1. Update on Latest Drug Trends
Jane C. Maxwell, Ph.D.
Addiction Research Institute
The University of Texas at Austin
www.utattc.net

2. Data Sources
• Overdose death certificates & Medical
Examiner Reports
• Poison Control Center cases
• Treatment admission records (TEDS)
• Emergency room data (DAWN)
• Price, purity, supply, trafficking data (DEA)
• Surveys (NSDUH, MTF,YRBS)
• Community Epidemiology Work Group (NIDA)
• Forensic laboratory tests (NFLIS, Police &
ME Labs)
• AIDS cases (Health Department)
• Community Epidemiology Work Group (NIDA)

3. Drug Use Patterns Vary
over Time and Space

4. Percentage of Drug Items Identified by
Toxicological Labs as Heroin by State, 2006
Source: NFLIS

5. Percentage of Drug Items Analyzed by Tox
Labs Identified as Cocaine, by State,
2006
Source: NFLIS

6. Percentage of Drug Items Analyzed by Tox
Labs Identified as Methamphetamine, by
State, 2006
Source: NFLIS

7. % Texas Treatment Admissions by
Primary Substance of Abuse:
1987-2009
Heroin Alcohol Stimulants Cocaine Marijuana
60
50
40
30
20
10
0
87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08
Source: DSHS

8. And Our Demand for Drugs
Influences Drug Use in Our
Neighbors

10. Primary Drug of Abuse at Admission
to Treatment: 2007
Cocaine
10% Cocaine
10% Cocaine
Heroin 8%
15% Heroin
9% Heroin Cocaine
Meth 10% 24%
35% Meth Heroin
22% Meth 10%
Meth 8%
42% Meth Meth
Heroin 35% Heroin 11%
33% Heroin 31%
15% Heroin
Cocaine 31%
22% Cocaine
Cocaine 64%
32% Cocaine
47%
SISVEA & TEDS

11. British
Columbia
Prairie Provinces
Ontario
Quebec
Atlantic Canada

12. Canadian Methamphetamine Seizures:
1988-2007
3000
British Columbia
Prairie Provinces
2500
Ontario
2000 Quebec
Atlantic Provinces
1500
1000
500
0
Source: Office of Research and Surveillance, Health Canada

13. Heroin Sources and Supply Routes

14. Mexican Black Tar Heroin
Mexican Brown Heroin
South American Heroin

15. Heroin Changes
• Increasing use by youth nationally. DAWN ED
cases for those ages 18-20 increased by 83%
between 2006 and 2008.
• Texas heroin treatment admissions for those
ages 20-29 increased from 35% in 2005 to
41% in 2009; admission for those 40-49
decreased from 22% to 16% in the same
period.
• So? Cheese Heroin now Heroin. Watch for more
and more young users and ways to prevent
transition from inhaling to needles.

16. Texas Heroin Admissions by Age
12000
Group: 2005-2009
10000
8000
50+
40s
6000
30s
20s
4000
U20
2000
0
2005 2006 2007 2008 2009
Source: DSHS data; analysis by JC Maxwell

17. Lag Between First Use of Heroin
and Admission to Treatment in
Texas
Under 20 20s 30s 40s+
30
25 2.8 years
20
15 6 years
10 11 years 25 years
5
0
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Source: DSHS data; analysis by JC Maxwell

18. Other Opiates
OxyContin, Vicodin, Darvocet,
hydrocodone, oxycodone,
methadone, codeine, etc.

19. Source Where Pain Relievers Were Obtained for Most
Recent Nonmedical Use among Past Year Users Aged 12 or
Older: NSDUH 2006
Source Where Respondent Obtained
Bought on
Drug Dealer/ Internet
Stranger 0.1% Other 1
More than 4% 5%
Source Where Friend/Relative Obtained
One Doctor More than One Doctor
2% 3% Free from
One Doctor Free from Friend/Relative
19% Friend/Relative 7%
56%
One Bought/Took from
Doctor Friend/Relative
Bought/Took 81% 5%
from Friend/Relative
15% Drug Dealer/
Stranger
Other 1 2%
2%
1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s
Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

20. Reason for Using Prescription Pain Relievers:
PATS Attitude Tracking Study: 2005
• Easy to get from parents' medicine cabinets--62%
• Available everywhere--52%
• They are not illegal drugs--51%
• Easy to get through other people's prescriptions--50%
• Teens can claim to have a prescription if caught--49%
• They are cheap--43%
• Safer to use than illegal drugs--35%
• Less shame attached to using--33%
• Easy to purchase over the Internet--32%
• Fewer side effects than street drugs--32%
• Can be used as study aids--25%
• Parents don't care as much if you get caught--21%

21. “SYRUP” in Texas
Codeine cough syrup continues
to be abused.
Cut with Karo syrup, jolly
ranchers, and soft drink.
Rap music on syrup continues.
Prepackaged to introduce to
youths or ready to add the
syrup?

