.2 # 21,000 || 3–5 || 2 Oſſ) ! .4 Stiliulants - ! 27,000 82.5 27,000 | 7.5 5,000 20,000 l 2, 4 —ll,000 1.0 !!_l.000 0.7 Depressants | 132,000 85.7 22,000 14.3 5,000 15,000 9.5 6,000 4. * A a . Tranquilizers 130,000 86.1 2} ,000 | 3.9 8,000 § 4,000 8.9 | 10,000 6.4 l,000 0.6 TCough fledicine with - - ...A Codeing $37,000 88. A 18,000 ll. 6 4,000 10,000 6. 6,000 3.9 l,000 * †. Other Narcotics 135,000 87. 20,000 12.9 4,000 l 3,000 8.3 3,000 l.9 || 1,000 0.5 £zergle cſ Boyſ to Read the Table: - XForg respond inj students, 18,000 , or 11.5%, have used PCP (angel dust) at least once. #3IÉ: The number of users in the table are underestimates since they do not include the nonrespondents. * . Less than 0.5%. ** Less than 500. Hallucinogens such as LSD, mescal ine, and psilocybin; and methaqualone; tranquilizers such as Walium and librium; stimulants such as amphetamines and diet pills; depressants such as barbiturates other' narcotics such as opium, morphine, and codeine. Date of Preparation: September 25, 1978 Syracuse Health Service Area (Cayuga, Cortland, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, and Tompkins Counties) (Tables 8,9, 12) The Syracuse HSA has levels of substance use that generally approximate the Statewide average. This HSA has the highest proportion of students in the state using depressants in their lifetime. Recent use of hallucinogens is substantially higher in this area than the statewide figure. This HSA has a substantially lower proportion of students than the statewide figure using: PCP during their lifetime. cocaine and other narcotics in the past month. one substance since school began in September, 1977 (Table 9). A-37 DIW ISI () H 0 F SUB STANCE ABUSE SERVICES g Iſlethaqual one; tranquilizers such as Walium and librium; other narcotics such as opium, Imorphine, and codei re. Date of Preparation: Sentomber 25, 1978 TABLE | 3. SUBSTANCE USE AMONG NEW YORK STATE STU DENTS ENROLLED IN THE RINGMA*Tnx HEALTH S FRV I CE A PFA 38,000 Students Enrolled in Grades 7 through 12, Spring 1978 * ºsmº - Never Used lifetime Use NO Recent Use Current Use Current Heavy Use fype of Substance” Response (Used since school (Used in past (Used l 0+ tiſ, és (Used at least once) began in Sept. '77) 30 days) in past 30 days) Il % N. % N H. 7. R. #. R % : PCP (Angel Qust) 33,000 86.8 5,000 ! 3.2 # * 4,000 9.8 l,000 2.9 gº ºf * † Hallucinogens 35,000 94.6 2,000 5. A l,000 i,000 2.4 l,000 l .. 4 * * a ‘ſ. l, - - • ; Cocaine 34,000 9] .9 3,000 8. I l,000 2,000 5. 8 l,000 2.3 # & * : Inhal ants. 30,000 8] . ) 7,000 18.9 l,000 4,000 l 0. 0 2,000 5. 3 l,000 ! .. 7 }{3roiſ) 36,000 97.3 l,000 2. 7 l,000 l,000 ! . Yº ſº. ! .. 2 * ºr a 'ſ, retladone (nicit) 36,000 97.3 l,000 2.7 l,000 * { 0.5 Tº ºf *7. * * a . Harijuana 19,000 51.4 18,000 48.6 ! ,000 l 6, (, )0 42. I 12,000 33.0 6,000 | 6.9 Hà Shi Sh 27,000 73.0 l 0,000 27.0 l,000 8,000 20.7 4,000 10.9 * † * @y Stithulants 3],000 83.8 6,000 16.2 l,000 3,000 8.9 2,000 4.2 k & * [. Depressants 33,000 89.2 4,000 10, 8 l,000 2,000 6. l,000 3.5 * † 0.8 Tranquilizers 33,000 89.2 4,000 ! 0.8 l,000 , 3,000 7. 1 2,000 4.4 * * *: gough Medicine with Tanoo ºld 6,000 l 6.2 l,000 4,000 l 0.4 2,000 5.9 * & * : Code i Iye s Other Harcotics 32,000 86.5 5,000 ! 3.5 l,000 3,000 8. 3 l,000 2.0 tº ºf a'ſ. {xeſºlc of l'OM to Read Îable: Kºj respºnſing students, 5,000 or 13.2%, have used PCP (angel dust) at least once. º fºſfi. The tutºber of users in the table are underestimates since they do not include the nonrespondents. * . Les S than 0.5%. ** less than 500. - - d Hallucinogens such as LSD, mescal ine, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as barbiturates and Binghamton Health Service Area (Broome, Chenango, and Tioga Counties) (Tables 3, 9, 13) The Binghamton HSA has substance use levels that generally approximate the statewide figures. This HSA has the state's highest proportion of students using cough medicine with codeine in their lifetime, recently, and currently. This HSA has the highest proportion of students in the state who began using inhalants and other narcotics since January, 1977 (Table 8). This HSA has a substantially lower proportion of students than in the state using: hallucinogens in their lifetime. hallucinogens recently. PCP, cocaine, and stimulants currently. The Binghamton HSA has the lowest proportion of students in the State using: illicit methadone recently. hallucinogens currently. ... hashish and stimulants heavily. hallucinogens, heroin and stimulants for the first time since January, 1977 (Table 8). A-39 ſ DIVISION OF SUBSTANCE ABusE SERVICES TABLE 14. SUBSTANCE USE AMONG NEW YORK STATE STUDENTS ENROLLED IN Tuf ALBANY HEALTH SERVIce AREA 146,000 Students [nrolled in Grades 7 through 12, Suring 1970 ºr a s a flever Used lifetime Use NO Recent Use Current Use Current Heavy Ute ſyi:c of Subºtance ſºcºponse (lised since school (Used in past (U:.ed l 0+ t iſ: 3 -*. —Y (Used at least once) began in Sept. '77) 30 days) in past 30 days.) tl : Il % ſ! Il % Il 1. Il 3. PCP (Angel Dust) 125,000 86.8 19,000 | 3.2 2,000 ll ,000 7.6 5,000 3, 6 l,000 0. E. Hallucinogens. l 30,000 90.9 l 3,000 9. 3,000 10,000 7. 1 6,000 4. I * * a 4 cocaine 135,000 93. I 10,000 6.9 l,000 6,000 4. | 2,000 l. 4 . * { * †. Inhalants ll 2,000 78.9 30,000 21.1 4,000 16,000 l l .. 2 10,000 7. ) 2,000 l. 5 Heroin . l'42,000 97.9 3,000 2, 1 l,000 1,000 0.8 l,000 0.5 * * * . Flethadone (Illicit) 141,000 97.9 3,000 2. l 2,000 l,000 (). 9 * ºr *% * * *: Marijuana 71,000 50.0 71,000 50.0 4,000 64,000 44.0 62,000 36. I 22,000 15.4 ilā Sltish 102,000 70.8 42,000 29.2 2,000 34,000 23.7 24,000 l 6.9 4,000 2.9 Stilnul ants ll 7,000 83.0 24,000 l 7.0 5,000 19,000 l 3.2 13,000 8.9 l,(:00 0.7 H --——---- * - Depress a ſits | 24,000 86.7 19,000 |3.3 3,000 12,000 8.6 7,000 4.9 l,000 0.7 Tranquilizers l 18,000 86. I 19,000 | 3.9 9,000 l3,000 9. 1 9,000 6.4 l,000 0.7 ºne with || 25,000 a. 18,000 l 2.6 || 3,000 l 2,000 8.6 8,000 5.7 l,000 l.0 | other Harcotics 125,000 88.0 17,000 l 2.0 4,000 l 2,000 8.3 5,000 3.4 * { 1 , or 13.2 Å, have used PCP (angel dust) at least once. Ii.6 m3ſ, ber of users in the table are underestiſlates since they do not include the nonrespondent S. ** Less than 500. Hallucinogens such as LSD, mescal ine, and psilocybin; methâqualone; tranquilizers such as Walium and libriuli); £z = zig ºf ºf to Read the lable: Żºcº regioiding students, Tig,000 f;3, E: *:: Le S 3 trium 0.57. d 03 te of Preparation: September 25, 1978 stimulants such as all phetaſhines and diet pills; other narcotics such as opium, Illorphine, and codeine. depressants such as barbiturates and Albany Health Service Area (Albany, Clinton, Columbia, Delaware, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Warren, and Washington Counties) (Tables 3,9, 14) The Albany HSA has substance use levels that generally approximate the statewide figures. This HSA has the state's highest proportion of students using: inhalants in lifetime, recently, and currently. tranquilizers heavily. depressants for the first time since January, 1977 (Table 8). This HSA has a substantially higher proportion of students than for the State as a whole using: ... depressants in their lifetime. ... hashish in their lifetime, recently, and currently. In this HSA, a substantially lower percentage of students than in A-l;1 the State used: ... cocaine and illicit methadone in their lifetime, recently and currently. ... PCP, cocaine, stimulants and other narcotics for the first time since January, 1977 (Table 8). one substance since school began in September, 1977 (Table 9). The Albany HSA has the lowest percentage of students in the state using heroin recently and currently. g DIVISION OF SUBSTATICE ALUSE SERVICES TABLE 5. SUBSTANCE USE AMONG !!EW YORK STATE, STUDENTS ENROLLED IN THE WHITE PLAINS HEALTH SF avi CE ARFA 2ll,000 Students Enrolled in Grades 7-12, Spring 1978 - d Never Used lifetime Use flo ſºccent Use Current Use Current lieavy Use Type of Substance -- ſtesponse (Used since school (Used in past (USGd 10+ tiſts (Used at least, once) began in Sept. '77) 30 days) in past 30 deys) Il * N 3. H Il % Il * Il º rer (Angel Dust) 174,000 84. ) 33,000 15, 9 4,000 21 000 l(). ll 1000 5.0 3,000 l, 3 Hallucinogens 18] ,000 88.3 24,000 l 1 .. 7 6,000 ! 6,000 7.5 ll ,000 5.2 l,000 * † Cocaine 187,000 89.5 22,000 l(). 5 2,000 l6,000 7. / 8,000 4.0 tº in * { Inhalants l 67,000 8] .. 5 38,000 l6.5 6,000 17,000 8.3 9,000 .4 l,000 * I. Heroin 205,000 98. I 4,000 | . 9 2,000 3,000 ! .. 2 2,000 0.8 tº ºr *t Methadone (Illicit) 203,000 98.1 4,000 | , 9 4,000 2,000 | . ) l,000 0.7 * * * : Marijuana 90,000 43.3 ll 8,000 56.7 3,000 105,000 50.3 84,000 40.6 37,000 l ty. () Hashish l 46,000 7] .. 2 59,000 28.8 6,000 46,000 22.3 26,000 l 2.6 5,000 2. 3. Stilllulants 175,000 86.2 28,000 13.8. 8,000 22,000 l 0.3 ! 3,000 6.3 l,000 0. 5 - - Depressants 187,000 90.8 19,000 9.2 5,000 12,000 6.0 6,000 2.9 l,000 * †. | Tranquilizers 179,000 89.1 22,000 l 0.9 10,000 15,000 7.3 8,000 3, 6 l,000 *7. T Cough floºdicine with - - É. | 79,000 88.2 24,000 l l .. 8 8,000 15,000 7. () 10,000 4.9 l,000 0. 6. 0ther flarcotics 179,000 87.3 26,000 | 2.7 6,000 ! 9 000 9. 1 8,000 3.7 1,000 0.6 | f> ºple of How to Read the Table: - l źg rºording students, 33,000 , or 15.9 #, have used PCP (angel dust) at least once. #OTE: The nutſiber of users in the table are underestimates since they do not include the nonrespondents. *: Less than 0.5%. * * Less than 500. d Hallucinogens such as LSD, mescal ine, and psilocybin; stimulants such as amphetamines and diet pills; depressants such as barbiturates and Illethaqualone; Date of Preparation: Senteuiller 25, 1978 tranquilizers such as Walium and Librium; other narcotics such is opium, morphine, and codeine. 6 9 White Plains Health Service Area (Dutchess, Orange, Putnam, Rockland, Sullivan, Ulster, and Westchester Counties) (Tables 8,9, 15) The White Plains HSA has substance use levels that generally approximate the statewide figures. This HSA has the highest proportion of students in the state using PCP 10 or more times in the past 30 days (heavily). This HSA has a substantially higher proportion of students than the state as a whole using hallucinogens and marijuana in the past 30 days (currently). This HSA has a substantially lower proportion of students than the state as a whole using depressants and tranquilizers currently. A-l. TABLE | 6. £ DIW ISION OF SUſ!.STANCE ABUSE SERVICES *-ºs----sm-- sº SUBSTANCE USE Aſiſ)!!(; NEW YORK STATE STUDſ RIS EtiſtOLLED 1 ti IIIE fiſy YORK CITY HEALTH SERVICE AREA 10,000 Students Enrolleq in Grades 7 through 12, Spring 1978 -* 532,000 90, 6 !!ever Used L if c title Use flo ſºccent Use Current Use Curr: at 1:33 w y i. S.- Type of Substanced Response (Used since school (UScd in pest (Us ca 1 Grt i: , ; (Used at least once) began in Sept. '77) 30 days) in ſ 35t 30 :::::, ; } Il % Il % Il N 7. H. £ !! – PCP (Angel Dust) 486,000 .81.3 ll 2,000 18.7 l 2, 000 65,000 l (), 9 38,000 6.3 4,000 0.7 !!al lucinogens 558,000 93.6 38,000 6.4 l 4,000 22,000 3.6 14,000 2.3 : 1,000 * . icocaine 512,000 85.5 87,000 l 4.5 |l,000 59,000 9.8 30,000 5.0 3,000 * : Inhalants 5l 6,000 86.9 78,000 13. ] 16,000 38,000 6.3 £2,000 3.7 |_2,000 *: tleroin 584,000 97.3 16,000 2.7 10,000 10,000 l. 6 6,000 0.9 {}()0 *% | Hathadone (micit) 583,000 97.7 l 4,000 2.3 13,000 9,000 ! .. 5 5,000 0.9 l,000 * . blarijuana 270,000 45, 6 322,000 54.4 10,000 269,000 44.9 209,000 35.6 90,000 l 5.4 Hashish 492,000 82.8 102,000 l 7.2 l6,000 65,000 l (), 8 4l,000 6, 7 1–6,000 0.9 stimulants 5l 6,000 . 87.0 77,000 l 3.0 17,000 54,000 8.9 34,000 5. 6 | 5,000 0.9 – Depressants 545,000 91.4 5],000 8.6 14,000 33,000 5.5 l 9,000 3. l | 2,000 * . Irºnizer: 521,000 88.9 65,000 ll. 1 |_24,000 45,000 7.4 30,000 5.0 | l,000 * †. ſºme with 530,000 90.l 58,000 9.9 22,000 34,000 5.7 24,000 3.9 | 2,000 * . Other Harcotics . 55,000 9.4 23,000 36,000 5.9 12,000 2.0 | 1,000 * { |-- --- Example of Ilovl to Read the Table: Åmong responding students, TT2, {{0TE: ** Less than 0.5%. Date of Preparation: September 25, 1918 1 brium; Öö0, or 18.7%, have used PCP (angel dust) at least once. The nulliber of users in the table are underestimates since they do not include the nonrespondents. ** Less than 500. * Hallucinogens such as LSD, DješCăline, and psilocybin; methaqualone; tranquilizers such as Walium and { $ttiyulant; such as Amphetamines and diet pills; depressants such as barbiturates and other narcotics such as opium, morphine, and codeine, New York City Health Service Area (Bronx, Kings, New York, Queens, and Richmond Counties) (Tables 3, 9, 16) The New York HSA generally has levels of substance use that are similar to the statewide figures. This HSA has the highest proportion of students in the state using the following substances: - - @ 9 in their lifetime: PCP and cocaine. since school began in September, 1977 (recently): PCP and Cocaine. in the past 30 days (currently): PCP and cocaine. for the first time since January, 1977: PCP (Table 8). The New York City HSA has the lowest proportion of students in the state using the following substances: - in their lifetime: inhalants and hashish. ... since school began in September, 1977 (recently): inhalants and hashish. in the past 30 days (currently): inhalants and hashish. ... for the first time since January, 1977: inhalants, hashish and cough medicine with codeine. - In addition to the above substances for which New York City rates are the lowest in the state, the proportion of students in the New York City HSA who have used hallucinogens since school began in September, 1977 (recently) is substantially lower than the statewide figure. A-LP # DIVISION OF SUBSTANCE ABUSE SERVICES TABLE 1 7. SUBSTANCE USE AMONG NEW YORK STATE STUDENTS ENROLLEſ) IN THE LONG ISLAND HEALTH SE PVI CE AREA 330,000 Students Enrolled in Grades 7 through 12, Spring 1970 d Never Used 1. if e title Use NO Recent Use Current Use Current cavy Uſ, e. Type of Sºbstance Response (Used since school (Used in past (Used l C+ tires (Used at least once) began in Sept. '77) 30 days) in past 30 d... ys !! 3. N. Ž Il | 4 N. % Il 3. PCP (Angel Dust) 269,000 83.0 55,000 17. () 6,000 35,000 l(). 18,000 5,5 2,000 (), Z - unucinogens 200,000 89.8 33,000 l (). 2 8,000 24,000 7. 13,000 4.0 2,000 0. Cocaine 290,000 89.2 35,000 l (). 8 5,000 27,000 8 13,000 A. l,000 * . Illalants 260,000 03.8 52,000 16.2 10,000 30,000 9. 15,000 4.7 2,000 0. 0 lleroin 3 l 6,000 96.9 10,000 3. I 4,000 7,000 2 4,000 l. 3 l,000 - "4 Methodone (Illicit) 315,000 96.9 l 0,000 3. l 5,000 6,000 ! . 5,000 l. 5 A ſk * . Marijuana l 30,000 40. 1 194,000 59.9 6,000 l 74,000 63. l 33,000 4 .. 4 69,000 20.3 lºsiºn 2] 6,000 67. ! 06,000 32.9 8,000 80,000 24. 40,000 a. 7,000 2. simulants 265,000 82. () 58,000 | 8.0 7,000 47,000 l 4. 27,000 8. I 5,000 1 .. 4 Tºrºnt, 279,000 86.6 43,000 l 3.4 6,000 30,000 9. 19,000 5.9 2,000 0. 6 irºnies 269,000 85.4 46,000 l 4.6 15,000 33,000 l O. : 23,000 6.9 2,000 0.0 ºlºne with 287,000 88.9 36,000 l l . ] 7,000 22,000 6. l 3,000 4.0 l,000 * { 0 ther flarcotics 278,000 87. ) 4] ,000 l 2.9 ! ,000 20,000 8. 