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Epidemiologic Trends in Drug Abuse - Proceedings of the Community Epidemiology Work Group


Overview

Originally Published: 01/31/2012

Post Date: 06/09/2013

by The Community Epidemiology Work Group | NIDA


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PDF Full Report | Epidemiologic Trends in Drug Abuse - Proceedings of the Community Epidemiology Work Group | Jan 2012

Summary/Abstract

CEWG Executive Summary provides a synthesis of findings from reports presented and data prepared for the 71st semiannual meeting of the National Institute on Drug Abuse (NIDA) Community Epidemiology Work Group (CEWG) held in San Antonio, Texas, on January 18–20, 2012.

Content

Foreword

This Executive Summary provides a synthesis of findings from reports presented and data prepared for the 71st semiannual meeting of the National Institute on Drug Abuse (NIDA) Community Epidemiology Work Group (CEWG) held in San Antonio, Texas, on January 18–20, 2012. The CEWG is a network of researchers from sentinel sites throughout the United States. It meets semiannually to provide ongoing community-level public health surveillance of drug abuse through presentation and discussion of quantitative and qualitative data. CEWG representatives access multiple sources of existing data from their local areas to report on drug abuse patterns and consequences in their areas and to provide an alert to potentially emerging new issues. Local area data are supplemented, as possible, with data available from federally supported projects, such as the Substance Abuse and Mental Health Services Administration (SAMHSA), Drug Abuse Warning Network (DAWN); Drug Enforcement Administration (DEA), National Forensic Laboratory Information System (NFLIS); and the DEA, Heroin Domestic Monitor Program (HDMP). This descriptive and analytic information is used to inform the health and scientific communities and the general public about the current nature and patterns of drug abuse, emerging trends, and consequences of drug abuse.

The CEWG convenes twice yearly, in January and June. For the June meetings, CEWG representatives pre­pare full reports on drug abuse patterns and trends in their areas. After the meeting, a Highlights and Execu­tive Summary Report is produced, and the full CEWG area reports are included in a second volume. For the January report, the representatives present an abbreviated report to provide an update on data newly avail­able since the prior June report and to identify significant issues that have emerged since the prior meeting. These abbreviated reports, or Update Briefs, are included in this Executive Summary, along with highlights from the meeting and cross-site data compilations.

The majority of the January 2012 meeting was devoted to the CEWG area reports and presentations. CEWG area representatives presented data on recent drug abuse patterns and trends. Other highlights of the meet­ing included a welcome from Mimi McKay, M.A., M.L.I.S., Chief of Staff for the Mental Health and Substance Abuse Services, Texas Department of State Health Services; a welcome and update from Wilson Compton, M.D., M.P.E., Director of NIDA’s Division of Epidemiology, Services and Prevention Research; an update on National Institute of Justice activities from Linda Truitt, Ph.D.; a presentation on scheduling emergency drugs of abuse by James Hunter, R.Ph., M.P.H., from the U.S. Food and Drug Administration; a presentation on trends in southwest border seizures by Sarah Bourne, from the DEA; a presentation from Richard Rawson, Ph.D., from the University of California, Los Angeles, on developing an Iraq CEWG; and presentations by DEA representatives, Cassandra Prioleau, Ph.D., and Artisha Polk, M.P.H., on NFLIS and emerging drugs of concern and drug scheduling issues. A workshop on poison control center data included these presenta­tions: “Overview of Poison Control Centers,” by Jan Scaglione, Pharm.D., M.T., D-ABAT, the CEWG guest researcher from Cincinnati, and “Poison Control Centers as a Data Source for Substance Abuse,” by Mathias Forrester, epidemiologist with the Texas Department of State Health Services.

This Highlights and Executive Summary Report for the January 2012 CEWG meeting includes the CEWG Update Briefs, along with additional reports, and highlights findings from the CEWG area reports and discussions.

 

Section I. Introduction

The 71st semiannual meeting of the Community Epidemiology Work Group (CEWG) was held on January 18–20, 2012, in San Antonio, Texas. During the meeting, CEWG area representatives from 20 geographically dispersed areas in the United States reported on current trends and emerging issues in their areas. In addition to the information provided for 18 sentinel areas that have contrib­uted to the network for many years, guest researchers from Cincinnati and Maine provided data from their respective areas.