22. New “Soft” Drinks:
Drank and Lean
Valerian Roots
Melatonin
Rose Hips
“Slow Your
Roll”
“Slow Motion
Potion”

23. SIZZURP
Cognac, Vodka, and Fruit Flavor

24. COCAINE
Still Around—
with New Users

26. Cocaine
• Indicators appear to be down.
• Different routes of administration—
Crack vs. powder.
• Injecting cocaine and heroin either
together or sequentially (“Speedball”)
• Risky sexual behaviors while smoking
crack and trading drugs for sex in
crack houses. Impact on HIV/AIDS
rates.
• Changes in characteristics of users.

27. Race-Ethnicity of Texas Cocaine Admissions:
1993 v. 2009
Black White Hispanic
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Crack-93 Crack-09 IDU-93 IDU-09 Inhale-93 Inhale-09
Source: DSHS analysis by JC Maxwell

28. Marijuana

29. MARIJUANA
• Indicators are fairly stable.
• Influence of Blunts and Wraps
• Use with Fry, PCP, DANK, crack,
cough syrup, honey, etc., continues.
• Continuing references to pot and
PCP and embalming fluid
(formaldehyde).
• CJ v. Non-CJ treatment admissions

30. % Texas Secondary Students Who
Had Used Marijuana in the Past
Month, by Ethnicity: 1990-2008
25%
20%
Anglos
15%
African Americans
10%
Hispanics
5%
0%
Source: DSHS

31. Ways Texas Secondary Students
Used Marijuana Most or Always:
2008
9% 8%
8%
Joints
7% 6%
6% 6% Blunts
5% 4%
Bongs
4%
3%
3% Pipes
2% Other Ways
1%
0%
Joints Blunts Bongs Pipes Other
Ways
Source: DSHS

32. Relationship of Use of Tobacco,
Marijuana & Blunts: 2008 Texas
Secondary School Survey
Tobacco Marijuana Cigars
Ever Never 2.5%
Never Ever 62.1%
Ever Ever 72.4%
Source: DSHS

33. Addiction Severity Index Problems of
Texans Treated with Primary Marijuana
Problem: 2009
Sub. Abuse
Emotional Non-CJ Referral
CJ Referral
Social
Family
Employment
Sickness
0.0 20.0 40.0 60.0
Source: DSHS; analysis by JC Maxwell

34. Cannabis Homologs
• Synthetic pot containing compounds that mimic
THC
• Names include K2, K2 summit, spice, spice gold,
spice silver, spice diamond, genie, zohai, space,
skunk, yucatan fire, halo, black mamba,
damiana, drolle.
• Not detected in normal drug screens.
• Still legal in most of the U.S.
• Side effects include chest pain, tachycardia,
skin pain, agitation, confusion, hyperventilation.
DSHS, Mathias Forrester

35. Calls on Marijuana Homologs
to Texas Poison Centers
1/1/10-4/31/10
• 36 exposures, 75% male, ages 14-38
• 86% intended to misuse or abuse
• 75% using at own home
• 33% minor & 33% moderate effect;
22% potentially toxic
• 33% tachycardia, 17% vomiting, 14%
confusion, 14% confusion
Source: DSHS,, Mathias Forrester

36. SPICE

38. Alcohol

39. % of Past Month Alcohol Use
Among 12 to 20: 2006 to 2008
24.5-27.4%

40. % of Past Month Drinkers 12 to 20
Who Purchased Their Own Alcohol
Last Time they Drank: 2006 to 2008
8.4-10.1%
24.5-27.4%

41. % Past Month Alcohol Users in the U.S.
Ages 12 to 20: 2005-2006
0% 10% 20% 30% 40% 50% 60%
Total Aged 12 to 20 28%
12 to 17 17%
18 to 20 51%
Male 29%
Female 28%
White 32%
Hispanic 26%
Black 19%
SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008

42. Average # Drinks per Day on the Days Used
Alcohol among Past Month U.S. Alcohol Users
Ages 12 to 20: 2005-2006
0 2 4 6 8
Total Aged 12 to 20 4.9
Aged 12 to 17 4.5
Aged 18 to 20 5.2
Male 5.8
Female 4
White 5.3
Hispanic 4.9
Black 2.8
SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008

43. Percentage of Texas Secondary
Students Who Reported They Normally
Consumed Five or More Drinks at One
Time, by Gender: 2000–2008
35%
32%
30% 30%
25% 26%
24% 23%
22% 22%
20% 20% Girls
18% 18%
15% Boys
10%
5%
0%
2000 2002 2004 2006 2003
Liu, L. Texas School Survey of Substance Use Among Students in Grades 7-12, DSHS.