11,000 3.5 l,000 . r — * - * *- * £:::: ) : « C. f {|0,1 to ſtead the Tat, le: X. & 3 rººf.Jrd T.J. slºfts, 55,000 , or 17.0 7, have used PCP (angel dust) at least once. ''{If : The rune 2r of uscrg in the table are underestimates S iſce they do not include the nonrespondents. *... I “ss than 0.5%. ** Less than 500. a Ilallucinogens such as LSD, Inescăline, and psilocybin; illethaqualone; tranquilizers such as Walium and Librium; stimulants such as amphetamines and diet pills; depressants such as barbiturates and other narcotics such as opium, Imorphine, and codeine. Date of Preparation: September 25, 1078 Long Island Health Service Area (Nassau and Suffolk Counties) (Tables 3,9,17) The Long Island HSA has levels of use that are generally higher than the statewide figures and among the highest in the state. This HSA has the highest proportion of students in the state using the following substances: ... during their lifetime: marijuana and hashish. ... since school began in September, 1977 (recently): marijuana; recent use of hashish is also substantially higher in the Long Island HSA than the State. in the past 30 days (currently): marijuana; 10 or more times in the past 30 days (heavily): hallucinogens, marijuana and stimulants. for the first time since January, 1977: cocaine (Table 8). This HSA has the lowest proportion of students in the state reporting no substance use since school began in September, 1977 (Table 9). A-l;7 1NTRODUCTION This survey is being conducted by the State Government in selected junior and senior high schools throughout New York State. The answers you give will help your school set up better programs to meet the needs of students who have questions or problems related to drug and alcohol use. This is your chance to make yourself he-rd. We - - | want to hear what you have to say. A-48 This survey is NOT A TEST. There are no right or wrong answers - to the questions. Taking part in this survey is completely voluntary. If there is any º question that you do not feel comfortable answering or that you feel \\ you cannot answer honestly, just leave it blank. If, for any reason, you § do not wish to complete the survey, please work quietly at your seat while other students complete it. - - All the information in this survey is CONFIDENTIAL. We do not want to know your name, so please DO NOT WRITE YOUR NAME ANYWHERE IN THIS BOOKLET. Please do not share confidential an- swers with anyone else. You, your class, and your school will never be identified. We hope you will feel free to answer exactly the way you feel. - We think you will enjoy completing this survey. Be sure to read the directions on the other side of this cover page before you begin to answer. Thank you for being an important part of this project. intran 1403-S719-54321 Di RECTIONs e Please follow all the instructions and read questions carefully. • Darken only one circle for each question or part of a question. e Your answers will be read automatically by a machine. Therefore: — Use only a number 2 pencil. — Make heavy black marks that completely fill the circles (see below). — Erase completely and neatly any answer you want to change. — Do not write your name or make any marks or comments in the booklet, Other marks or doodles will interfere with the machine. These marks will work: © Q @ These marks will NOT work: G & © & X Zº c | 1 If you feel you cannot answer a question honestly, please leave it blank. THE FOLLOWING ARE SOME GENERAL OUESTIONS ABOUT YOU. 1. Are you O Male O Female 2. What grade are you in? O7th O8th O9th O 10th O 11th O 12th . How old are you? O 11 or younger O 12 O 13 O 14 O 15 O 16 O 17 O 18 O 19 55 20 or older 4. Where do you live? O Manhattan, New York City O Bronx, New York City O Brooklyn, New York City O Oueens, New York City O Staten Island, New York City O Somewhere else in New York State. º 3& 5. What grades do you usually get? . O Mostly A's (A-. A or A+; 90–100) O Mostly B's (B-, B or B+; 80–89) O Mostly C's (C-, C or C+; 70–79) O Mostly D's (D-, D or D+, 65–69) O Mostly F's (64 and under) 6. Are you living with O Both parents O Mother only O Father only O Mother and Stepfather O Father and Stepmother O Foster or adoptive parents O Other 7. How close do you feel to your family? O Extremely close O Fairly close O Not very close O Not at all close 8. Are you O White O Black or Afro-American O Hispanic (Puerto Rican, Cuban, Dominican, etc.) O West Indian (Haitian, Jamaican, etc.) O Oriental or Asian-American O American Indian O Other O I'd rather not answer THE FOLLOWING OUESTIONS ARE ABOUT ALCOHOL. In the questions below, don't count the times you drank for religious reasons. A DRINK means an amount equal to a can or bottle of BEER, a glass of WINE, or a shot of HARD LI CUOR (like scotch, gin, vodka, other flavored drinks containing alcohol). , , § & ^ º $2 - - º Q} .# §§ § & 9. How many times (if any) have § & cº & > * s you had a drink of beer, wine & S aſ ºf S $ $ or hard liquor in your lifetime?. . . . OOOOOOO 10. During the past 30 days, on how many days (if any) did you have one or more drinks of . . . • sº DARKEN ONE Cl RCLE s sº FOR EACH LINE a, b, c. g = S Sº Sº Saſ’s’S & a. BEER7 . . . . . . . . . . . . . . . . . OOOOOO b. WINE.2 . . . . . . . . . . . . . . . . . OOOOOO c. HARD LI OUOR7 . . . . . . . . . . OOOOOO 11. On the days (if any) that you use alcohol, about how many drinks do you usually §§’sº have of & S & S º º & 3° S ; 2.9 S \ ^% tº AN a. BEER7 . . . . . . . . . . . . . . . . . . . OOOOO b. WINE.2 . . . . . . . . . . . . . . . . . . . OOOOO c. HARD LIOUOR2 . . . . . . . . . . . . OOOOO 12. In the past 30 days, what is the greatest to number of drinks (if any) you had & § sº on any one day of . . . & §§§ 3; sº S aſ sº wº a. BEER7 . . . . . . . . . . . . . . . . . . . OOOOO b. WINEP . . . . . . . . . . . . . . , s = e º 'º OOOOO c. HARD LiOUOR7 . . . . . . . . . . . . OOOOO I I I I I I I I I I I I I I I I I I I I I I I'I I I I I I I I I I I I I I I I I I I I I I I 13. 14. 15. 16. 17. 18. 19. If you feel you cannot answer a question honestly, please leave it blank. THE FOLLOWING OUESTIONS ARE ABOUT DRUGS. Remember, your answers are strictly confidential: they are never connected with your name or your class. FOR THE QUESTIONS ON DRUGS, DARKEN ONE CIRCLE FOR EACH LINE: a, b. How many times (if any) have & & # & S.$ 3. & you used MARIJUANA (grass, gº gº & & & # pot, herb, reefer) . . . $ §.S.S 3 * $ & § 4S.)”. 2 S S S Sé's S. S. Aſ ºf S’ \' & S o a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO Ry How many times (if any) have you used * HASHISH (hash, hash oil) . . . $ § 3. § ^3 @ S ^y 9) / / 5. S Q) & S. Aſ ºf S & $ $ a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO How many times (if any) have you used & O Sº •S ANGEL DUST (PCP) . . . § º, 9, 17° %. $'s © º, • Aſ ºf S & S $ 3 s a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO How many times (if any) have used LSD 8 (acid) or other HALLUCINOGENS g (mescaline). . . # * ~ Sº & $.S. - Sº, yº’s $ $ $3 a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO Ry How many times (if any) have you gº used COCA NE . . . $ $ 8. §§ 9) Z N ºv, tº N ſy tº $ a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO b How many times (if any) have you used HEROIN sº (smack, horse, skag). . . $. Sº §.S. § ..” .” S. & g Sºś a. in your lifetime? . . . . . . . OOOOOOO O b. in the last 30 days?. . . . . . OOOOOOO How many times (if any) have you sniffed GLUE or ſ: . . . & ar d *** . . - ... . º sº § inhalad solve NTS or SPRAYS for * “kicks” or a “high” . . . $ Sº & 3. to o *S s’s wº s & $ sº a. in your lifetime? . . . . . . . OOOOOO O b. in the last 30 days? . . . . . . Ooooooo 20. 21. 22. 23. 24. 25. 26. How many times (if any) have you taken TRANOUILIZERS (like Valium, Librium, Miltown, “nervous pills") without a doctor * telling you to . . . © C) •S g Y t § ^o o > ; Y. * $ S. Aſ Y S S S $ 3 a, in your lifetime? . . . OOOOOOO O b. in the last 30 days?. OOOOOOO How many times (if any) have you taken “UPS" (like amphetamines, speed, pep pills, diet pills) without a * º º O S) •S doctor telling you to . . . $ o, X_2 , §§ s Qºy © & S aſ tº S & S $ $ a. in your lifetime? . . . OOOOOOO O b. in the last 30 days?. . OOOOOOO How many times (if any) have you taken “DOWNS” (like barbiturates, Tuinals, Seconal, goofballs, “reds”, "rainbows", sedatives, Ouaaludes, Darvons) without b a doctor telling you to . . . sº $. Sº & & @ no o - sº S- sºs aſ "S.S. $ $3 a. in your lifetime? . . . OOOOOOO O b. in the last 30 days?. . OOOOOOO How many times (if any) have you taken A-51 METHADONE without a * * O •S doctor telling you to... § O) s * , ºs sº Q, ~ Aſ ºf S S $ $º & S - a. in your lifetime? ... OOOOOOO b. in the last 30 days? . OOOOOOO How many times (if any) have you taken NARCOT1CS other than heroin or methadone (like opium, morphine, codeine, Demerol) without a $ doctor telling you to . . . & Sº & 3. § 12.5°.S. sſ’s sº & S. Aſ ºf S & $ $3 a. in your lifetime? . . . OOOOOOO O b. in the last 30 days?. . OOOOOOO How many times (if any) have you taken COUGH MEDICINE or cold remedies for “kicks” or a “high” . . . © 65 S Q & “S Nº as §, º, 9 Z 7” x & & S aſ tº S S S $ $ ... ny, ſºund ... 5666666 'o b. in the last 30 days?... OOOOOOO Sº sº Q, About how many times (if any) have you taken a drug for “kicks” or to get “high" but you did NOT KNOW WHAT DRUG IT WAS . . . & Sº & *. ..”.” S. & § •S a. in your lifetime? . . . OOOOOOO b. in the last 30 days?. . OOOOOOO I I I I I I I I I I I I I I I I I I If you feel you cannot answer a question honestly, please leave it blank. Ł00K UP AT THE BOARD # N THE ROOMſ iF THE INSTRUCTIONs SAY To “skiP oUESTION 27”, GO DIRECTLY TO OUESTION 28. y #F THE NAME OF A PROGRAM/PERSON IS ON THE BOARD, ANSWER OUESTION 27 a-h. 27. On the board is the name of a program/person in your school that offers help to students. Students usually talk (“rap") with a counselor or a small group of other students about relationships with people at school, farm- ily and friends; use of drugs and alcohol; and general problems that young people face. a. Are you aware that your school has the program/person named YES NO on the board? . . . . . . . . . . . . . . . O O b. If a friend of yours needed help with a drug or other problem, DON'T YES KNOW would you tell him/her to go c. If you had a problem with drugs DON'T or alcohol would you go to this YES NO KNOW A-52 program/person for help?. . . . . . . . O O O d. If you had other problems—with school, family or friends—would DON'T YES NO KNOW. you go to this program/person for help?. . . . . . . . . . . . . . . . . . . O O O e. Has a counselor, teacher, principal, IDON'T or dean ever suggested that you YES NO KNOW participate in this program? . . . . . . O O - DON'T f. Have you ever participated in YES KNOW this program? . . . . . . . . . . . . . . . O g. Since school began in September, how many times have you had individual counseling or a private gº gº gº meeting with a staff member of s & S.S.S this program or the person $’ aſ ºf S named on the board?. . . . . . . . . . . OOOOO h. Since school began in September, how many times have you been to a rap group or group counsel- & ºy Q X ing session offered by this $’ ‘, aſ ºf S program/person? . . . . . . . . . . . . . OOOOO sº- 28. 29. 30. 31. 32. Was health information on drugs or alcohol (or both) DON'T presented to you in grades. YES No REMEMBER O Was information on drugs or alcohol (or both) presented to you in a health class when you were in . . . DON'T YES NO REMEMBER a. Grades 7–8? . . . . . . . . . . . . O O O b. Grades 9–12? . . . . . . . . . ... O O O What grade were you in when you most recently received information on drugs or alcohol (or both) . . . (Mark one circle on each line) § Qö & CŞ a, in a health class? . . . . . OOOOOOO O O |NOW! GO TO OU £STi OM! 28. . . . OOOOOOOOO b. in some other class? c. in an assembly program? OOOOOOOOO THE FOLLOWING OUEST ONS ARE ABOUT CIGARETTES, Have you ever smoked cigarettes? Never. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . O Once or twice only . . . . . . . . . . . . . . . . . . . . . . O Occasionally but not regularly. . . . . . . . . . . . . . . O Regularly in the past. . . . . . . . . . . . . . . . . . . . . O Regularly now & tº a tº e s tº q is tº ºn tº a tº g g tº e º a tº gº tº $ tº How often have you smoked cigarettes in the past 30 days? . I have not smoked in the past 30 days . . . . . . . . . O Less than one cigarette per day . . . . . . . . . . . . . . O i to 5 cigarettes per day About / pack per day. . . . . . . . . . . . . . . . . . . . About 1 pack per day About 1% packs per day 2 or more påcks per day * g º tº & g º e º 'º ºf a s tº $ tº º & 8 º' if you feel you cannot answer a question honestly, please leave it blank. THE FOi-LOWiNG OUEST ONS ARE ABOUT DRUGS AND ALCOHOL. 33. About how old were you when § s you FIRST (if ever). , , s’ gº - sº S v 9 S. & S S S & S a. Smoked a CIGARETTEŽ . . . . . . OOOOOOOOOOO b. drank a can/bottle of BEER7 . . . OOOOOOOOOOO c. drank a glass of WINE7 . . . . . . . OOOOOOOOOOO d, had a drink of HARD LIOUOR7. . . . . . . . . . . . . . . . OOOOOOOOOOO e used MARIJUANA’......... OOOOOOOOOOO f, used HASH ISH? . . . . . . . . . . . OOOOOOOOOOO a used ANGELDUs (PCP, ... OOOOOOOOOOO h. used LSD or other HALLUCINOGENS7 . . . . . . . . OOOOOOOOOOO i. used COCAINE2 . . . . . . . . . . . OOOOOOOOOOO j. used HEROIN? . . . . . . . . . . . . G) OOOOOOOOOO k. sniffed GLUE or inhaled SOLVENTS or SPRAYS for "kicks" or a "high"? . . . . . . . . OOOOOOOOOOO |.. used COUGH MEDi C NE for “kicks" or a “high"? . . . . . . OOOOOOOOOOO 34. About how old were you when you FiRST (if ever) took the following without & - s & a doctor telling you to? & Gº s s #S's 6 s 9 s 3 s s & a. "UPS" . . . . . . . . . . . . . . . . . . OOOOOOOOOOO b. "DOWNS” . . . . . . . . . . . . . . . OOOOOOOOOOO c. TRANOUILIZERs . . . . . . . . . OOOOOOOOOOO d. METHADONE . . . . . . . . . . . . OOOOOOOOOOO e. OTHER NARCOTCS . . . . . . . OOOOOOOOOOO & § & 35. About how old were you when §§§ & you FiRST (if ever) . . . gºš gº So Sº sºy & S. & S S $ 3 & a. Smoked a cigarette DAl LY? . . . . OOOOOOOOOOO & G tº e o a s a n e º e e º a OOOOOOOOOOO OOOOOOOOOOO . . ; ; ; ; ; ; ; ; § 3. § º § §: ſº §§ ºrg $ b. had a drink of alcohol WEEKLY7 36. As far as you know, since school began in September, about how many of your friends have . . . .8 & al, y of y * ºffs a smoked CIGARETTES daily? . . . . OOOOO b. had ALCOHOL weekly? . . . . . . . . OOOOO c. used MARIJUANA or HASHISH?. OOOOO d. used ANGEL DUST (PCP), LSD or other HALLUCINOGENS2. . . . . OOOOO e. used COCAINE7 . . . . . . . . . . . . . OOOOO f. used HERO | N or STREET METHADONE2 . . . . . . . . . . . . . . OOOOO g. sniffed GLUE or inhaled SOLVENTS or SPRAYS for “kicks” or a “high"?. OOOOO h. used “UPS", "DOWNS” or TRANOUILIZERS (without a prescription)? . . . . . . . . . . . . . . OOOOO 37. Since school began in September, have YOU! . . . - YES NO a. Smoked a CIGARETTE7 . . . . . . . . . . . . O O b. had a drink of ALCOHOL? . . . . . . . . ... O * c. used MARIJUANA?'. . . . . . . . . . . . . . . O O u. used HASHISH? . . . . . . . . . . . . . . . . . O O. e, used ANGEL DUST (PCP)? . . . . . . . . . . O O f. used LSD or other HALLUCINOGENS2. O O g. used COCAINE 2 . . . . . . . . . . . . . . . . . O O h. used HEROIN? . . . . . . . . . . . . . . . . . . O O i. sniffed GLUE or inhaled SOLVENTS or SPRAYS for "kicks" or a "high"? . . . . O O j. used COUGH MEDICINE for “kicks" or a "high"? . . . . . . . . . . . . . . . . . . . . O O 38. Since school began in September, without a doctor telling you to, have you used: YES NO a. "UPS" . . . . . . . . . . . . . . . . . . . . . . . . O O b. “DOWNS” . . . . . . . . . . . . . . . . . . . . . O O c. TRANOUli_{ZERS. . . . . . . . . . . . . . . . O O d. METHADONE . . . . . . . . . . . . . . . . . . O O O O 3 if you feel you cannot answer a question honestly, please leave it blank. 