The CEWG Network

The CEWG is a unique epidemiology network that has functioned since 1976 as a drug abuse surveillance system to identify and assess current and emerging drug abuse patterns, trends, and issues, using multiple sources of information. Each source provides information about the abuse of particular drugs, drug-using populations, and/or different facets of the behaviors and outcomes related to drug abuse. The information obtained from each source is considered a drug abuse indicator. Typically, indicators do not provide estimates of the number (prevalence) of drug abusers at any given time or the rate at which drug-abusing populations may be increasing or decreasing in size. However, indicators do help to characterize drug abuse trends and different types of drug abusers (such as those who have been treated in hospital emergency departments, admitted to drug treatment programs, or died with drugs found in their bodies). Data on items submitted for forensic chemical analysis serve as indicators of availability of different substances and engage­ment of law enforcement at the local level, and data such as drug price and purity are indicators of availability, accessibility, and potency of specific drugs. Drug abuse indicators are examined over time to monitor the nature and extent of drug abuse and associated problems within and across geographic areas. The CEWG areas for which presentations were made at the January 2012 meet­ing are depicted in the map below, with one area presentation including data on Baltimore, Mary­land, and Washington, DC. A second area presentation for South Florida included data on two Miami Metropolitan Statistical Area (MSA) counties.

Community-Epidemiology-Work Group Map-choopersguide















 

CEWG Meetings

The CEWG convenes semiannually; these meetings continue to be a major and distinguishing fea­ture of the workgroup. CEWG representatives and guest researchers present information on drug abuse patterns and trends in their areas, and personnel from Federal agencies provide updates of data sets used by the CEWG. In addition, time is set aside for discussion sessions. The meetings provide a foundation for continuity in the monitoring and surveillance of current and emerging drug problems and related health and social consequences.

Through the meetings, the CEWG aims to:

  • Disseminate the most up-to-date information on drug abuse patterns and trends in each CEWG area
  • Identify changing drug abuse patterns and trends within and across CEWG areas

In addition to CEWG area presentations, time at each meeting is devoted to presentations by invited speakers. These sessions typically focus on the following:

  • Presentations by researchers in the CEWG host city
  • Updates by Federal personnel on key data sets used by CEWG representatives
  • Drug abuse patterns and trends in other countries

Identification of changing drug abuse patterns is part of the discussions at each CEWG meeting. Through this process, CEWG representatives can alert one another to the emergence of a poten­tially new drug of abuse. The CEWG is uniquely positioned to bring crucial perspectives to bear on urgent drug abuse issues in a timely fashion and to illuminate their various facets within the local context through its semiannual meetings and post-meeting communications.

Data Sources

To assess drug abuse patterns and trends, city- and State-specific data were compiled from a vari­ety of health and other drug abuse indicator sources. Such sources include public health agencies; medical and treatment facilities; ethnographic research; key informant discussions; criminal justice, correctional, and other law enforcement agencies; surveys; and other sources unique to local areas. Availability of data varies by area, so reporting varies by area. Examples of types of data reviewed by CEWG representatives to derive drug indicators include the following:

  • Admissions to drug abuse treatment programs by primary substance of abuse or primary reason for treatment admission reported by clients at admission
  • Drug-involved emergency department (ED) reports of drugs mentioned in ED visits reported by the Drug Abuse Warning Network (DAWN)
  • Seizure, average price, average purity, and related data obtained from the Drug Enforcement Administration (DEA) and from State and local law enforcement agencies
  • Drug-related deaths reported by medical examiner (ME) or local coroner offices or State public health agencies
  • Arrestee urinalysis results and other toxicology data
  • Surveys of drug use
  • Poison control center data1

Sources of data used by several or most of the CEWG area representatives and presented in this Highlights and Executive Summary Report are summarized below, along with some caveats related to their use and interpretation. The terminology that a particular data source uses to characterize a drug, for example, cannabis versus marijuana, is replicated here.

Treatment data

Were derived from CEWG area reports. For this report, they represent data for 17 CEWG metropolitan areas and 5 States: Colorado, Hawaii, Maine, Maryland, and Texas. Recent or complete treatment admissions data were not available for Chicago or Washington, DC. Data for several States are included with metropolitan data for comparison, including data for Colorado with Denver, Hawaii with Honolulu, and Maryland with Baltimore City. The reporting period is cited as the first half (1H) of calendar year (CY) 2011 (January—June 2011) for all areas. Appendix table 1 shows overall treatment admissions data by drug and CEWG area for the current reporting period. Table 2 in section II and several tables in section IV (tables 3, 4, 5, 7, 9, and 10) also display cross-area treatment admissions data.