44. Relationship Between Age of Onset of
Drinking and Prevalence of DSM-IV Alcohol
Abuse and Dependence: 1994
100
90
80
70
60
50
40 No Alcohol
30 Dependence
20
Abuse
10
0

45. Binge Drinking and Women
• Women binge drinkers engaged in anal sex more often than women who
drank alcohol without binges (33% vs. 16%) and 3 times the rate of
women who abstained from alcohol (11%).
• Having multiple sex partners was more than twice as common among
women binge drinkers than women abstainers (41% vs. 17%).
• Gonorrhea was nearly 5 times higher among women binge drinkers
compared to women abstainers (11% vs. 2%).
• Among men, rates of risky sexual behaviors/STDs were high, but did
not differ by alcohol use.
• The findings support the need to routinely screen for binge drinking
as part of clinical care in STD clinics.
• Women binge drinkers may benefit from interventions that jointly
address binge drinking and risky sexual behaviors.
• Developing gender-specific interventions could improve overall health
outcomes in this population.
Hutton, H. et al., (2008). The Relationship Between Recent Alcohol Use and Sexual Behaviors: Gender Differences
Among Sexually Transmitted Disease Clinic Patients, Alcoholism: Clinical and Experimental Research

46. Texas STD Case Rates: 2009
10,000.0
1,000.0
Syphilis Male
Syphilis Female
100.0
Gonorrhea Male
Gonorrhea Female
10.0
Chlamydia Male
Chlamydia Female
1.0
Source: DSHS

47. % of Weekend Nighttime Drivers with
BACs>0.08g/dL or Positive for Drugs
in the 2007 National Roadside Survey
16 14.4
14
12
10
% Drivers
8
6
4
2.2
2
0
Alcohol Drugs
NHTSA Traffic Safety Facts, 2009

48. Primary Problem Substance of Texas
DUI Admissions to Treatment
1996 2008
Alcohol
Heroin 12%
5%
Other Opiates
Amphet/ Meth
Powder Cocaine 67%
75%
Cannabis
Crack Cocaine
Other
Maxwell, Impaired Drivers at Admission to Substance Abuse Treatment, RSA Poster, 2006.

49. Sources of Amphetamine-
Type Substances
Sources of ephedrine
Major producers of methamphetamine

50. # Methamphetamine Clandestine Laboratory
Incidents and % of All Substances Identified
That Were Methamphetamine in the US:
1999-2008
# Laboratory Incidents % of All Identified Substances
20000 18%
18000 16%
16000 14%
14000
12%
12000
10%
10000
8%
8000
6%
6000
4000 4%
2000 2%
0 0%
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
Source: NFLIS & DEA

51. Routes of Administration of
Methamphetamine of Clients in Texas
Programs: 1988-2009
90
80
70
60
50
Smoking
40
Inhaling
30
Injecting
20
10
0
DSHS data; analysis by JC Maxwell

52. Early Findings from NIDA Study of Meth in the
Austin Area
• Users from Austin and other states (CA, ARK,
NY) report it’s very available
• Powder called Pill Dope, Biker Dope, Bathtub
Dope, Crank
• Pseudoephedrine easy to obtain in Texas.
Sudafeds==“Walfeds”==”Red Hots” Smurfers.
• Different recipes for powdered meth. “One Pot”
and “Shake and Bake”. BYO.
• Ice can be made locally (like rock candy).
String, cooler or fish tank, 30 days
underground or in dark place, battery charger.
Or lithium and copper tubing
52
Source Jane Maxwell

53. • Methylsulfonylmethane (MSM) being used to cut
pure Ice.
• Increases in injecting lower potency “home-
made” instead of smoking high quality Ice.
• Price: $100-120/gm. Ten “points” to a gram.
• Taste: “Burns Bad, Tastes Terrible”.
• Unclear of source (Mexico or local—or don’t
want to say). Role of Mexican Mafia, La
Familia, Aryan Brotherhood?
• Clients had gained weight and looked good, but
self-reports of rage, outbursts, mental
obsessions, visions, shadow people, schizophrenic
episodes prior to coming to treatment.
Source: Jane Maxwell