39. Since September 1977, have you used the following together, either at the same time or within an hour of each other? YES NO a. ALCOHOL AND MARIJUANA/HASHISH.. O O b. ALCOHOL AND "DOWNS" . . . . . . . . . . ... O O c. “UPS" AND "DOWNS". . . . . . . . . . . . . . * * O O d. ALCOHOL AND TRANOUILIZERS. . . . . . O O e. ALCOHOL AND HEROHN OR METHADONE . . . . . . . . . . . . . . . . . . . . O O 40. Since school began in September, have you gotten any of the following from your home? YES NO a. ALCOHOL . . . . . . . . . . . , , s s a s = e s a s a • O O (not for religious reasons) b. “UPS'' . . . . . . . . . . . . . . . . . . . . . . . . . . O O c. "DOWNS". . . . . . . . . . . . . . . . . . . . . . . . O O d. TRANOU | LIZERS. . . . . . . . . . . . . . . . . . O O A–5|| THE FOLLOW. NG OUESTIONS ARE ABOUT BE HAVIORS |N WHICH YOUTH ARE SOMETIMES INVOLVED. DARKEN ONE CIRCLE FOR EACH LANE a, b. 41. About how many times have you been drunk, sick or VERY high on alcohol . . . & 32 & & A.Ş., $ 3. & S ^_^ Sº AS AS S) º AS & S ; O) > jº. sº " Aſ ºf S S $’ a. in the last 30 days?. . . . . . . . . . OOOOOOO b. since September '77 while in any class? . . . . . . . . . . . . . . OOOOOOO 42. About how many times have you been VERY high (“stoned") on marijuana or hashish . . . O S) © Sº dº sé Jºs'ss a. in the last 30 days? . . . . . . . . . . OOOOOOO b, since September '77 while - - in any class? . . . . . . . . . . . . . . OOOOOOO ; ; ; ; ; ; ; ; ; ; ; 43. About how many times have you been VERY high (“stoned”) on other drugs (“ups”, “downs", hallucinogens, cocaine, heroin, etc.)... 9 @ & Rºs sfs * .* s' $ § a. in the last 30 days?. . . . . . . . OOOOOOO b. since September '77 while - in any class? . . . . . . . . . . . . OOOOOOO 44. About how many times have you cut a class or classes . . . & 6, 9, s 3. - $’ s aſ ºf S S $ a. in the last 30 days?. . . . . . . . OOOOOOO b. during the school day since September '77? . . . . . . . . . . OOOOOOO 45. About how many times have you failed a test . . . $ to o Sº & Sé's wº's $ $ a. since September '77? . . . . . . OOOOOOO b. in the last 30 days? . . . . . . . . OOOOOOO 46. About how many times have you been sent by a teacher to the Dean, Principal or guidance counselor because of your conduct or attitude . . . & & & Q, AS ASS 'S & AS AS S$.6 Aft’,”s a. since September '77? . . . . . . . . . . OOOOO b. in the last 30 days?. . . . . . . . . . . . OOOOO 47. About how many times has someone from home been called to school because of your conduct or attitude . . . © Sº & s's º º S $ $ a. Since September '77? . . . . . . OOOOOOO b. in the last 30 days?. . . . . . . . OOOOOOO WHEN YOU HAVE COMPLETED THIS OUESTION- NAIRE, PLEASE CHECK TO MAKE SURE YOUR ANSWERS HAVE BEEN FILLED IN NEATLY AND YOUR ERASING IS CLEAN. THEN TAKE THIS BOOKLET AND PLACE IT IN THE SEALED Box AT THE FRONT OF THE ROOM. Aſp;pfjW DIX B CODAMA - SLIDE SHOW SCRIPT SANDI MACCONNEL CODAMA Services, Inc. Planning and Research Division September 20, 1978 FINDINGS--COMMUNITY SURVEYS 1. The proportion of teenagers who would encourage a friend to seek help for drug abuse problems has increased from 55% in 1971 to 66% in 1977. TIP-OFF (summary sheet) 2 The percentage of teenagers who have taken drugs only once as an experi- ment has steadily increased since 1968 (1968: 6%; 1971: 9%; 1973: 5%; 1975: 14%; 1977: 15%). TIP-OFF (summary sheet) 3. The percentage of teenagers who have had the opportunity to obtain either marijuana or hard drugs has increased from 50% in 1968 to 76% in 1977. TIP-OFF (summary sheet) 4. The percentage of teenagers Who Would take drugs if given the chance has increased from 29% in 1968 to 41% in 1977. TIP-0FF (summary sheet) 5. The percentage of teenagers who have tried marijuana has increased from 14% in 1968 to 46% in 1977, while use of heroin has remained Stable at B-1 around 5%. TIP-0FF (summary sheet) 6. The percentage of teenagers who have been busted on drug-related charges has increased from 4% in 1971 to 9% in 1977. TIP-0FF (summary sheet) 7. Although the percentage of teenagers who drink alcoholic beverages has increased from 59% in 1968 to 77% in 1977, the percentage who feel that drinking is becoming more of a problem has remained stable at about 28%. TIP-0FF (summary sheet) CODAMA Services, Inc. Planning and Research Division TIP-OFF SUMMARY SHEET Do you think marijuana usage among teenagers is increasing? 66% 57% 59% 65% Do you think hard drug usage is increasing? 34% 30% 35% If you learned your best friend was taking drugs, Would you urge him to Seek help? 55% 58% 57% 66% Which of the following drugs should be legalized? Marijuana 27% 33% 36%. 37% 39% If marijuana Was legalized, Would you use it? (Yes) 19%. 26% 30% 31% 30% Have you taken drugs? (Once, experiment) 6% 9% 5% 4% 15% Have you ever been offered the opportunity to obtain illegal drugs? (Yes) 50%. 65% 73% 62% 76% Would you take drugs if you had the chance? tºº (Yes) 29% 32% 36% 4.1% 4.1% B-2 Have you taken MJ 14% 28%. 39%. 37% 46% Heroin 3% 4% 5% 5% 5% PCP 12% Have you ever been busted on drug-related charges? (Yes) 4% 4% 8% 9% Do you think drinking among high School students is becoming more of a problem? (Yes) 28%. 22% 28%. 33% 31% Do you ever drink alcoholic beverages? (Yes) 59% 73% 76% 80% 77% What do you drink? (Beer) 41%. 49% 54% 62% 57% Why do you drink? (Enjoy it) 35% 52% 48% 6.1% 58% By which of the following methods do you obtain alcoholic beverages? (At home with parents' consent) 23% 34%. 28%. 33% 28% CODAMA SERVICES, INC. Slide Show Script One day in the not-too-distant past a few individuals, who had more than average curiosity and powers of observation, noted that there were other individuals in Phoenix who were participating in, or victims of, drug abuse. They noted that few, if any, were doing anything about it. Then, the Severity of the drug abuse problem was evident. The lack of resources Was evident. The need for action was evident. These persons shared their concern With others, pointing out the reasoning behind their observations and conclusions. When a number of like-minded individuals joined together With determination to do something, CODAC, the Community Organization for Drug AbuSe Control, Was the result. This new organization was formed to provide a funding umbrella for a wide range of drug abuse treatment programs. The primary types of programs funded included detoxification, methadone maintenance, drug-free outpatient counseling, and drug-free residential Cd Y’e. CODAC continued to serve the community for the next eight years. Then, in 1977, CODAC evolved into CODAMA Services, Inc., the Community Organization for Drug Abuse, Mental Health and Alcoholism. The new organization was a result of a growing awareness that behavioral B-3 health problems were intricately connected, and additional regional pro- grams for drug abuse, alcoholism and mental health became eligible to become part of the CODAMA system. Entry is made into the CODAMA treatment system through Central Intake Unit. Clients receive both physical and psychological exams and then receive Counseling and referral to appropriate treatment programs. Another component for entry is through the Treatment Alternatives to Street Crime Program. TASC works with drug abusers involved in the criminal justice system and takes pre-trial intervention and diversion clients, as Well as probation and parole referrals. St. Joseph's Drug Abuse Program is one of the programs which provides treatment to heroin and polydrug abusers who are also involved in the Criminal Justice System. For the past 10 years St. Joseph's has been able to handle that fine line of balance between treatment and legal controls placed on the clients. In addition, the program offers a special treatment component for Women, as well as a variety of treatment and techniques. Biofeedback equipment is used for the reduction of anxiety and tension, as part of the detox process and as an adjunct to counseling sessions. Abibifo Korye Kuw, Inc. was organized in late 1971 and began providing Services to the community of South Phoenix in early 1972. Abibifo grew Out of the Work of a group of concerned citizens who felt the need to address the problem of drug abuse in the South Phoenix area. During that time it was felt that the existing treatment network was not pro- Viding needed services to the black community. Abibifo today provides a comprehensive program of methadone maintenance Outpatient treatment Services, including vocational counseling assistance and assistance With job placement throughout greater Phoenix. Although Valle Del Sol, Inc. is primarily a methadone maintenance program, intensive professional counseling, employment assistance, and educational assistance—both academic and vocational —for substance abuse clients are provided. Throughout its history, Terros has been an innovator in new programs designed to provide better service to its clients. It is because of this Willingness to try new approaches that programs like the Crisis Inter- vention Services have been described as the state of the art by organi- Zations such as the Joint Commission on the Accreditation of Hospital S. In the past Several years Terros has also taken part in two studies by Eli Lilly Company comparing different medication therapies for opiate detoxification. Currently, Terros offers: The New Arizona Family program is one of total abstinance from chemicals and violence, a living/learning center. It is a long-term, residential treatment program which operates in a Community setting. The program provides intake, screening, evaluation, Occupational/educational assistance, individual and group therapy, and referral, as well as a nursery for clients' children. When a youth's problems are severe enough to indicate a 24-hour-a-day treatment program, extreme care and dedication must be directed towards providing the most effective programs in the shortest possible time. The New Foundation has long been serving the needs of those young people for whom drug abuse has necessitated removal from the community and placement into a residential treatment setting. During the last three years that service has expanded to deal with the "whole" adolescent whose problems usually transcend drug abuse to include emotional/Social adjustment problems. CODAMA funds Prehab of Mesa to provide (l) a summer day school for adolescents and (2) two school year projects: Teachers Available to Listen to Kids (TALK) and Night Circles. The Summer day school is provided for borderline dysfunctional drug, alcohol, and polysubstance abusers, and includes group and individual therapy in conjunction with day-to-day classroom courses. - Night Circles is an evening program designed to develop skills in youth and their parents to better cope with problems encountered. The TALK (Teachers Available to Listen to Kids) program trains teachers, School nurses and other school personnel to establish rapport with high School students and Work with them as help is needed. Training includes basic structure skills, counseling methods, Parent Effectiveness Training, as well as meditation and human awareness experiences. Calvary Rehabilitation Center began as a mission house for alcoholics. In thirteen years Calvary has developed into a sophisticated program. At present Calvary is best described as a residential treatment program With primary care, transitional care, after-care, and community education and counseling components. The concept for the Arizona Guidance Center was born late in 1974 as an increasing need for general mental health services in the north central region of Phoenix began to be felt. Now in its fourth year of operation, the Center has maintained and expanded its commitment to comprehensive behavioral health Services. Recently four newcomers have been brought under the CODAMA umbrella. B-5 The Indian Health Advisory Board's alcohol component sees that Indians in need of treatment get into programs or alcohol counselors are placed at locations such as LARC and the Phoenix Indian Hospital where many Indians With alcohol problems eventually come. Friends of the Family offers temporary Shelter for abused Women and their children. During this period a woman is required to participate in both individual and group therapy. She is also assisted with procuring Welfare, food stamps, employment and medical treatment if needed. - The Arizona Recovery Centers Association program (ARCA) is especially designed for the recovering female alcoholic. Here Women receive both individual and group counseling emphasizing values clarification, assertiveness training, sexuality, feelings, and coping skills. The program requires the Women to choose from a wide range of community resources and make a commitment to participate in one for a predetermined length of time. Because many of the Women in this program are primarily single parents, special emphasis is placed on groups which help develop good parenting skills, such as parent effectiveness training, and par- ticipation in parent-child programs. B-6 Support Services for youth and family is provided by Family Villas. This program uses Volunteer foster parents and community resource people as its key ingredients. This unique approach to dealing with drug and alcohol addiction provides structured and varied time out options for the family and youth experiencing Substance abuse problems. Emphasis is on strengthening the family unit through the identification of needs, inner resources, the improvement and development of communication, coping and problem solving skills. The community based halfway homes and partial-care treatment do not carry the Stigma associated With state foster homes and/or detention. Using these facilities would mean the family does not have to enter any of the bureaucratic systems such as juvenile court, Welfare foster homes, or the State Department of Corrections. CODAMA, however, is more than just the Services it Subcontracts With to provide. In order to continue to administer and provide adequate Services to the community, a dynamic and responsive organization is needed. The effective management of both the internal organization of CODAMA and the system as a total entity is the responsibility of administration. Such responsibility includes liaison with Federal, State, and local Com- munity agencies and leaders. Ultimate responsibility for all CODAMA corporate actions, however, belongs to the CODAMA Board of Directors. The Fiscal Unit is responsible for preparing CODAMA's annual budget, numerous proposed budgets, and reporting to funding Sources. Other functions of the unit include purchasing, personnel as well as moni- toring and assisting subcontractors in the preparation of their budgets. The unit also offers technical assistance in the area of management and hiring procedures. Program Evaluation The CODAMA Evaluation Unit monitors and evaluates the agency's treatment