DAWN ED Weighted Estimates

for 12 CEWG areas for 2004 through 2009 were accessed on the DAWN Web site (https://dawninfo.samhsa.gov/default.asp) maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA). A description of the DAWN system can be found at https://dawninfo.samhsa.gov/default.asp. CEWG Update Briefs in section III that include DAWN data are Denver/Colorado and Detroit.

Forensic laboratory data

for a total of 23 CEWG sites were available for the first half of 2011. Data for all CEWG metropolitan areas in the first half of 2011 were provided by the National Forensic Laboratory Information System (NFLIS), maintained by the DEA. NFLIS is a program in the DEA Office of Diversion Control that systematically and continuously collects results from drug analyses of items received from drug seizures by law enforcement authorities. Drug analyses are conducted by Federal (DEA) forensic laboratories and participating State and local forensic laboratories. As of August 2011, in addition to the DEA laboratories, the NFLIS system included 48 State systems and 94 local or municipal laboratories/laboratory systems, representing a total of 283 individual laboratories. These laboratories handled more than 88 percent of the Nation’s estimated 1.3 million annual State and local drug analysis distinct cases. Data are entered daily based on seizure date and the county in which the seizure occurred. NFLIS provides information on the types of controlled substances secured in law enforcement operations and assists in identifying emerging drug prob­lems and changes in drug availability and in monitoring illicit drug use and trafficking, including the diversion of legally manufactured drugs into illegal markets. A list of participating and reporting State and local forensic laboratories is included in Appendix B of the U.S. Drug Enforcement Adminis­tration, Office of Diversion Control report, National Forensic Laboratory Information System: Year

1Poison control center data are reported here as they are reported by area representatives in their Update Briefs and slide presentations. The fact that the terminology used by area representatives is repeated here does not necessarily mean that particular synthetic cannabinoids or cathinones are chemically verified.

 

Section I. Introduction

2010 Annual Report (Washington, DC: U.S. Drug Enforcement Administration)2. The NFLIS data provided from DEA to the CEWG includes the first drug reported for each drug item identified. In most cases, data are for MSAs, rather than single metropolitan counties, but the exact geographic areas covered in this report are defined in appendix table 2. A map displaying NFLIS data for the first half of 2011 for 23 CEWG areas is included as figure 5 in section II, while table 1 and figure 1 in section II, and in section IV, figures 6-12 and tables 6, 8, 11, and 12, along with appendix tables 2.1-2.23, are provided to display the data on forensic laboratory drug items identified for the period across areas. Update Briefs in section III of this report also include NFLIS data for CEWG areas.

Local drug-related mortality data from medical examiners/coroners (ME/Cs) or State public health agencies were reported for 16 CEWG areas: the Baltimore/Maryland/Washington, DC, area; Boston; Cincinnati; Denver/Colorado; Detroit; Honolulu; Los Angeles; Maine; Miami-Dade and Bro­ward Counties in South Florida; Minneapolis/St. Paul; Philadelphia; St. Louis; San Diego; San Fran­cisco; Seattle; and Texas. These are described in Update Briefs in section III.

Other data cited in this report were local data accessed and analyzed by CEWG representatives. The sources included the Centers for Disease Control and Prevention (CDC)’s Youth Risk Behavior Surveillance System (YRBSS) and Youth Risk Behavior Survey (YRBS); DEA ARCOS (Automation of Reports and Consolidated Orders System) data; DEA Heroin Domestic Monitor Program (HDMP) data; local law enforcement (e.g., data on drug arrests); local DEA offices (DEA field reports); High Intensity Drug Trafficking Area (HIDTA) reports; arrestee drug information from the Arrestee Drug Abuse Monitoring (ADAM) II system and from local and State corrections departments and facili­ties; poison control centers; crisis lines and help lines; prescription drug monitoring systems; local and State surveys; hospital admissions and discharge data; key informants and ethnographers; and human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) data from local and State health departments. As an important additional data source for surveillance of new and emerging drugs, poison control center data were used by several area representatives for this meeting reporting; figures 2, 3, and 4 in section II exemplify their use of these data.

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