54. FINALLY?
• Based on previous drug epidemics, it appears we
may have reached a point in the meth epidemic
where we will see:
a decreased number of initiates;
communities with substantial numbers of
addicts regardless of supply reduction efforts
(like crack cocaine in the inner city);
meth established with cocaine and heroin as
major chronic drug problems, each with its
own geography and specific user groups.
• If this proves to be accurate, there will be
increasing need for treatment for severely
impaired addicts, including increased residential
treatment capacity. 54

55. DOWNERS
• Barbiturates (phenobarbital), benzos
(diazepam-Valium, alprazolam-
Xanax, clonazepam-Klonopin,
lorazepam-Ativan, chlordiazepoxide-
Librium).
• Potentiate low-quality heroin (and
seen in heroin overdoses)
• Come down from speed or cocaine
trips
• Kids like Xanax (Four Bars).

56. % Texas Secondary School Students
Who Had Ever Used a Prescription Drug
for the Experience or Feeling: 2008
14 13
12
10
Percent
8
6
6 5
4 3 3
2
0
Codeine Oxycodone Vicodin Valium Xanax
DSHS data

57. Admissions to Texas Treatment
Programs by Primary, Secondary or
Tertiary Problem with a Club Drug:
1988-2009
1600
1400
Ecstasy
1200
GHB
1000
Hallucinogens
800
Ketamine
600
Rohypnol
400 PCP
200
0
DSHS data; analysis by JC Maxwell

58. Ecstasy Indicators in Texas: 1998-
2009
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
PCC Calls Treatment DPS Labs Deaths

59. Texas Treatment Admissions with a
Primary, Secondary or Tertiary
Problem with Ecstasy: 1998-2009
White Hispanic Black
100%
80%
60%
40%
20%
0%
DSHS data; analysis by JC Maxwell

60. Piperazines
Including BZP & TFMPP
• “A2”, “Frenzy”,
• “Nemesis,” ”Pure”.
• Stimulants which are combined to
be alternative to Ecstasy &
methamphetamine.
• BZP is Schedule 1 but TFMPP is
legal in US.

61. BZP, “P”, “Pure”
• Texas DPS laboratory items of
Benzylopiperazine (BZP) and
trifluoromethylphenylpiperazine (TFMPP)
identified.
NFLIS

62. GHB/Fantasy Indicators in Texas:
1998-2009
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
1000
100
10
1
# PCC Calls # Treatment # DPS Labs # Deaths

63. DISSOCIATIVE DRUGS:
PCP, Ketamine, DXM
Distort perceptions of sight
and sound and produce feelings
of detachment, but not
hallucinations (Zombie effect)

64. Salvia Divinorum
• Family : Lamiaceae (mint)
• Slang: Ska Maria Pastora, La Pastora,
Yerba Maria, The Shepherdess, Diviner's
Mint, Diviner's Sage
• Most potent natural hallucinogen
• Clinical: Visual distortions; feeling of
unreality; depersonalization, dissociation;
motor incoordination.
• Many Salvia users try it only once because
of unpleasant effects.
• Route: chewed or smoked; onset 1 minute;
duration 1 hour.

65. PCP Indicators in Texas:
1998-2009
1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009
10000
1000
100
10
1
# PCC # Houston # # DPS # Deaths
Calls DAWN Treatment Labs

66. Phencyclidine
• PCP, Angel Dust, Killer Weed
• Dissolved in embalming fluid or ether
(“Fry,” “Amp,” “Water, Water”).
• Swallowed, sniffed, smoked on joints
dipped in “Fry”.
• Menthol cigarettes are dipped into liquid
PCP or blunts are laced with powdered
PCP.
• Out of body strength.

67. KETAMINE
• Anesthetic still occasionally used with
humans; primarily known as horse or
elephant tranquilizer.
• Has stimulant and hallucinogenic
properties.
• Alters perceptions, leaving user feeling
detached from themselves and others
around them.
• Snorted or swallowed: dose dependent.

68. Percent of Texas AIDS Cases Reported by
Selected Modes of Exposure: 1987-2008
90%
80%
70%
60% MSM
50% IDU
40% M-M & IDU
30% Hetero
20%
10%
0%
Source: DSHS

69. Texas Male and Female AIDS Cases
by Race/Ethnicity: 1999-2008
100%
90%
80%
70%
Hispanic Male
60%
Black Male
50%
40% White Male
30% Hispanic Female
20% Black Female
10% White Female
0%
Source: DSHS

70. WWW.UTATTC.NET