subcontractors for contract compliance and quality of client Care. The major focus of this unit is in providing assistance to Subcontractors in improving their programs. - Components of the Evaluation Unit include: Data Collection Site Visits Record Audits (Slide) Treatment Outcome Studies Technical ASSistance The Data Collection System which encompasses Federal, State, and CODAMA needs is developed and refined, edited, verified and reported to the appro- priate funding sources as well as back to the Subcontractors. Monthly and quarterly statistical reports are then generated from this data. Both formal and informal site Visits are conducted on each subcontractor at frequent intervals to review the total program including management and clinical aspects with recommendations and assistance given regarding necessary ChangeS. In addition, clients are interviewed from each sub- contract agency to determine client satisfaction with the services they received. (Slide) After program completion, the Evaluation Unit conducts follow-up inter- views on Selected Samples of ex-clients. (Slide—Interview situation) All of these unit functions are used to provide feedback to the subcon- tractors regarding their program strengths and weaknesses with technical assistance being provided by CODAMA to make any necessary changes, either in program or funding decisions. Planning and Research The accurate measuring of community needs, community resources and the most efficient Way to apply the resources to the needs are what the Planning and Research Division is designed to do. An Annual Action Plan translates into action items and tasks that provide the CODAMA Board a management tool for measuring attainments versus goals. The Division is conducting leadership surveys, key informant surveys, B–7 general behavioral health surveys, literature research, data research, and client satisfaction surveys throughout the year. The Division prepares and responds to numerous Requests for Proposals received. Also, the Division prepares the Letter of Intent and Requests for Proposals that CODAMA itself Sends out. (Art Stillwell) Finally, Planning and Research is responsible for facilitating long-range planning for future CODAMA services. Prevention Prevention of behavioral health problems is a priority at CODAMA. CODAMA Prevention programs are currently being offered to over 5,000 children in Valley schools. Prevention training programs are community- oriented and are offered to educators, parents, social Service Workers and behavioral health specialists. In addition, a three-credit graduate course in decision-making skills is offered by CODAMA through A.S.U. Also, CODAMA contracts with Family Willas and CLYDE to provide Prevention services to parents and high school youth. CODAMA's Prevention programs have been designed to develop positive self-concepts, decision-making skills and attitudes of positive self-worth. If people feel good about B-8 themselves they are less likely to be influenced by peer pressure, media, or other social forces when confronting choices concerning drug and alcohol US6. Community Relations CODAMA's Community Relations Unit is responsible for providing information and education to the general community as well as to appointed and elected officials and media. (Phoenix City with CR) The Unit provides speakers, literature, and audio-visual material to the public upon request, as well as participates in many community events throughout the year. (Shot of booth) Other responsibilities of the Community Relations Unit include publications Such as the CODAMA newsletter, brochures, news releases, and public Service announcements. (Shot of literature) Finally, Community Relations is responsible for the coordination of CODAMA's fundraising endeavors. (Shot of TV Auction) Summary In the future, CODAMA will continue to fund needed behavioral health Ser- vices as well as expand its geographical service area. CODAMA will also Continue to actively promote positive alternatives in coping With the daily problems and stresses that every individual confronts in our fast- paced Society. CODAMA-The Community Organization for People—is striving to offer the most effective and innovative treatment and prevention programs to the community for both today and tomorrow. Q T 0. | ] . | 2. Reports Available from CODAMA Services, Inc. Raymond, J. S. , Rhoads, D. L., Oxley, D. Community Needs Assessment and Multi-Catchment Area Planning. A paper presented at the 1972 meeting of the American Psychological Association, Toronto, Ontario- Raymond, J. S., Hurwitz, S. Client Preference – Treatment Congruence As A Facilitator of Length of Stay: Supporting an Old Truism, 1978. Stillwell, A., & Raymond, J. S. Arizona Leadership Survey, October, 1978. Raymond, J. S. Primary Prevention: Structure & Process, 1977. Gutierres, S. Women in Drug Treatment: Literature Review, 1978. Rhoads, D - L. , Raymond, J. S., Carpenter, K., Ramsay, T - A General Behavioral Health Survey of 547 South Phoenix Residents, October, 1978. B–9 Flory, A. Treatment Outcome Research Project, 1978- 1979–1980 CODAMA Annual Action Plan (available after Jan. T) 0xley, D. & Raymond, J. S. Organizational Ambiance: A Behavioral Health Agency Before and After Relocation, 1978. Raymond, J. S., Rhoads, D . L., Oxley, D. , MacConnel i , S - Technical Reports 001-009: General Behavioral. Health Survey by Catchment Areas, 1977. (does not include the South or Southwest catchment areas) Oxley, D. & Raymond, J. S. Technical Report 10] : Primary Prevention, 1978. Rhoads, D. L., Raymond, J. S., Oxley, D., MacConnell > S - Technical Report 011: General Behavioral Health Survey for Haricopa County, 1977 - 13. Rhoads, D. L. & Raymond, J. S. Technical Report 012: Validation of Social Indicators, 1977. 14. Todd, R., Raymond, J. S., Marton, T. An approach to planning organizatio transition. Public Administration Review, Sep/0ct, 1977, 534–538- - 15. Katz, E. Prevention Division of CODAMA Services Final Evaſtation Report. for 1977–1978, 1978. A number of concrete benefits have resulted or are being formulated from these studies, including: funding for an additional drug and alcohol treatment program in the Northwest catchment area; technical assistance to drug treatmen programs in meeting the special needs of women; public education to lessen the B-10 discrepancy between official attitudes about needed services and the actual needs as reported by Phoenix residents; and refinement and expansion of prever tion programs in the public schools. A pºp'EN'ſ).I.Y. G WIRAL HEPATITIS FORM MARSHALL SCHREEDER This report is authorized by law (Public Health Service Act, 42 USC 241). While your response is voluntary, your cooperation is necessary for the understanding and control of the disease. º, NO'ſ WR TE : N THES 30X §§ V#RAL HEPATHTS CASE RECORD - STATE GEOGRAPH |C CO DE YEAR QUARTER STATE ū); V Si Ojº DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE }{ - *- . PUBLIC HEALTH SERVICE *** *** **mºsasº. ººº-ºpe ** == -º-º: (1 ) (2) (3) (4) (5) CENTER FOR DISEASE CONTROL (1) (2) (3) (4) (5) (6) (7) Bureau of Epidemiology C º STATE CASE NO. Phoenix Laboratories Division DC CASE No. DATE RECEIVED 4402 North 7th Street (8) (9) (10) (11) Phoenix, Arizona 85014 (8) (9) (10) (11) z: PATIENT's LAST NAME(please print clearly) (12-17) - - FIRST AND MIDDLE NAME (or initial) {} ." - E; - 2 ºf STREET ADDRESS TOWN OR CITY STATE(Zip Code) COUNTY (18-21) #. ''. #: 3. - * † AGE (22-23)|SEx (26) R^°F (27) 1 Dwhite, not of Hispanic Origin 2 DBlack, not of Hispanic origin OCCUPATHON ſº Years — 1 DMale2 DFemale || 4 DAmerican Indian or Alaskan Native 5 D Asian or Pacific Islander 6 DHispanic 9 Dunk. ~! - --------- - Hepatitis A Hepatitis B - 54 Reporting physician's diagnosis: (28) 1 D (Infectious Hepatitis) 2 D (serum Hepatitis) 3 Dunspecified or Unknown z: {}3te of Z / was the patient jaundiced? (33) was the patient hospitalized? (34) 1 []ves 2 []No 9 Dunk. + £3; first symptom: . MO. Day Yr. {} 2 (29-30) (31-32) - 1 DYes 2 DNo 9 Dunk. lf yes, where? !. Was there personal contact, excluding needle sharing, with known jaundiced person or hepatitis case during the 6 months prior to onset? (35) 1. DYes, within 2 mos. 3 DYes, 2-6 mos. prior to onset 4. DBoth 2 []No 9 Clunknown if yes, who?(36) 1 DHousehold Member 2 DNonhousehold Member 3 DBoth 9 Dunknown #. Were raw cłams or oysters eaten in the | | |. Were drugs such as narcotics, barbiturates, or amphetamines injected by patient during the 6 months prior 2 tº oſºths before onset? - (40) to onset? (42) 1 DYes, within 2 m OS. 4 DYes, 2-6 mos. prior to Onset 5 Deoth 1 DYes 2 DNo 9 Dunknown 2 []Not admitted, but suspected 3 DNo 9 Dunknown iv. Did patient receive transfusion of blood or biood products in the six months before onset? (43) 1 []Yes 2 []No 9 []Unknown if yes, - (a) Where? Name of Hospital Name of Bloodbank Supplying Blood and/or Components: (b) When did the patient receive the transfusion(s)? (44) 1 Don 1 day—date / / 2 Clover a 2-7 day period / / TO / / MO. Day Yr. Mo. Day Yr. MO. Day Yr. 3 Dover a period of 8 days or more — dates not necessary 9 Dunknown º Number Sº tº (c) Please record the number of units received in appropriate box (if unknown write 99) Whole Blood, packed red cells (48-49) of Units ._ § - - - - - Numbe, F- other (Albumin, Frozen RBC, Number T- *ſ Fibrinogen, Factor VIII, Factor IX concentrate (52-53) of Units – plasma protein fraction, etc.) (54-55) of Units L- Cl - º (...) V. Did the patient die as a result of hepatitis? (56) Vi. Was patient a food handler? (57) § l DYes 2 [...] NO 9 DUnknown l DYes 2 DNo 9 Dunk. lf yes, where? 3 Vil. In the 6 months prior to the onset of symptoms was the patient admitted to a hospital? (58) ; w | Tlves, with in 2 mos. 4. DYes, 2-6 months prior to onset 5 [] Both 2 []No 9 DUnknown ; V! t . In the 6 months prior to onset of symptoms did the patient have any of the following procedures performed? isi Yes NO Unk. Yes NO Unk. Yes No Unk. (59) Surgery (excluding dental) 1 D 2 [] 9 [] (62) Ear piercing 1 [] 2 D 9 D (65) Acupuncture 1 D 2 [] 9 [] (so) Dental work (excluding surgery) 1 D 2 D 9 D (63) Tattooing 1 DJ 2 DJ 9 D (66) other percutaneous 1 DJ 2 D 9 D (61) a. Plasmapheresis i [T] 2 [...] 9 [] (64) Oral surgery 1 [] 2 […] 9 D exposure(skin tests, b. If yes, specify the name hair transplant, etc.) of plasmaphs resis Center: Specify : X. is the patient employed in a health-related field? (67) 1 DYes 2 DNo 9 DUnknown lf yes, Specify:(68) 1. DPhysician 2 DNurse 3DLaboratory or Medical Technician 4 DDentist 5 DDental Hygienist or Assistant 6 DHospital Attendant 7 DHospital employee other than above 8 [T] Other (Specify: 9 D Unknown X. is the patient associated with a hemodialysis unit or transplant program? (69) 1 [] Yes 2 DNo 9 DUnknown If yes, specify:(70) 1 DDialysis/Transplant Patient 2 DDialysis/Transplant employee 3 D Household contact of Dialysis/Transplant Patient - - - Name of unit 4 D Household contact of Dialysis/Transplant Employee 9 D. Unknown or program: Xi. is the patient associated with a nursery or day care program? (71) l DYes 2 []No 9 Dunk. N. Of urSery: lf yes, specify: (72) } Dohild in program 2 D.Parent with child in program 3 [ ]Employee 4. Dsibling of child in program 9 Dunk tiſſ XII. Was the patient's serum positive for the Hepatitis B surface antiger (HB,Ag, Australia antigen, HAA)? (78)] DYes 2 DNo 8 DNot tested for 9 Dunk. <ſ ºf - - -] ſº X; i !. Was the patient's serum positive for the Hepatitis B surface antibody (Anti-He, anti-HAA)? (79) 1 DJYes 2 DNo 8 DNot tested for 9 [...]Unk COfft ºf ENTS: NVESTIGATO R'S NAME AND THTLE PHYSICIAN's NAME （DATE OF INTERVIEW Z A Month - Day Year CDC 4.19.1 C 9-77 1. CDC HEPATITIs LABORATOREs Division Form approved one No. senio- Aſpſ?'EN DIOC ſy ROCK SURVEY JOHN NEWMEYER 6) (amyl nitrite) 7) 8) 9) What City or town do you now live in? HAIGHT - ASHBURY FREE MEDICAL CLINIC M. F. I.)] (* A {, S. H. ("Ti () N | \{{ {, , , F ] { } N if I ("ATI, N. \\ { } \! {^N S N }. F. S S K ("TI () \, 558 ('lay (or Street |*|| | | \ }}|ſ. ['l A'i' () N \ \, , ) 55° ( lay on St Fººt T (, ; };} | | 7 || | \} | FIR ("A Riº 1'K). F. | | | | | | | ()(): ; 5''' ('t ºf St - T. j. 'l 2( i ! . . . . .'; ' ' ', * * - - . . . " . S. 1) # 1 . . . . is , ( , " , ; ; This confidential questionnaire is part of a survey to help us learn more about the people we are caring for at concerts. Please do not put your name on this questionnaire. What is your age? Are you male or female 2 What was your father's occupation? Are you presently employed? Full-time Part-time NO How much schooling have you had 2. *-** Grade School only Some college, but ho degree Some high school, but College graduate not graduated Post-graduate work ***- High school graduate T *-*-*-*.*-a In the last month, how much have you used each of the following drugs? (Check the appropriate column) Not at Once or A few A few times Daily or all twice times a Week almost daily D–l Gra SS Acid Speed Barbs PCP Cocaine ***** ***.*** ***-** --wººtºººººº-ºººººººº- -------- ****sse-rººm-tº- ***-*-**** * * Heroin Quaalude Walium Tobacco Poppers --º-º-º-º- -*s--- -**** --------e------- What drugs have you taken today? How do you think the quality of life in the Bay Area, for persons like yourself, compares to that of three years ago? Much better now Somewhat worse now *****-------> Somewhat better row Much worse now About the same sessmemº-mº sº- 10) Medi-Cal 2 yes nO Thank you very much for your time. Z(ſp.? EN'ſ).I.Y. E HEROIN SUBSTITUTE REPORT RAQUEL CRIDER, NIDA Heroin Substitutes Report to the Heroin Indicator Trend Task Force Dr. Raquel Crider Forecasting Branch National Institute on Drug Abuse Rockville, Maryland HEROIN SUBSTITUTES AND SUPPLEMENTS When heroin trend indicators began to decline in mid 1976, it was assumed that heroin was becoming less available and some drug abuse researchers believed that other drugs with similar analgesic qualities were being substituted for heroin. Identifying these substitutes using national statistics such as the number of emergency room mentions, proved to be difficult since no single drug appeared to take the place of heroin nationwide. Analyzing the percent of mentions for potential E-1 heroin substitutes in some Standard Metropolitan Statistical Areas (SMSAs) however, did produce consistent and interpretable results. The focus of this paper is to describe these potential heroin substitutes using an analysis of drug abuse mentions reported to the Drug Abuse Warning Network (DAWN) during 1977 and 1978. In the process of examining percent of mentions, trends, and reports from residents of the communities involved, it was thought that some of the drugs were used in combination with heroin (supplement) rather than as a heroin substitute. In addition, during the process of identifying potential heroin substitutes, it was noticed that heroin trends for emergency room mentions and deaths in some SMSAs were increasing and these trends are also reported. Methodology Only narcotic and non-narcotic analgesics were considered as potential heroin substitutes except for aspirin and acetaminophen (Tylenol). Meperidine HCL (Demerol) was also excluded because the low frequencies preclude analysis. All other narcotic and non-narcotic analgesics as reported in the DAWN Quarterly April–June, 1979 are presented and analyzed. DAWN involves 24 SMSAs with numbers of mentions per quarter ranging from approximately 300 to more than 6,000. Only SMSAs with 1,000 mentions or more were used in the analysis because of the small percentages in- volved for some drugs. In each of the SMSAs both emergency room reports of drug involved incidents and reports of deaths are received. For the primary analysis, only emergency room mentions were considered while deaths were used to support the con- clusions found from hospital emergency rooms. A secondary analysis was conducted, i.e. no new information was obtained other than that already available in the published DAWN Quarterly April– June 1978. The published reports of the National Institute on Drug Abuse (NIDA) Community Correspondents Group June 1978 were used to supplement the findings from DAWN. The percent of mentions for heroin and the drugs thought to be potential heroin substitutes for each SMSA were the basis for analysis. The mean and standard deviation of the percentages were calculated for each drug and a criteria consisting of the mean plus one-half standard deviation was established. If the percent of mentions in an SMSA exceeded the Criteria, an SMSA was said to have a high proportion of mentions. Findings Table l illustrates the 13 SMSAs having 1,000 mentions or more per quarter and the percent of mentions for each drug considered. The Detroit, San Francisco, and San Diego SMSAs had 13.4 percent, 10.9 and 8.5 percent respectively of the total mentions in the SMSA that were heroin/morphine involved. These three areas exceeded the criteria of 7.1 percent. New York was the only SMSA exceeding the criteria of 2.3 percent of the E-3 mentions for methadone having 7.4 percent of its total mentions for that drug. Codeine showed high proportions in Los Angeles, San Diego, San Francisco, and Philadelphia, with 2. 1, 1.1, 1.5, and 1.2 percent respectively Compared to the criteria of 1.1 percent. Emergency room mentions for hydro- morphone (Dilaudid) occurred most frequently in Washington, D.C. (1.3 percent of the total mentions in the SMSA). No other SMSA exceeded the criteria of 0.6 percent except for Boston with 0.8 percent. Percodan mentions seemed to occur in many SMSAs, e.g. Boston (2.2 percent), Denver (1.6 percent), Miami (1.5 percent), Phoenix (2.5 percent) and Seattle (1.6 percent), each of which had a greater proportion of mentions than the criteria of 1.5 percent. Table 1 Percent of Mentions for Selected Drugs in Selected SMSAs April–June, 1978 º O C CU O U) •r— (ſ) ºn Q) ~ •r- ſ r— Cl4 O C) O Q) º r— bO C 4–) O 4–). bſ) }– $4 Q) Q) (U QU Ö0 C bſ) H *H C O •r- rö •r- $– r— C O (U Cl) O – G (U C Pi— 4–) • H 4–) O > H E Q) r— 4–) -C (ſ) •r- C 4–) (ſ) tū 3. O •r— C C (U Ú) O .C. (1) Q) O •r— Q) .C. .C. (U (U Gl) (U pº C C C H >. 2. P- Q- UD Uſ) C/D º: Heroin/Mor. 4.2 5.8 0.5 13.4 2.7 4.8 5. 3 4.1 1.5 8.5 10.9 1.8 3.6 Methadone 1.1 0.4 0.4 0.5 0.3 1.4 7.4 1.3 0.1 0.4 0.9 0.8 0.8 Codeine 0.9 0.2 0.5 0.5 2. 1 0.2 0.2 0.4 1.2 1.1 1.5 0.6 0.4 Hydromorphone 0.8 0.0 0.4 0.2 0.1 0.2 0.1 0.6 0.3 0.0 0.4 0.3 1.3 Percodan 2.2 0.1 1.6 0.5 0.4 1.5 0.3 2.5 0.9 0.9 0.3 1.6 0.8 E-4d-Propox. 2.1 2.1 3.3 2.2 1.5 0.9 1.9 3.9 2.3 1.6 0.5 1.3 1.5 Pentazocine o 0.5 4.6 0.7 0.4 0.4 0.3 0.3 0.6 0.8 0.3 0.2 0.5 0.3 No. of 2889 3220 2862 1059 1262 119.5 Mentions 1718 1314 4139 6,386 3.210 1171 1593 Source: DAWN Quarterly Report April–June 1978 Other analgesics such as d-propoxyphene (Darvon) and pentazocine (Talwin) appeared to be associated with a number of emergency room mentions. Denver and Phoenix had a high proportion of Darvon mentions with percentages of 3.3 and 3.9 percent respectively, both of which were greater than the 2.4 percent criteria. For Talwin , only Chicago (4.6 percent) had a larger percent of mentions than the criteria of 1.4 percent. 5. º i 27 3 1. l 0.6 1.5 2.4 1.4 Table 2 shows the SMSAs having a percentage of mentions worthy of note. These areas can be grouped into three types: Type I – SMSAs experiencing a heroin/morphine or codeine problem. Type II- SMSAs with one clear drug of choice such as hydromorphone, pentazocine or methadone. Type III-SMSAs experiencing problems with other drugs, e.g. d-propoxyphene percodan or hydromorphone. Table 2 Grouped SMSAs Using Percent of Mentions to Determine Type of Drug Problem Type I Heroin or Codeine Detroit Heroin San Francisco Heroin Codeine San Diego Heroin Codeine Los Angeles Codeine Philadelphia Codeine Type II Single Drug as Potential Heroin Substitute Chicago Pentazocine (Talwin) New York Methadone Washington, D.C. Hydromorphone (Dilaudid) Type III Other Drugs as Potential Heroin Substitutes Denver Perco dan d—Propoxyphene (Darvon) Phoenix Percodan d—Propoxyphene (Darvon) Boston Percodan Hydromorphone (Dilaudid) Seattle Perco dan Miami Per codan Discussion The preceding analysis involved an examination of percent of mentions for each of the drugs considered to be potential heroin/morphine substitutes. Comparing percent of mentions has at least one major limitation. Namely, when the percent for one drug is high, the percent for another drug must be low. Therefore, the analysis of percent of mentions can only be used as an indicator of potential heroin substitutes. Other evidence such as death and emergency room trend lines and reports from persons residing in the SMSA should be used to support the conclusions. Type I – Heroin/Morphine, Codeine Heroin/Morphine Two of the three SMSAs found to have a high proportion of heroin/morphine emergency room mentions i. e. San Francisco and Detroit, but not San Diego, also showed an increase in absolute number of mentions. Table 3 shows the number of emergency room mentions by quarter starting in January 1977. In both San Francisco and Detroit the increase began in the April–June quarter of 1978. Tablo 3 Heroin/Morphine Mentions – Consistent Emergency Room Reporters 1977 1978 J–M A-J J-S O-D J-M A-J J–S Detroit 4.71 463 554 575 398 416 443 San Francisco 133 109 86 81 74 116 208 Source: DAWN Quarterly Report April–June 1978 and DAWN NOWHIST Computer Tape Although the analysis of percent of mentions was not applied to medical examiner data due to the low frequencies involved, the heroin/morphine related death trends were of interest. In Los Angeles and Philadelphia (and only in Los Angeles and Philadelphia) the number of deaths began to increase in the January–March quarter 1978. Table 4 shows the frequencies by quarter. Because of the considerable lag time for medical examiners' to report and since the increase was noted for only one quarter, the medical examiner data should be interpreted with extreme caution. Nonetheless, based on the trend lines for heroin/morphine deaths, Los Angeles and Philadelphia are considered to have a potentially increasing heroin problem. Table 4 Heroin/Morphine – Consistent Medical Examiner Mentions 1977 1978 TJ LM A-J J–S O–D J-M Los Angeles 37 49 49 33 56 Philadelphia 11 7 9 9 16 Source: DAWN Quarterly Report April–June 1978 Codeine Codeine emergency room trends are illustrated in Table 5 showing an increase in two of the four SMSAs with high proportions of mentions; San Francisco, Los Angeles, and perhaps even San Diego but not Philadelphia. : The codeine medical examiner trends were not given because of the small frequencies. Based on the emergency room trend lines, codeine appeared to be primarily a California problem with the high proportions of mentions and increasing numbers of mentions. A high proportion of mentions without an accompanying increase in trend was noted in Philadelphia. Table 5 Codeine – Consistent Emergency Room Mentions 1977–1978 1977 1978 J–M A-J J-S O–D J–M A—J -sº-sº-sºº -m ºs-- *** San Francisco 12 10 7 15 12 17 San view 9 13 7 9 8 14 Los Angeles 38 46 38 33 70 66 Philadelphia 12 9 8 12 9 5 Source: DAWN Quarterly Report April–June 1978 Another kind of supporting evidence contributing to the consideration of heroin and codeine as drugs of concern is this report from a drug abuse researcher and resident of the SMSA involved." In San Francisco, Dr. John Newmeyer reported to the Community Correspondent Group in June 1979 an increase in other heroin indicators such as robberies, survey data, and estimated number of new users. Community Correspondents from other Type I SMSAs did not observe a problem with heroin or codeine with the exception of Philadelphia. The Philadelphia correspondent did report an increase in the proportion of recent new users coming into treatment for primary heroin use. Type II – SMSAs with One Clear Drug of Choice The second type of SMSA is the area with one single drug emerging as a potential heroin substitute, These include Chicago, New York, and Washington, D.C. with pentazocine (Talwin), methadone and hydromorphone (Dilaudid) respectively as the drug of concern. Each of these SMSAs had other evidence lending support to the conclusion that these drugs are being used as heroin replacements. The primary support was the emergency room mentions trend data shown in Table 6. Table 6 Pentazocine, Methadone and Hydromorphone Mentions Consistent Panel of Emergency Rooms 1977 1978 J–M A-J J–S O–D J–M A-J . . . . E-9 Chicago 25 28 43 21. 53 46 (Pentazocine) - New York 222 221 179 2O7 188 1.90 (Methadone) Washington, D.C. 9 11 10 10 22, 20 (Hydromorphone) Source: DAWN Quarterly Report April–June 1978 Pentazocine - Pentazocine (Talwin) in Chicago increased through the first quarter of 1978 (Table 6). Rescheduling the drug by the State of Illinois from controlled Substance Act Schedule I to Schedule II in August of 1978 may reverse the trend, however. Additional evidence of a Talwin problem in Chicago came * Proceedings – Community Correspondents Group Meeting Four, Volumes I and II. Sponsored by the Forecasting Branch, Division of Resource Development, National Institute on Drug Abuse, June 21–23, 1978 from the Chicago Community Correspondent Group representative in June 1978. The representative discussed a combination called T's and Blue's (pentazocine and tripelennamine) which were dissolved and injected in much the same manner has heroin. Methadone Although New York showed the greatest proportion of methadone mentions, the drug did not show an increasing trend as heroin mentions decreased. Since, methadone ranks 4th among heroin combinations shown in Table 7, methadone is considered more likely to be a heroin supplement (taken with) than a heroin substitute. Table 7 Example of Drugs Used in combination with Heroin/Morphine, E-10 All Emergency Room Mentions January–October 1978 Drug Combined with Heroin Mentions Rank Alcohol 749 1. Cocaine 317 2 Diazepam (Valium) 279 3 Methadone 259 4 Codeine 142 5 Secobarbital (Seconal) 78 6 Quinine 75 7 PCP 74 8 Methylphenidate (Ritalin) 74 9 Pentazocine (Talwin) 72 10 Methaqualone (Quaalude) 68 11 Barbiturate Sedatives 59 12 Marijuana 51. \ 13.5 Secobarbital/Amobarbital (Tuinal) 51. 13. 5 Heroin Alone 4, 552 Source: DAWN NOWHIST Tape Hydromorphone The number of emergency room mentions in Washington, D.C., for this drug began to increase sharply in the first quarter of 1978 although a modest increase was noted before that time. Table 6 shows the number of mentions by SMSA as reported in the April–June 1978 Quarterly Report. In Washington, D.C. abuse of hydromorphone (Dilaudid) is well known among law enforcement officials and drug abuse treatment personnel. A routine urine surveillance of arrestees by the D. C. Courts showed that the number of persons with a urine positive for hydromorphone had been increasing for sometime and is at present almost equal to the number of persons with a urine positive for heroin. Type III — SMSAs Experiencing Problems with Other Drugs Percodan, d-Propoxyphene and Hydromorphone The number of mentions per quarter for percodan, d-propoxyphene and E–11 hydromorphone are given in Table 8. Increases were noted for per codan and hydromorphone in Boston and for percodan and d-propoxyphene in Phoenix. Table 8 Percodan, d-Propoxyphene and Hydromorphone Mentions, Consistent Emergency Room Reporters 1977 1978 J-M A-J J-S O-D J-M A-J Boston (Percodan) 34 24 23 23 21 29 Boston (Hydromorphone) O l 3 4 4 11 Phoenix (Percodan) - 18 20 18 12 10 24 Phoenix (d—Propoxyphene) 30 24 31 38 37 37 SOURCE: DAWN Quarterly Report, April–June 1978 E-12 Other documentation for considering d-propoxyphene in Phoenix a drug Of concern is a report from the Phoenix community Correspondent and the results of a pilot-study funded by the National Institute on Drug Abuse. The Phoenix Community Correspondent in December 1978 noted a number of deaths associated with d-propoxyphene. In addition, a pilot study in- volving a urinalysis of arrestees during January and February 1978 showed that 39 percent of those found positive for any drug were positive for d-propoxyphene. This percentage is contrasted to 3–6 percent for other {} a & ºk Cities. * Criminal Justice Drug Abuse Surveillane System: Final Report. National Institute on Drug Abuse, Contract No. 271-77-1215 Work Order No. 01, May 1978 Conclusion some SMSAs were found to have a high proportion of drug mentions compared to other SMSAs for selected drugs in the narcotic and non-narcotic analgesic category. These SMSAs fell into three groups: those with a high proportion of heroin/morphine mentions along with codeine mentions, those with a high proportion of one specific drug thought to be a potential heroin substitute, and those with a high percentage of mentions for other drugs such as percodan, d-propoxyphene and hydromorphone. A heroin or codeine problem was noted in Detroit, San Francisco, San Diego, Los Angeles, and Philadelphia. The single drug as the potential heroin substitute occurred in Chicago with pentazocine, New York with methadone, and Washington, D.C. with hydromorphone. The SMSAs with a high proportion of mentions of E–13 other drugs were Denver, Phoenix, Boston, Seattle and Miami. POTENTIAL HEROIN SUBSTITUTES IN SELECTED SMSAS Based on Emergency Room Mentions NARCOTIC ANALGESICS lº -A &|-}º percodan tieroin -- *. R *: Dilaudid | Codeine 9: "Percodan At 1antic and Pacific Coasta 1 Cities SEDATIVES --- ſº TS \" V_% 2. |----- 7 *, Socobarbital º If "-- t A * / --|--|->º | BARBITURATE º 1|| As { \ \ Tuinal 7. Tuina 1. * Tuinal - Tuinn J. in California See obarbital in New York NON NARCOTIC ANALGESICS ºf Cities Centra 1 and Eas Note: Pentazocine increasing in Chicago and Philadelphia Note: 1)al 2 of increasing in Phoenix and Boston - NON BARBITURATE SEDATIVES *~~ - ºl Sºul ºf *-i-l. jº Lº º, be lieue . CŞ2 - PºS - Sº... N. *ALCOHOL-IN-COMBINATION Ży (Jº - Hº ſº |||—s, ſº Rºlº V_l- };" /. ** Coastal C uaalude Southern and Mexican Border Cities ities and Donver : 2500 2000 1500 | 000 500 Psychostimulants 1–1 –1–1–1–1–1–1–1 4 || 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 NATIONAL Methylphenidate 750 C/O H; 500|- O tº . ài 250 |_ CY . . ~~~~~~~ Lil. 0–1–1–1–1–1–1–1–1–1–1–1 4 1 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 Amitriptyline tº 750 L Cl O C/) LLl - à 250 L * ––––––––––– 4 1 2 3 4 1 2 3 4 || 2 1975 | 976 1977 1978 º : 2500 2000 1500 | 000 500 | 4 | 1975 H–– Barbiturates l ---|- H- 2 3 4 1 2 3 4 || 2 1976 1977 1978 Secobarbital 750 L 500 |_ `-- 250 |_ 0 | | | | | | | | | | | 4 l 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 Secobarbital/Amobarbital 750 * > -->~~. . . . 250L "————— 4 || 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 Pentobarbital 750 L 500 |_ 250l 4 1 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 600 500 400 300 200 | 00 mºs pºse NATIONAL Amphetamines 4 l 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 E-17 WASHINGTON, D.C. Tranquilizers PCP 500 — 500 — 400 400 mºns ſ tº- 2 C $2 300 – 2 300 – = ği # 200 L tº 200 – CY Lil 100 L 100 – 0 I-I-I-I-I-I-I-I-I-I-I 0 ---T - 4 1 2 3 4 1 2 3 4 2 4 || 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 1975 1976 1977 1978 E-18 50 40 30 20 10 50 40 Amphetamines SAN DIEGO I-I-I-I-I-I-I-I | 4 1 2 3 4 || 2 3 4 l 2 1975 1976 1977 Amitriptyline | § | | I-T-I-I-I-I- 2 3 4 1 2 3 4 || 2 4 T 1975 1976 1977 1978 50 40 30 20 10 Flurazepam — | | I | ! I-I 4 2 3 4 1 2 3 4 1 2 1975 1976 1977 1978 E-1ſ SAN DIEGO (Con't) Narcotic Analgesics Heroin/Morphine 300 300 250 250 (/) - (/) 2. $2 200 # 200 H. C/) … H- # 150 Éh 150 É É | 00 | 00 50 - 50 O 0 - 4 1 2 3 4 1 2 3 4 || 2 4 1 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 1975 1976 1977 1978 PHILADELPHIA Cannabis Secobarbital |00 — 100 H. 80 |_ 3-tºº º 80 |_ ** (/) 60 |_ * 60 – O º 40 – 5. 40 CY 20 – Lu 20 0 F-I-I-I-I-I-I-I-I-I-T- 0 —T-T—t—T-I-I-I-I-I-H 4 || 2 3 4 || 2 3 4 || 2 4 l 2 3 4 l 2 3 4 l 2 1975 1976 1977 1978 1975 1976 1977 1978 E-2 100 — EthchlorVynol 100 Methadone 80 – vo 80 – Lil Cl 60 — à 60 2. – LL 40 H £ 40 H 20 – " 20 H I-I-I-I-I-I-I-I-I-I-I I-T-I-T-I-T-I-T-I-T- 4 || 2 3 4 || 2 3 4 || 2 4 1 2 3 4 1 2 3 4 1 2 1975 1976 1977 1978 1975 1976 1977 1978 E–22 : 50 40 30 20 10 50 40 30 20 | 0 MINNEAPOLIS Cocaine H-H 4 || 2 3 4 1 2 3 4 l 2 1975 1976 1977 1978 Phenobarbital —H-T—T-I-T-T 4 1 2 3 4 || 2 3 4 || 2 1975 1976 1978 1977 : 50 40 30 20 10 Codeine/Combinations 4 1 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 : 3 0 O 200 | 00 300 200 | 00 300 200 100 MIAMI Non-Narcotic Analgesics * - ———————1–1—1–1— 4 l 2 3 4 || 2 3 4 2 1975 1976 1977 1978 Anticonvul/Antinaus --~~ - | | | |- 4 || 2 3 4 | l | l 2 3 4 || 2 1975 1976 1977 1978 Dipherylhydantoin Sodium . . . . . . . . . 4 1 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 : Cannabis 300 – 200 || |00 – ©- 0 | | | | | | | | | | | | 4 l 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 Marijuana 300 – 200 L E–23 .100 L 2^--~~ _*~~~" 0 I-1–1—1–1—1–1—l—1–1—l- 4 || 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 E–2|| . | 00 80 60 40 20 100 80 L Hallucinogens T-I-I-I-I-I-I-I-I-I-I 4 l 2 3 4 l? 3 4 1 2 – 1975 1976 1977 1978 Hashish MIAMI (Cont'd) Phenobarbital | 00 80 60 40 |_ 20 | 0 975 1976 PCP 100 - 80 L 60 E. 40 20 L Nº º tº º gº - & º; r—r-T-f 4 1 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 6 0 4 0 2 0 CHICAGO Meprobamate 4 1 2 3 4 1 2 3 4 2 1975 1976 1977 1978 60 40 20 Pentazocine 4 | 1975 2 3 4 || 2 3 4 | 1976 1977 2 1978 E–25 E–26 : : 300 200 100 300 200 100 Tranquilizers DENVER sº (/) 2. S -, 2-º-' H. × Lil >. |* Cr. Lil |→––––––––– 4 l 2 3 4 1 2 3 4 1 2 1975 1976 1977 1978 Alcohol-in-Combination sº ‘ſ Cl * -º O (A) S. LL] º __--~/ > É 1–1–1–1–1–1–1–1–1–1–1 4 2 3 4 2 3 4 2 1975 1976 1977 1978 300 200 | 00 300 200 100 Non-Barbiturate Sedatives sº . . ~~~~ | | | | | | | | | | || 4 || 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 Diazepam |- ~~~~~~ | | | | | 1—1–1—l—l-l 2 3 4 | 1976 4 | 1975 2 3 4 || 2 1977 1978 DENVER (Con't) Cannabis Flurazepam | 00 |00 80 80 3 60 3 60 C/) 5. 40 Lu 40 CY Lil 20 20 "Hº-Pi——H 9 | | | | | | | | | | | | 4 l 2 3 4 1 2 3 4 l 2 4 1 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 1975 1976 1977 1978 E-27 Methaqualone Heroin/Morphine 100 100 80 80 § 60 92 60 | É 40 CY 40 Lil 20 20 A 2 3 4 || 2 3 4 || 2 A ; ; 4 || 2 3 4 i 1975 1976 1977 1978 1975 1976 1977 1978 E–23 : 350 300 L 2 5 0 me |2 50 00 T l 50 00 – SAN FRANCISCO Alcohol-in-Combination I 4 1975 350 300 L 250 L 200 – 150 L 100 50 L Heroin/Morphine T l . I T 3 4 1976 97 I-T-I-T-I | 2 3 4 || 2 l 7 Ti 1978 350 300 250 200 150 100 50 O 350 300 250 200 | 50 | 00 50 Secobarbital -º--------> | I-1- 4 || 2 3 4 || 2 3 4 || 2 1978 1975 | 976 1977 Methylphenidate . . . . . . | I-I-I I I 4 1 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 SAN ANTONIO Non-Barbiturate Sedatives 100 – 80 - 60 H. C/C) Lil CD • /\!/~~ 3 R. 20 L Lil CC Lil 0 –1–1–H–1–1– 4 l 2 3 4 || 2 3 4 1 2 1975 1976 1977 1978 Perphenazine | 00 80 – 60 H 40 20 Yes-l I I TI T-I-T- 4 1 2 3 4 || 2 3 4 l 2 1975 1976 1977 1978 Codeine Combinations 30 — 20 |_ 10 — 0 I-I-I-I-I-I-I-I-I -i-H 4 l 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 ATLANTA Methadone 30 H. 20 – 10 – 0 || "N I-r-I-I-I-I-I-I-I - I - I 4 || 2 3 4 || 2 3 4 l 2 1975 1976 1977 1978 E–30 : 30 20 10 30 20 | 0 PsychoStimulants Amitriptyline F-I-I-I-I-I-I-I- 2 3 4 1 2 3 4 || 2 1976 1977 1978 BUFFALO 30 20 | 0 30 20 10 Flurazepam I I I ſ | 2 3 4 1 2 3 4 1 2 1977 1978 E–31 PCP I I | I | 3 4 1 2 3 4 l 2 1977 1978 E–32 DETROIT Secobarbital/Amobarbital | 00 80 60 40 - 20 V-y—yº 4 2 3 4 2 3 4 2 1975 1976 1977 1978 : 50 40 30 20 10 Psychostimulants 4 2 3 4 1 2 3 4 2 1975 1976 1977 1978 KANSAS CITY 50 40 30 20 . Amitriptyline – H. ———————1–1—l—H 4 1 2 3 4 1 2 3 4 l 2 1975 1976 1977 1978 E–33 SEATTLE Codeine Combinations Marijuana 50 50 - 40 40 | º: . V) * # 30 g " | 2 * H S a- H. 20 * 20 | § 10 L 10 |. 0 |-l————————1–1 O - 1–––––– 4————l- 4 1 2 3 4 1 2 3 4 || 2 4 1 2 3 4.1 2 3 4 l 2 1975 1976 1977 1978 1975 1976 1977 1978 E-34 : LOS ANGELES Cannabis Codeine | 00 | 00 80 3 80 B On 60 60 º Lil 40 fº 40 20 20 91–1––––––––– 0 H––––––––– 4 1 2 3 4 1 2 3 4 l 2 4 || 2 3 4 1 2 3 4 || 2 1975 1976 1977 1978 1975 1976 1977 1978 E–35 Marii | 00 Methylphendate | 00 arl Juana 80 80 C/) Lil 60 5 60 C/) º 40 H 40 CY LL 20 20 | 0. 1–1–1–1–1–1–1 0 |→--|--|--|--|--| 4 l 2 3 4 1 2 3 4 l 2 6 1 2 3 4 || 2 3 4 || 2 1975 1976 1977 1978 1975 1976 1977 1978 : L0S ANGELES (Cont'd) Hallucinogers - Secobarbital/Amobarbital 300 300 C/) Lil O 200 5, 200 S. Lil - | 00 à 100 . . . . /> \. O | | 1 | | | | | | | | 0 ! ! l | | | 1 H | | | 4 2 3 4 1 2 3 4 2 4 1 2 3 4 1 2 3 4 l 2 1975 1976 1977 1978 1975 1976 1977 1978 PCP Heroin/Morphine 300 300 - (/) Lil O 200 3 200 º LL! O T w Tºr 0 l | | 1 –4– ! 4———— 4 1 2 3 4 1 2 3 4 l 2 4 1 2 3 4 1 2 3 4 l 2 1975 1976 1977 1978 1975 1976 1977 1978 00 80 60 40 20 LOS ANGELES (Con't) Al cohol-in-Combination 100 80 L 60 40 20 4. 975 Amitriptyline T l 2 3 4 2 3 4 2 4 976 977 978 1975 l 23 976 3 4 77 E-37 Aſp2 FNſ)I.Y F NATIONAL DRUG AND ALCOHOLISM TREATMENT UTILIZATION SURVEY ANN BLANKEN, NIDA dEPARTMENT OF HEALTH, EDt., (, ATION, AND WELFARE PUBLIC HEALTH SE FRV CE ALCOHC L, DRUG ABUSE, AND MENT A L H EALTH ADM NISTRATION NATIO NAL | NST TU T E O N D R U G A BUSE ** NATIONAL DRUG AND ALcoholiSM TREATMENT UTILIZATION SURVEY {NDATUS) This survey is conducted by the National Institute on Drug Abuse in conjunction with the National institute on Alcohol Abuse and Alcoholism and the Food and Drug Administration. NDATUS is intended to collect data from all units providing drug and alcohol abuse services. The survey purposes are: (a) to collect management, staffing, funding and treatment information which describes the drug and alcohol abuse services capacity across the United States, (b) to assist in the planning and policy development for national and State programs regardless of funding source and (c) to assist the Food and Drug Administration (FDA) to verify the safe and effective use of methadone as a new drug in the treatment of narcotic addiction. A treatment service unit (TSU) is a facility having (1) a formal structured arrangement for alcohol or drug treatment using alcohol or drug-specified personnel, or (2) a designated portion of the facility (or resources) for providing alcohol or drug treatment services, or (3) an allocated budget for such treat- ment services, A TSU must directly provide treatment services to clients at the facility's address. The survey form is designed so that the units listed below must complete the pages indicated as follows: - ". REOU RED Y N TYPE OF UNIT PAGES Units providing methadone or LAAM - $ -6 treatment and also alcohol treatment Other treatment units serving both - 4-5. drug and alcohol clients t) rug treatment units providing - 1,2,4,5,6 methadone or LAAM treatment - - Other treatments units serving only drug 1,2,4,5 clients - Other treatment units serving only 1,3,4,5 alcohol clients All other units which do not provide i treatment, such as administrative units Legislative Authorization NDATUS drug abuse and alcoholism data is authorized by P.L. 92255 as amended by P. L. 94.237 (21 USC 1133, 21 USC 1 172(b), and 21 USC 1173); and by the Comprehensive Alcohol Abuse and Alcoholism Prevention Treatment and Rehabilitation Act of 1970, P.L. 91-616, as amended by P.L. 92.554, 93-282, 94-371, 94-573, 94-581 and 95-83. Staffing information is authorized by P.L. 94-484, the Health Professions Educational Assistance Act. - The methadone treatment data is required by P.L. 91-51321 CFR 291.505. The National Institute on Drug Abuse, National Institute on Alcohol Abuse and Alcoholism, and the Food and Drug Administration express their appreciation to all participants in NDATUS. N DATUS : ['. . . . I f {{? | | | | | | | | (8) # } SERVICE AVA || ".. [3] LITY The following information is requested by the State Drug and/or Alcohol Authority. It is intended for State use only. From the lists below, check all items which may be used to describe this unit in a services directory. Drug Abuse Treatment Settings: Alcoholism Treatment Settings: 41 7 419 [...] 1. Outpatient Treatment [] 1. Outpatient Treatment [] 2. Residential Treatment D 2. Intermediate-Short Term D 3. Day, are D 3. Intermediate-Long Term D 4. Hospital/Inpatient Program D 4. Half-way House [] 5. Prison Program D 5. Ouarter-way House D 6. Drug Free Treatment [] 6. Foster Home [] 7. Detoxification [] 7. Residentiaſ Care D 8. Methadone Maintenance D 8. Hospital/Inpatient Program D 9. LAAM or Darvon Maintenance D 9. Prison Program D 10. Other (Specify Below): D 10. Detoxification-Medical Model D 11. Detoxification-Social Setting D 12. Other (Specify Below): 418 (20) 420 (20) Drug Abuse and/or Alcoholism Treatment Services: 421 D 1. Joint Drug Abuse/Alcohol Treatment D 2. Individual Therapy and/or Counseling D 3. Group Therapy and/or Counseling D 4. Family Therapy and/or Counseling D 5. Legal Counseling and/or Representation [] 6. Job Counseling and Placement D 7. Vocational Rehabilitation and Skill Training F-2 D 8. Remedial/Continuing Education - D 9. Psychological Testing [] 10. Physical Examinations [] 11. Outreach D 12. Aftercare Follow-up [] 13. Runaway Shelter [] 14. Emergency Overdose D 15. Other Medical Services D 16. Hotline D 17. Referral D 18. Drug Abuse or Alcoholism Education/information D 19. Other (Specify Below): 422 (20) Check or complete the box which best describes the hours this unit open: (Select one) from to Example: Mon. 0300A/f O430 pm - 3. 1. Are you open 24 2. D 7 Days/Week Mon. hours/day, 7 - days/week? from to Tues, 426 (6) 427 (6) 428 (6) 429 (6) Wed. --- 424 (6) 425 (6) 430 (6) 431 (6) UNIT'S HOURS: - - Thurs. —T- º 423 432 (6) 433 (6) D 1. Yes - Fri D 2. No ſ/f not the same hours 434 (6) 435 (6) seven days/week, Sat. complete box no. 3) 436 (6) 437 (6) Sun. * *-** ** 438 (6) 439 (6) 440 Do you have a 24 hourſday 7 day/week HOTLINE7 [] 1. Yes (Chock one) D 2. No ADM 515 (Rev. 1278)." i}{. P/\{{l Mſ fil & ) { } : t ,\t. I i. 1 ( , ! ('A' ||.)?J. Ah! J Y, L if ... is t ! ( ): "...t : : , , t ry PU(3 UTC HEAl || ${ {{V}CE OMB NO C3 R 14 NO ALCOHOL, t) RUC, Aº’s: Artſ) tº , ! it Al." H a ſhºtri STRAT toºl *J A T UY N A Nº. Y : . . . . . . . . . . . . . . . . A #3. t NATIONAL DRUG AND ALCOHOLISM I REATMENT UTILIZATION SURVEY *------ - |, |OENTIF I CAT | ON | NJ ſ () RMATION 1 This page is to be corn; lº'. ' ' , all reporting units. A. T E MS TO 3{ C(X?,APLE T & O BY STATE : CJ ". . * ES- NOATUS ". . AAA FOA LOCATION S!C"NAL IDENTIF IER ICE’. TIFIER |OENT | F | ER CODE SMSA D1ST RICT | | | | |-|--|--|--|--|--|--|--|--|--|--|--|--|--|--|--|--| – {B} 2 (8) 3 (8) 4 {10) 5 (4) 6 (2) B. ITEMS TO BE COMPLETED BY REPORTING UNITS. For items 7 through 21 use the space provided to enter the information requested. Complete remaining items by checking response options which best describe your unit. NAME (line 1) (Unit) 7 (38) MAME (line 2} 8 (38) STREET ADDRESS 9 (38) Room No.fotoG./dEPT./P.O. Box 10 (38) CITY STATE ZIP CODE | 1 (29) 12 (2) || 13 (5) COUNTY NAME STATE REGIONAL CODE 1 4 (20) || 15 {2} AREA CODE TELEPHONE NO, (Unit) ExT ENSION (if any) 16 (10) || 17 (5) ŁAST NAME. F. RST NAME, M! ODLE INITIAL (Director) 18 (38) TiT LE 19 (38) AR#A CODE TELEPHONE NO. (Director) ExTENSION (if any) F 3 2O —º (10) 21 (5) C. Check the response below which best describes your unit's primary emphasis. 22 UNIT'S FOCUS 1. Alcoholism treatment 3. Combined drug and alcoholism treatment 2. Drug abuse treatment 4. Other (speciſy) 23 {2O) D. Check the response below which best describes the type of organization legally responsible for the operation of this facility. 2 FOR PROFIT NONPROFIT 4 1. individual 9. Church related 2. Partnership 10. Nonprofit corporation 3. Corporation 11. Other nonprofit OWNERSHIP STATE. LOCAL GOVER Nº," ENT FEDERAL GOVERNMENT 4. State government 12. U.S. Public Health Scrvice 5. County government 13. Armed Forces 6. City government 14. Veterans Administration 7. City-county government 15. Other Federal Agency 8. Hospital district E. . Check residence of the principal population served. PopULATION 25 SERVED [] 1. Rural [...] 2. Inner City D 3. Urban/Suburban F. Check the response which best describes this unit's physical environment. 26 UNIT'S 1. Community Mental Hea':h Center 5. Correctional Facilities D 8. Other (speciſy) PHYSICAL 2, Mcntal/Psychiatric Hospital 6. Half-Way House ENVIRONMENT 3. VA Hospital 7. Free Standing Facility other than Half-Way House 4. Other Hospital 27 - (3*: G. Check the futictions per for red at this unit. 28 UNIT'S 1. Administration - 4. Training 7. Rewest ch/Eva'uations SCOPE OF 2. Mt. thadore.'LA AM Trea tºrent 5. Prevention/Education 8. Other / gertſy / ACT | V | | | ES 3. Treatment (other) 6. Central intake, Screening and/or Referral wº jº * wº A, ºrºwa t.” “... *.*** AOfM 515 “ Unit; checking boxe; 2 or 3 must complete the remaining section of tº Gºto". Rev. 12.78 () { PART *, *, *, * ºf n . ; : : A L TH}, {{) Uſ.” & . . . . . ( AL ] } | {, , ſ , ALCOHOL, D: 33 … º ſ , a riſ) Nºt N T Al , * “ . . . . . ; ; , , , , , , ; ". . . . . . . . ſº. [… . . . ,”, t + f\ $3 E. (O A* 8. f. p. 64; } t t 4 X () * . . . . . ." N S T R AT ICN *, *, T : C N A L ; NST TU) T E ON ( ); ' ' ' ( , , , , ; St NAT O'. At DRUG AND A CO HOl. ISM TREAT M ( " 'I tº 12 ATION SURVEY (NDATUS) |, | DE', 'ſ F | CAT ON INFORMA | ON This page is to be completed by all reporting units. A. T EMS TO BE COMPLETED OR CORRECTED BY STATE: NDATUS N! AAA FDA LOCAT ION CONGRESSIONAL HD ENT | F | ER |OENT | F | ER IDENTIF ER CODE | SMSA DiST R CT 1 (8) 2 (8) 3 (8) 4 (10) 5 {4} 8 (2} 8. TEMS TO BE COMPLETED BY REPORT i NG UNITS: For items 7 through 21, use space provided on right side of page to enter or update preprinted information on left side of page which is missing or incorrect. Complete remain- ing items by checking response option(s) which best describe your unit. F-lis NAME (ſing 1/ (UN; T ) NAME (fire 1) 7 7 (38) NAME (line 2) *A*,” 5 [1,ne 2} 8 8 } (38) STREET ADDRESS STREET ADDRESS 9 9 {33} ROOM NO./8 LOG./DEPT./P.O. BOX ROOM NOJBLDG /DEPT /P.O. BOX 10 70 {33} City STATE Z P CODE CIT Y STATE Z}P CODE 1 | - 12 13 11 (29) || 12 [2] : 13 (5) COUNTY NAME STAT E REGIONAL COUNTY NAME - st ATE REGIONAL CODE CODE 14 15 1 4 (201 || $5 (2) Af{{A CODE TELEPHONE NO. (UNIT ] EXTENSION (if any) || ARE A COOE TELEPHONE NO. tº XTENSION (if any) 16 17 16 (10) || 1 7 {5}. LASY NAME, FIRST WAME, MIDDLE NiſłAL (DIRECTOR) LAST N AME, FIRST NAME, MEDDLE NATIAL (e.g., Smith, John A. J 18 (38) TITLE T IT LE (only if other than Director/ $9 19 (38) AREA CODE TELEPHONE NO. (DIRECTOR) 5XT ENSION (if any) || AREA CODE TELEPHONE NO. exiºn ſif gny) 20 2} 20 { i o) || 2 | (5) ' C, Check the response below which best describes your unit's primary emphasis. 22 - UNIT'S FOCUS 1. [...] Alcoholism treatment 3. [T] Cornbined drug and alcoholism treatment 2. D Drug abuse treatment 4. [] Other (specify) (20) O. Check the response belov, which best describes the type of organization legally responsible for the operation of this facility. 24 FOR PROFIT NONPROFIT [] 1. individual [] 9. Church related [] 2. Partnership [] 10. Nonprofit corporation D 3. Corporation D 11. Other nonprofit p ! ownership STATE. LOCAL GOVERNMENT FEDERAL GOVERNMENT [T] 4. State government D 12. U.S. Public Health Service [...] 5. County government [T] 13. Armed Forces [...] 6. City government [T] 14. Veterans Administration [T] 7. City-county government [T] 15. Other Federal Agency [] 8. Hospital district E. Check residence of the principai population served. —w POPULATION . 25 SERVEO [] Rural […] Inner City [...] Urban/Suburbon F. : Check the response which best describes this unit's physical environmcnt. - 26 - UN | T'S 1. Community Mental Health Center [T] 5. Correctional Facilities [T] 8. Other (Specify) PHYSICAL 2. Mental/Psychiatric Hospital D 6. Half-Way House ENVIRONMENT [...] 3. VA Hospital [] 7. Free Standing Facility other than [...] 4. Other Hospitaſ Half-Way House 27 {20) G. Check the functions per for nºed at this unit. 28 U*, T'S [] . Administration [] 4. Training [T] 7. Research/Evaluation SCOPE OF [I] 2. Methadone/LAA'A Treatment [...] 5. Prevention/Education [] 8. Other (Specify/ ACT ViT | ES [...] 3. Treatment (other ; [] 6. Coryttal intake, Screening and/or Refer ral 29 # *rs ACM 515 "Units checking boxes 2 or 3 invst complete the remaining sections of the questronnaire Rev. ) 2.78 NOATUS iſ) ENT | F 18 H | | | | | | | | ||. DRUG ABUSE TREAT M fify T POPULATION This pano is to be complete by 3.1 ºn tº providing treatm ant Services to drug all “ (:{ients The purpose of this section is to compare the available canacity of drug abuse treatment with the utilization of these resources. This information will be aggregated to report findings at the national, State and regional levels. INSTRUCTIONS FOR COMPLET ING THIS SECTION The unit's capacity and utilization data entered below are based on a point prevalence date (poi it in time) which is specified as the last day of the month on which the data are collected, i.e., April 30, 1979. The population includes only clients being treated at this treatment Service unit for a drug problem. Do not include client's parents, relatives or friends. As BUDGETED TREATMENT CAPACITY The budgeted drug abuse treatment capacity is the number of clients this unit is able to treat as of April 30, 1979 when operating at full capacity. BUDGETED TREATMENT CAPACITY ON APR L 30, 1979 CLIENT ENVIRONMENT MODALITY & *E* OUTPAT | E N T RESIDENTIAL DAYCARE HOSPITAL/INPAT | ENT PRISON TOTALS 30 {4} : 31 {4} | 32 {4} | 33 - {4}|34 {4} 35 (5) a. Drug Free 36 {4} | 37 (4) 38 {4} | 39 {4}|40 {4} || 4 ||. (5) b. Detoxification - 42 {4} || 43 (4) || 44 {4} | 45 (4) || 46 {4} 47 (5) c. Methadorne Maintenance 48 {4} || 49 * {4} |50 {4} || 51 {4} | 52 {4} 53 (5) d, LAAM or Darvon Maintenance 54 {4} 55 {4} 56 {4} || 57 (4) |58 {4} i 59 [5] e. Other Modality (Speciſy) 66 (2O) - 60 {5} : 61 (5) 62 (5) # 63 (5) 64 {5} 65 F=5W f. Totals B. ACTUAL CLIENTS IN TREAT MENT (Census) Enter the total number of active clients in treatment as of April 30, 1979. An active client is an individual: who has been admitted to this treatment unit and for whom a treatment plan has been developed; who has been seen on a sched jied appointment basis at least once during the 30 days preceding April 30, 1979; and who has not been discharged from treatment (i.e., continued care is expected to be given to this client). ACTUAL CLIENTS IN TREATMENT ON APRIL 30, 1979 CLIENT ENVIRONMENT MOOALITY * - OUTPAT, ENT RESI DENTHAL DAYCARE HOSPITAL/INPATIENT PRISON TOTALS 67 (4) 68 {4} 69 * {4} 70 (4}} 71 (4) . 72 [5]" 8. Drug Free 73 (4) 74 (4) . 75 {4} i 76 {4}| 77 {4} 78 is b. Detoxification - 79 (4) jø0 {4} |81 {4} {82 {4} |83 {4} 84 (5) c. Methadone Maintenance 85 {4} |86 (4) j67 {4}|88 {4}|89 {4} {90 (5) d. LAAM or Darvon Maintenance 9 | (4) 92 {4} |93 (4) gº {4}{95 (Ajić6 {5} e. Other Modality (Specify/ 103 (20) 97 {5} {08 {5} j99 {5} | 100 (5) || 101 (5) jio2 (6) f. Totals ADM 615 Rey, 12.78 * , , ; A US 1 () { N | | | | : R | | | | | | | | | | | }. ALCOHOL ABUSE TRE , , , , , ; ; T POPULATION This page is to be completed by all units providing treatment services to alcohº sº clºts. The ſurpºo : . . . . . . ºn 1, to roºf: -, “ . . . . . . . . ;...&#y of , º, . . . . . . . . thent with the utilizatiot o' tº $6 resources. This infot ination will be eq; ºut ... to ; ; ; ; ; ; ; ; Jing', at the nation 3, State and regional ſcvcis. INSTRUCTIONS FOR CO".YPLET ING THIS SECTION This unit's capacity and utilization data entered below are based on a point prevalence date (point in time) which is specified as the last day of the month on which the data are collected, i.e., April 30, 1979. The population includes only clients treated at this treatment service unit for an alcohol problem, Do not include client's parents, relatives, or friends. A. TREATMENT CAPACITY The alcohol abuse treatment capacity is the number of clients this unit is able to treat as of April 30, 1979 when operating at full capacity. TREATMENT CAPACITY ON APRIL 30, 1979 CLIENT ENVIRONMEN, T MODA LITY |NT E R A E DÍA T E * ! N T E #3 ME DIATE * H CSP TALſ - T.A. OUT PAT I ENT SHORT.T. E. RM LONG.T ERM }** PAT E NT PRISON Tor AL 1 O4 {4) 105 {4} : 106 (4) 107 {4} i 108 {4} | 109 {5} a. Detoxification — Medical *.ſode! 1 1 0 (4) || 1 || | {4} | 1 12 (4) 113. (4) || 1 || 4 {4} | 115 (5) b. Detoxification — Social Setting 1 16 (4) || 1 1 7 {4} 118 (4) || 1 19 {4} | 120 (4) 121 {5} c. Alcoholism Treatment 1 22 {4} | 123 {4} | | 24 {4} | 125 [4] | 126 (4) || 127 {5} d. Other Modality (Speciſy) (20) F– 6 128 (5) 129 (5) ; 130 (5) |131 {5} | 132 (5) || 133 (6; e. Totals B. ACTUAL CL1 ENTS IN TREATMENT (Census) Enter the total number of active clients in treatment as of April 30, 1979. An active client is an individual: who has been admitted to this treatment unit and for whom a treatment plan has been developed; who has been seen on a scheduled appointment basis at least once during the 30 days preceding April 30, 1979; an who has not been discharged from treatment (i.e., continued care is expected to be given to this client). ACTUAL CLIENTS IN TREATMENT ON APRIL 30, 1979 CLIENT ENVIRONMENT MODALITY | |NT E FRM. EDIATE • |NT ERMEDIATE * HOSP; "A L/ OUT PAT; ENT sHoRT-7 ERM | LONG-TERM |N PAT : E *w T PRison TOTAL 135 . (4) || 36 (4) ; ; 37 . (4) || 1 38 * 139 {4} | | 40 {5} . a. Detoxification — Medical Model | 4 | (4) || 42 (4) ; ; 43 (4) || | 44 {4} | 1.45 (4 | 1.46 (5) b. Detoxification — Social Setting 147 (4) || 48 (4; ; ; 49 (4) 150 (4) 151 {4} | 152 - (5) c. Alcoholism Treatment t 53 (4) 154 {4} } i B5 (4) || 156 {4} 157 {4} : 138 {5} d. Other Modality (Speciſy) 1 65 (20) 159 {5} | 160 {5} | 161 {5} | 162 {5} | 163 tº 164 |C) e, Totals | ------------ --------- R AD fM 5 15 * For example, Half-way House, Quarter-way House, Foster Home, residcntial care, Rev., 12.78 I hit st:ction request: ; ; ºr fundinſ information 10 did in understanding the funding and budget p, tuirements of treatment service units regardless of funding source(s). INSTRUCTIONS FOR COMPLET ING TH |S PAGE . 1. Column 1, Funding Source Code. Enter this unit's funding sources in column 1. The fºr ; ; ; sources are: F (JºJOING $9.9 FCE N | OA NIDA 409 Formula Funds NHAAA NIAAA Formula Funds Other Federal BOP State Local Title XX Private Welfare Public Insurance Private Insurance F ºf J() | N (; SOURCE CODE : !: W H | ! V. F. UNL)|NG | N F : ) "," ſº I |ON This pole is to be completed by itſ tº eatrinent service units. Statewide services contracts, 410 funds and other grants or contracts, f\ | DA 400 Formula funds. NIAAA contracts or grants. NIAAA Formula funds, and Uniform Act funds. DEFINITION * * * NOAY US IOINT || |{ R |--|--|--|-- - - - - - -- * *-*. Includes Federal funds from agencies other than those ſisted above, e.g., Veteran's Administration, Drug Enforce. ment Administration, Bureau of Community Health Services, Law Enforcement Assistance Administration, National Institute on Mental Health. Funds from Bureau of Prisons. Includes State contracts, appropriations, grants and state matching funds. Includes municipal funds awarded by contract or grant from towns, cities, or counties, as well as municipal matching funds. Support for services provided on behalf of alcohol and/or drug abuse clients through the Title XX Program. Contributions from foundation grants, cash contributions, cash value of donated goods, and contributions from United Way/Community Chest charities. Medical or social service benefits payments associated with local general assistance or general relief programs includ. ing food stamps. Public health insurance provided to eligible clients, e.g., CHAMPUS, Medicaid, and Medicare. Private health insurance provided to eligible clients, e.g., Blue Cross/Blue Shield. State and Local fees for Service. Fees paid out of pocket by the client that are not reimbursed from insurance or general welfare. State and Local Reimbursements Client Fees R F 2. Column 2 and 3, Funding Period Start and End Date. Enter the start and end date of the funding period for each source of funding. The start and end dates are to reflect a time period which includes the point prevalence date (April 30, 1979). 3. Column 4, Total Alcohol Dollar Amount. Enter the amount of funding allocated for alcoholism treatment. 4. Column 5, Total Drug Dollar Amount. Enter the amount of funding allocated for drug abuse treatment. EXAMPLE: A treatment service unit estimates it will collect $7,000 in client fees (F) for alcohol treatment and $10,000 for drug abuse during calendar year 1979, $10,000 in NIDA 409 Funds (D), $30,000 in NIDA contracts (N), $40,000 in State (S) monies with the alcohol and drug components each receiving $20,000, and $30,000 from NIAAA (A). FUNDING FUND ING PERIOD TOTAL ALCOHOL ToTAL DRUG F-7 SOURCE START DATE END DATE DOLLAR AMOUNT DOLLAR AMOUNT ROW cºs Eºnth, Year Month Year (in thousands) (in thousands) Column ! SS ~tº 2 Column 3 Column 4 Column 5 1 166 A. (1) [167] J-X2% ºz LZI ºff: 1 G9 -Z (4) || 1 70 A/2 (4) 2. 17 /2 {1} 17%2 || > I Z. jºr 3 & L. CA (4) 174 a {4} i 175 Z/2 (4) 3. *—/ ºn 1770 *i'ZºZLZ, L- * IO (4) 179 O {4} i 18O 2O (4) 4. 181 ST (1) * O. ‘tº gº / ! z ºr 262 (4) 185 .3 (4) 5. 186 /? tº 187/7] *2] % | 2. (24. º . 3’O (4) 190 Ö {4} 6. 191 (1) [192_ | | - | | 2*- {4} 195 - (4) 7. 196 tº 197 | | | {4} | 198 N S. Ø-iss Y (4) 200 (4) 8. 20 ! (1) |2O2 | | | (4) 203 | | | {4} 204 (4) 1205 (4) 9. 2O6 (*) |237 | | (4) 208 | | N (4) 1209 (4) ; 210 (4) 10 21 (1) || 2 || 2 | | | (4) 213 | | | {4} 214 {4} 215 {4} TOTAL |216 (5) 21 7 (5) FUNDING INFORMATION FUNDING FUND}NG PERIOD TOTAL At COHOL TOTAL DRUG SOURCE START DATE END DATE DOLLAR AMOUNT DOLLAR AMOUNT ROW CODE Month Year Month Year (in thousands) (in thousands) Column 1 Column 2 Column 3 Column 4 Colurnn 5 1 166 ( !) 167 | | | (4} | 1.68 | | | {4} 169 (4) 170 {4} 2. 171 In 172 | | (4) 173 | I | {4} 174 (4) 175 (4) 3. 1 76 In 177 | | tº 178 | | {4} | . 79 (4) 18O —r ºx-wrv (4) 4. 181 ºn 182 | | {4} | 183 | | | (4) | | 84 {4} | | 85 (4) 5. 186 tº 187 | | (4) 183 | | I tº 189 (4) . 790 (4) 6. 191 (1) : 192 | | | (4} | 193 | | L_{4, 194 (4) 195 * (4) 7 196 tº 197__ | | (4) 198 | | | (4) 199 {4} | 200 (4) 8 2O } {1} {202 | | | {4} | 203 | | | (4) 204 {4} | 205 (4) 9 2. YG (1) 207 | | | {4} {208 | | | {4} 209 {4} || 2 || 0 {4} 10 2 : 1 (1) || 2 | 2 l | | {4} || 2 || 3 | | {4} || 2 || 4 {4} 215 (4) TOTAL |216 (5) 217 {5} AOfM 515 - Rev. 12-78 NDATUS OENT | f | ER |--|--|--|-- V. Tſº EATMENT UN | | ST * F FING This page is to be completed by ai. ' ' ', ''” ent service units. gºssºm sº *** ** * * * * * * * * * * * * * * * * * * *** * * * * * * * ***.*, *, * * * * *.* . * * * * * * * * --- -- * This section requests information on the staffing patterns of drug abuse and/or alcohol units for tº "onth ending April 30, 1979. mºſauctions FOR COMPLETING TH!S PAGE: For each category of staff, enter the total number of employees (both paid and volunteer) who work at this unit. All staff members who work anytime during the month are to be included. Under turnover include all staff hirings and separations that occurred during the period May 1, 1978 – April 30, 1979. All staff categories include only those individuals who work at the facility. UNIT STAFF PAID VOLUNTEERS PAID STAFF TURNOVER FULL-T1?," E * PART.T ME * * FULL.TIME." PART .TIME * * NUM BER OF MAY 1, 1978 – APRIL 30, 1979 cºw STAFF BE (NG - Number of Number of Total Number of Number of Total RECRUITED Number Number Employees Employees Hours Worked Volunteers Volunteers Hours Worked Hired Separated 218 {2} 219 (2) #220 (3) 22} {2} |222 {2} |223 - (3) #224 (2) (225 {2} {226 {2} Psychiatrists 277 [Ti22á {2} {229 {3}; 230 {2} }23? {2} |232 |3} |233 (2) #234 (2) [2.35 T2) Other Physicians - 236 {2} || 237 {2} | .238 {3}{239 (2) 240 (2) |241 {3} |242 {2} {243 (2) 244 {2} Psychologists/ - Ooctoral Level 245 (2) 246 (7,1747 (3) 248 {2} .249 {2} 250 {3} |251 {2} .252 {2} |253 {2} Psychologists/ . Master Level $ 2 & 254 {2} i 255 {2}|256 {3} 257 {2} {258 (2) 1259 {3} {260 {2} .261 {2} |262 (2) Nurse Practitioner/ Physician's Assistant º * 263 {2} . 264 {2) 265 {3}| 266 (2) j.67 {2} |268 (3) [269 (2) 270 {2} i 271 (2) Registered Nurses Master Lewel & Above 272 {2} } 273 {2} 274 (3) 275 {2} }.276 {2} .277 (3) #278 (2) #279 (2) # 280 {2} Other Registered Nurses tº g - 281 {2} | .282 283 4 ** * licensed Practical & (2)|28 (3)|28 {2} |285 {2} 286 (3) [287 {2} .288 {2} | .289 {2} F- goatoms Nurses - 290 {2} | 29 | (2) i 292 {3}| 293 2) 294 - 2) 295 3} |29 2) #297 - Social Workers ſ ſ {3} 6 {2} {29 (2) 238 {2} Master Level & Above * | | | * 795 {2} i 300 {2}{301 (3): 302 (2) #303 . (2) 1304 (3) [305 (2) |306 {2} 307 {2} Social Workers 8achelor Level 308 {2} i 309 {2} 31 O {3) 3 || 1 (2) |312 {2} {3 13 {3} |314 {2} {315 (2) #316 (2) Other Degreed Counselors Bachelor level & Above 317 {2} | 3 18 {2} | 319 {3}} 320 (2) 321 {2} |322 (3) [323 (2) #324 {2} 325 {2} Oegreed Counselors AA Level . 326 (2) 327 (2) ; 328 (3) | 329 (2) #330 (2) #331 (3) #332 {2} {333 {2} 1334 {2} Non-Degreed Counselors 335 {2} 336 {2}{337 {3} | .338 {2} {339 (2) [340 (3) |34 | (2) 342 {2} |343 {2} Therapists (Vocational, Recreational Activities, etc.) ſº tº & 344 {2} | .345 {2} |346 (3) ; 347 (2) #348 2} 249 3} |35 Other Administrative & | {3} |350 (2) |351 {2} || 352 {2} Support Staff 353 {2} {354 {2) 355 {3}|356 (2} |357 {2} |358 (3) is 59 {2} {360 • {2} || 361 {2} Student Trainee sión ATURE OF DIRECTOR NAME AND TITLE OF PERSON COMPLET ING FORM | DATE FOR M. COMPLETED MONTH OAY YEAF; 362 (3) ADM 515 The National Institute on Drug Abuse, The National Institute on Alcohol Abuse and Alcoholism, and the food and Drug Administration wish to express sincere appreciation for your participa. Rev. 12.78 tion in this survey, tº . Full-time includes those who work 35 or more hours per week. : Part-time includes those who work less than 35 hours per week. g | i : ; ; ; A : " , ; ; ; ; ; ; ; ; ; ; ; ; ; i | * - *** [ _ _ _ _ FDA OE NT F | E R |- | 1 |0|| || º V}. MET HADONE AND LAAM TREAT M N U*J|T INFORMATION This page must be completed by all methadon, and LAAM treatment units. ——4---------- * * * * * * * * * *- :------- - - - - - - - - - --~ *- :--------~~~ *... • * > * * ~ * * *.*.*.*.* > . * * ~ * ~... -- - --------, - - - - - - - - - - - - - -- - - - - - - - * * * . . … • *-* * * * * * * ~ * *::= --- ºr - - - - - - - - - - - - - *2. - . . . *-* * : * * : *** * ********* * ~ * * * * * This section, , º, ºr , ; ; r. A nº , ! : . . . . . . . . . . . . ; tın. In 1 Prſ … . . . . . . . .” - 'h it ºntº, : . . . . . F D 233.: . . previously required by the Food and Dr. g ... 2 ºn in is- tration and is required by 21 CFR § 3 ; ; 3. Cºnditions for tº: ' ' '.' ºne. Name of Unit's Sponsor A. UNIT'S SPONSOR , 8) Number of grams of drug dispensed during the 12 month period May 1, 1978 through April 30, 1979: B. AMOUNT OF DRUG 364 (5) 365 {5} D!SPENSED Methadone lAAM (to the nearest gram) (to the nearest gram) METHADO.NE ŁAA* C. CL ENT TREATME?JT DYNAMICS - - - g : * - - - Maintenance Detoxification Maintenance | TJetoxification º-------- - - - - - - - * 366 (5),367 (5) is 68 ºf 3:3 Tº 1. Number of cients in treatment on May 1, - 1978. e s & 370 {5} |37 | {5} |372 (5', 373 (5) 2. Number of clients in treatment on April 30, 1979. 374 (3:375 {5} 376 (5' 357 {5} 3. Number of clients admitted to treat ºn rat during the pºriod May 1, 1978 - Aſ ril 30, | 1979 who were treated in a previous year. } 378 {5} | 379 {5} |380 (5,3s. TV5; 4. Number of clients admitted to treatrent $ t for the ‘i: "t tºº. 2 ºr cl: ring th: oº icº May 1, 1973 - April 30, 1979. - & |382 {5} |383 (5) #384 (5.1365 {5} 5. Number of clients reaching the methadone/ | LAAM-free state during the period May 1, 1978 - April 30, 1979. - - For clºn's in treatment on April 30, 1379 enter the number of Foºth 3C'on, and LA A'ſ maintenance clients who are tº ºrg ºn gintained at ºf-9 D. CLI ENT DOSAGE - - ! $ . LEVELS of the dosage levels below. (Maintained means at the same dose for at least two weeks): DAl LY DOSAGE | N MG. | $20 Uncler 20 20–39 40-59 60-79 80–99 - 100- 1 19 * TOTA MG. **G fMG, ... c. **G. | MG. C- r- r - 2 OTAL | !, G — --------------- M 386 (5) 387 (#388 (5) 383 {5} |390 {5} |391 {5} | 392 {5,333 T. Tº E FEMALE T H - A 394 {5} 1395 {5} 396 (5) 397 {5} .398 {5} {399 {5} 400 {5} 401 (5) [) - - O MALE N L E l 402 (5) |403 {5} |404 tº) |405 (5) |406 {5} |407 {5} |408 (5) 409 {5} A r A MALE M E. ADDITIONAL For clients receiving methadone/LAAM treatment during the period May 1, 1978 through April 30, 1979 enter the following: INFORMATION METHADO.NE LAAM 4 : 0 {5} *- t 1. The number of pregnant clients who were treated with methadone. is, 2. The number of clients who had adverse reactions to the methadone/ 411 (5) || 4 || 2 {5} : LAAM requiring medical attention." - —l 413 (5) || 4 || 4 {5} : 3. The number of client deaths related to methadone/LAAM alone." | 3. | * e - 6. 5) 41 R. 4. The number of Cient deaths related to methadone/LAAM in cornbi. 4 $5 {5} || 4 16 tº nation with other drugs." * Attach FD 1639, Drug Experience Report, for each case not previously reported to the Food and Drug Administration. ADM 515 Ray, 12.78 DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION NATIONAL INSTITUTE ON DRUG ABUSE CL ENT ORIENTED DATA ACOUISITION PROCESS (CODAP) ADMISSION REPORT (AR) --~~ *P* | Item 21-DRUG TYPE(s) * †. CLINIC IDENTIFIER - | | | | | | | | | 11-18 indicate in the following order: —Drug problems for which the client is being admitted for treatment Month Day Year —Other drugs used during the month prior to admission * 2. DATE FORM, COMPLETED | | | | | | | 1924 | If 00 for None is entered, leave Items 22.25 blank. 00 = None 08 = Cocaine ° 3. CLIENT NUMBER | | | | | | | | | | || 25-34 Q1 = Heroin 09 = Marihuana/Hashish - 02 = Non-Rx Methadone 10 = Hallucinogens 03 = Other Opiates and Synthetics 1 1 = |nhalants * 4. DATE OF ADMISSION TO Month Day Year º: : §. t }: := ºntºr = baroſ turates = | ranquilizers TH IS CL |N|C | | | | | | | 35-40 06 = Other Sedatives Or Hynotics 14 = Other 07 = Amphetamines 21 = PCP 5. ADMISSION TYPE [ ] 41 Item 22–SEVERITY OF DRUG PROBLEM (S) AT TIME OF ADMISSION 1 = First Admission—To Any ‘Clinic Within This Program +: 2 = Readmission—To Any Clinic Within This Program - ! : ; º A Problem) 3 = Transfer Admission—From Another CODAP Reporting 2 = Secondary Clinic Within This Program 3 = Tertiary 4 = Transfer Admission–From A Non-CODAP Reporting Clinic Within This Program item 23-FREOUENCY OF USE DURING MONTH PRIOR TO ADMISSION 0 = No Use During Month Prior ºfo [T] 42 To Admission 4 = Once Daily 1 = Less Than Once Per Week 5 = Two To Three Times Daily 2 = Once Per Week 6 = More Than Three Times Daily. ºftbro [...] 43 || 3 = several times Per Week 8. MEDICATION PRESCRIBED [T] Item 24-MOST RECENT USUAL ROUTE OF ADMINISTRATION (See reverse side for codes) 44-45 1 = Oral 4 = Intramuscular 2 = Smoking 5 = intravenous 1 = MALE :: * & * 9. SEX 2 = FEMALE [T] 46 3 * inhalation Month Year DRUG PATTERNS PRIMARY SECON DARY TER TI ARY * 10. DATE OF BIRTH PROB 1–EM PROB t EM PROB LEM [TTTT 47.50 | AT ADMIss' ons O R USE O R USE O R \JSE CARD 2 11 12 13 14 1 1 º: BACKGROUND | || 51-52 5 6 e6 reverse side for codes) 21. DRUG TYPE(S) 12. SOURCE OF REFER FAL (Complete all blocks) (See reverse side for codes) [T] 53-54 13.MARITAL STATUS 19 20 21 (See reverse side for codes) T 55 22. iºns 14. EMPLOYMENT STATUS [I] 57 AT TIME OF (See reverse side for codes) ADMISSION isºlºist SCHOOL GRADE COMPLETED [T] 59-60 23. FR EO UENCY OF 23 24 25 - USE DURING 16, CURRENTLY N EDUCATIONAL OR SKILL T 61 MONTH PRIOR DEVELOPMENT PROGRAM 1 = Yes 2 = No TO ADMISSION 17. NUMBER OF TH MES AR RESTED WITH IN 24 27 • 28 29 MONTHS PRIOR TO THIS ADMISSION (00 for none) 62-63 24. º: 18. NUMBER OF PRIOR ADMISSIONS TO ANY DRUG [T] 6 OF ADMINIS TREATMENT PROGRAM (OO for none) 64-65 | TRATION 19. MONTHS SINCE LAST DISCHARGE FROM ANY - DRUG TREATMENT PROGRAM T 66-67 31 32 33 34 35 | 36 (00 = none; 97 = not applicable) 25. YEAR OF 20. HEALTH INSURANCE TYPE [T] FIRST USE 19 19 19 (See reverse side for codes) 68 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 26. CODED REMARKS | I-I-I-T-I-T-I-T- | || 58 | ||||||||ITTTTT W 7 47 48 53 | ] 47.77 77 Special Studies 73 *The information entered in these Critical items is used to match client's Admission and Discharge Reports snd to match Corrected Copy with Admission Report. This report is required by P. L. 92-255. Failure to report may result in the suspension or termination of NIDA Treatment Grant or contract. The information entered on this form will be handled In the strictest confidence and will not be released to unauthorized personnel. ADMISSION REPORT CODES Listed below are the codes required for the completion of Items on the front of this Admission Report. This aid is NOT de- signed to replace the comprehensive definitions and instructions contained in Chapter 2 – Admission Report of the CODAP Instruction Manual. A thorough review of the Instruction Manual and its accessibility at the reporting unit is required. Item 6 – Modality Admitted To Item 13 – Marital Status 1 = Detoxification 1 * Never Married 2 * Maintenance 2 = Married 3 - Drug Free 3 * Widowed 4 = Other 4 = Divorced 5 = Separated item 7 – Environment Admitted To Item 14 — Employrnent Status 1 = Prison 1 = Unemployed, Has Not Sought Employment 2 = Hospital ln Last 30 Days 3 = Residential 2 = Unarmployed, Has Sought Employment In 4 = Day Care Last 30 Days 5 * Outpatient 3 = Part-Time (Less Than 35 Hours A Week) 4 = Full-Time (35 Or More Hours A Week) Item 8 – Medication Prescribed item 20 – Health insurance Type. 00 = None O = No Health Insurance 01 as Methadone 1 = Blue Cross/Blue Shield O2 = LAAM 2 = Other Private insurance 03 * Propoxyphene-N 3 = Medicaid/Medicare 04 = Naloxone 4 =CHAMPUS (Civilian Health And Medical 05 = Cyclazocine Program Of The Uniformed Services) F-11 06 = Disulfiram 5 = Other Public Funds For Health Care 07 = Other Antagonist 08 = Naitrexone 09 = Other Item 11 — Race/Ethnic Background 01 = White (Not Of Hispanic Origin) 02 = Black (Not Of Hispanic Origin) 03 = American Indian 04 = Alaskan Native (Aleut, Eskimo Indian) 05 = Asian Or Pacific Islander O6 = Hispanic-Mexican 07 = Hispanic-Puerto Rican 08 = Hispanic-Cuban 09 = Other Hispanic !tem 12 — Source of Referral FOR BUREAU OF PR SONS ONLY 01 = Self Referral 02 * Hospital 13 * BOP NARA || 03 = Community Mental Health Center 14 = BOP - PDDR 04 * Community Services Agencies/individuals 15 = BOP Study 05 - Family/Friend 16 = BOP Probationer 06 = Employer 17 = Other BOP (Formerly DAP) 07 m. School 08 = Other Voluntary FOR VETERANS ADMINISTRATION ONLY 09 • Treatment Alternatives to Street Crime (TASC) 10 - Federal/State/County Probation 18 - VA ASMRO 11 - Federal/State/County Parole 12 = Other Non-Voluntary -12 CLIENT ORIENTED DATA ACOUISITION PROCESS (CODAP) DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE ALCOHOL, DRUG ABUSE, AND MENTAL HEALTH ADMINISTRATION MATIONAL INSTITUTE ON DRUG ABUSE DISCHARGE REPORT (DR) & CARD ! | 17. SKILL DEVELOPMENT PROGRAM compleTED | 71 DURING TREATMENT 1 = YES 2 = No 18. NUMBER OF TiMES CLIENT WAS AR RESTED - 1. CLINIC idFMTI FIER | | | | | | | | | 11-18 DURING TREATMENT (00 for none) TT| 72-73 Month Day Year Item 19—DRUG TYPE(S) 2. DATE FORM COMPLETED | | | | | | 19-24 indicate in the following order: § 3. CLIENT NUMBER L* 4. DATE OF DISCHARGE FROM Month Day Year {} THIS CLIN; C | | | | | | || 35-40 5. DATE OF ADMISSION TO Month Day Year THIS CLiNIC || || || || 41-46 6, DATE OF ADMISSION TO THIS PROGRAM | Month Day Year | | | | || 47-52 —Drug Problem(s) at the time of discharge regardless of frequency of use at discharge —Other Drug (s) used during month prior to discharge, whether or not a problem. - lf 00 for None is entered, leave items 20-22 blank 00 = None 01 = Heroin 02 = Non-Rx Methadone 03 = Other Opiates and Synthetics 04 * Alcohol 09 = Marihuana/Hashish 10 = Halfucinogens 11 * inhalants 12 = Over-The-Counter 13 = Tranquilizers 05 = Barbiturates 14 = Other 06 = Other Sedatives Or Hypnotics 15 = Drug Unknown 07 = Amphetamines 21 = PCP 08 = Cocaine Item 20–SEVERITY OF DRUG PROBLEM (S) AT TIME OF DISCHARGE O = Use (Not A Problem) 7, REASON FOR DISCHARGE - 53-54 || 1 = Primary - | | || 2 = Secondary 01 = Completed Treatment, No Drug Use 3 = Tertiary 02 = Completed Treatment, Some Drug Use O3 = Transfer To A CODAP Reporting Clinic Within This Program Item 21 –FREOUENCY OF USE DURING MONTH PRIOR TO DESCHARGE Q4 = Transfer To A Non-CODAP Reporting Clinic Within This Program 0 = No Use During Month Prior 4 = Once Daily § sº 5. Outside This Program - e * To Discharge 5 = Two To Three Times Daily = Program Decision To Discharge Client For Noncompliance with 1 = Less Than Once Per Week 6 = More Than Three Times Daily Program Rules - 2 = Once Per Week 7 = Frequency Unknown 07 = Client Left Before Completing Treatment 3 = Several Times Per Week 08 = Incarcerated 09 as Death |term 22–MOST RECENT USUAL ROUTE OF ADMINISTRATION 8, Mioſ)ALITY AT TIME OF D SCHARGE [T] 65 1 = Oral 4 * |ntramuscular (See reverse side for codes) 2 = Smoking 5 = Intravenous 3 = Inhalation 6 = Route Unknown 9. ENVIRONMENT AT TIME OF DISCHARGE [T] 56 - (See reverse side for codes) * DRUG PATTERNS PRIMARY | SECON DARY | TERTI ARY 1 = MALE AT DISCHARGE PROBLEM PROBLEM PROBLEM := OR USE OR USE OR USE *10. SEX 2 = FEMALE [ ] 57 CARD 2 11 12 13 14 15 16 Month Year • * * 58-61 | 19. DRUG TYPE(S) 11. DATE OF BIRTH (Complete all blocks) 12. RACE/ETHNIC BACKGROUND 19 20 21 .s as a - 62-63 (See reverse side for codes) | || 20. SEVER iTY OF DRUG 13. MARITAL STATUS T º TiME (See reverse side for codes) - 64 - 23 24 25 #4. EMPLOYMENT STATUS (See reverse side for codes) [T] 66 |21. ſºº º #ion 15. HiGHEST SCHOOL GRADE COMPLETED t TO DISCHARGE 4 (00-20) | | | 68-69 27 28 29 16. CURRENTLY IN EDUCATIONA. OR SK! LL DE- T yo 22. Mº. Bººk VELOPMENT PROGRAM 1 ºr Yes 2 = No º ADMIN IS- - cARD2 1 2 3 4 5 6 7 8 9 10 1 1 12 13 14 15 16 i 7 18 19 20 21 22 23 24 25 26 - 23. CODED ɺrs LL | | | | | | | | | | | || 31-56 3? 32 42 Special Studios —i- *The informetion entered in those Critical items is used to match client’s Admission and D lecharge Reporta and to match Corrected Copy with Discharge Report. This report is required by P. L. 92-255. Failure to report may rogutt in the suspenalon or termination of N D A Treatment Grant or Contract. The information ontored on this form will be hendled in the strictset confidence and will not be roleased to unauthorized personnel. Listed below are the codes required for the completion of ſtems on the front of this Discharge Report. This aid is NOT designed to replace the comprehensive definitions and instructions contained in Chapter 3 — Discharge Report of the CODAP instruction Manual. A thorough review of the ſnstruction Manual and its accessibility at the reporting unit is required. *3 U. S. DISCHARGE REPORT CODES item 8 – Modality At Time Of Discharge 1 = Detoxification 2 = Maintenance 3 = Drug Free 4 = Other Item 9 - Environment At Time Of Discharge 1 = Prison 2 = Hospital 3 = Residential 4 = Day Care 5 = Outpatient Item 12 – Race/Ethnic Background 01 = White (Not Of Hispanic Origin) 02 = Black (Not Of Hispanic Origin) 03 = American Indian 04 = Alaskan Native (Aleut, Eskimo Indian) 05 = Asian Or Pacific Islander 06 = Hispanic-Mexican 07 = Hispanic-Puerto Rican 08 = Hispanic-Cuban 09 = Other Hispanic item 13 — Marital Status 1 = Never Married .2 = Married 3 = Widowed 4 = Divorced 5 = Separated ltem 14 — Employment Status 1 = Unemployed, Has Not Sought Employment in Last 30 Days 2 = Unemployed, Has Sought Employment in Last 30 Days 3 = Part-Time (Less Than 35 Hours A Week) 4 = Full-Time (35 Or More Hours A Week) GOVERNMENT P R J N T | N G O F F : C E : 1 9 79-28 1 - 265 / 1 O 46 F-15 Public Health T TV jº i i \! § 82; C. Ç º: • '-' Y *...* - ~s x,-------' cºmr-: *****ru*~ * : * ~ * rf-----------n -> --------- . . . ." -- ~ ^ -, --, -i-, -, -- .--~ : ... ' § { } { } }. Cy C. C. Y' rºº & O O ºh- .. * - -- ` - --> * * ~ -}. !C & Giº oup , ºe et – -: , , -- i + - T C, ~7 ºr irº. Five , 1978. *** * * ... . - 4. * " ' ) C tº G d i Y) ºr Ç ... }. ....' ... K. .*. -d-. . . | º – ~ +...+---ºr-wrver- **.*.* twº-k --- *:::... •:-ºr: * *... -- - - - { t * * | ! -v-- *** * -----4- - .* ~1.--- - -------., --, --> viz: - cº-au--ar-rº-rº-- *.*.*.*-wr-ºr-tº-º-º:-------- --------- - ~ *:------tº-r-------es--a --rºr=~.. ! | DD NOT REMOVE 0R MUTIILATE [ ARD