Drug Abuse Patterns and Trends in Greater Boston—Update: January 2014
Daniel P. Dooley
Overview of Findings: Two key findings were noted for Boston in this reporting period—increases in unintentional overdoses and continuing increases in heroin indicators. The number of unintentional drug overdoses in the city of Boston were at an 11-year high; unintentional drug overdoses reported in Boston hospitals increased by 40 percent from fiscal year (FY) 2010 to FY 2012 (from n=780 to n=1,089). Heroin levels continued to be high, with most heroin indicators showing increases between FY 2012 and FY 2013. These increasing heroin indicators included the number of unintentional overdoses in FY 2012, proportions of primary heroin treatment admissions in FY 2013, the proportion of arrests for heroin in calendar (CY) 2012, and the proportion of heroin drug reports among drug items analyzed by National Forensic Laboratory System Laboratories (NFLIS) laboratories in the first half of 2013. Heroin and cocaine continued as the most dominant drugs of abuse in the Boston area in this reporting period, while prescription opioids/opiates other than heroin and benzodiazepines remained at moderate levels relative to other drugs. Heroin dominated among drug indicators (in numbers of drug overdoses and as the primary drug among substance treatment admissions). Cocaine was also prominent among Boston drug overdoses, but the drug showed decreases in this reporting period among treatment admissions, arrests, and drug reports among items analyzed in NFLIS laboratories. Marijuana indicators were observed at moderate levels relative to other drugs. Methamphetamine, MDMA (3,4-methylenedioxymethamphetamine), hallucinogens, and other drugs were present in area indicators but at relatively low levels overall.
Updated Drug Abuse Trends and Emerging Patterns
Cocaine levels remained relatively high when compared with other drugs in Boston. Although most cocaine indicators were decreasing, the unintentional cocaine overdose hospital patient rate per 100,000 population increased by 41 percent from FY 2010 (23.4 per 100,000) to FY 2012 (34.3 per 100,000). During the same period, the number of nonoverdose cocaine dependence and abuse hospital patients decreased by 12 percent (from n=1,801 to n=1,592). The proportion of primary cocaine treatment admissions decreased steadily, from 9 percent of total admissions in FY 2008 to 5 percent in both FY 2012 and FY 2013. The proportion of unique-person treatment admissions citing cocaine as the primary, secondary, or tertiary drug of abuse decreased steadily over time as well, from 40 percent of total admissions in FY 2007, to 28 percent in both FY 2012 and FY 2013. The proportion of Class B drug arrests (mainly cocaine) was stable between 48 and 49 percent from 2009 to 2011, before decreasing to 43 percent in 2012. The proportion of cocaine drug reports among items analyzed by NFLIS laboratories decreased from 25 percent of the total in 2009 to 19 percent by 2012. Preliminary NFLIS data for the first half 2013 show cocaine drug reports to be stable at 20 percent of total drug reports.
Heroin abuse indicators in Boston were mostly increasing at very high levels. The unintentional heroin overdose hospital patient rate per 100,000 population increased by 76 percent from FY 2010 (37.6 per 100,000) to FY 2012 (66.1 per 100,000). The number of nonoverdose opioid (including heroin) dependence and abuse hospital patients increased by 13 percent (from n=2,105 to n=2,384) from FY 2011 to FY 2012. The proportion of primary heroin treatment admissions increased from 52 to 56 percent between FY 2012 and FY 2013. Similarly, the proportion of unique-person treatment admissions citing heroin as the primary, secondary, or tertiary drug of abuse increased from 45 to 49 percent during the same period. The proportion of Class A drug arrests (mainly heroin) increased from 22 percent in both 2009 and 2010, to 28 percent in 2012. From 2009 to 2012, the proportion of heroin drug reports among items seized by law enforcement and analyzed by NFLIS laboratories ranged from 14 to 18 percent. Preliminary data from the first half of 2013 show heroin was identified in 15 percent of total drug reports.
Prescription Opioids/Opiates Other Than Heroin: Indicators of prescription opioids and nonheroin opiates showed different trends for different data sources, but remained at moderate levels. The unintentional overdose hospital patient rate for prescription opioids/opiates other than heroin steadily increased by 66 percent over 5 years, from FY 2008 to FY 2012. However, the proportion of primary treatment admissions for prescription opioids/opiates other than heroin decreased slightly, from 5 percent in FY 2011 to 3 percent in FY 2013. Similarly, the proportion of unique-person treatment admissions with prescription opioids/opiates other than heroin as the primary, secondary, or tertiary drug of abuse decreased from 14 percent in FY 2011 to 11 percent in FY 2013. The proportion of NFLIS drug reports identified as oxycodone increased from 6 percent in 2009 to 10 percent in 2011 before decreasing to 8 percent in 2012. In the first half of 2013, 6 percent of drug reports among items analyzed in NFLIS laboratories were identified as oxycodone.
Benzodiazepines: Benzodiazepine indicators in Boston were mainly increasing at moderate levels. The unintentional benzodiazepine overdose hospital patient rate steadily increased by 54 percent from FY 2009 (26.9 per 100,000) to FY 2012 (41.4 per 100,000). The number of hospital patients with nonoverdose benzodiazepines, barbiturates, sedatives, and tranquilizers dependence and abuse was fairly stable (at n=297 in FY 2010 and n=308 in FY 2012, but it increased in a longer trend by 33 percent from FY 2002 (n=231) to FY 2012. In FY 2013, the proportion of unique-person treatment admissions citing benzodiazepines as primary, secondary, or tertiary drugs of abuse reached 12 percent of the total, having increased from 5 percent in FY 2005. Clonazepam and alprazolam ranked seventh and eighth among drug reports of items analyzed by NFLIS laboratories in 2012 and continued to rank among the top 10 in preliminary half-year 2013 data (with clonazepam ranking seventh with 1.6 percent of all drug reports and alprazolam ranking ninth with 1.0 percent).
Methamphetamine levels remained very low in Boston, representing 57 of 15,135 (less than 1.0 percent) of total primary treatment admissions in FY 2013. Methamphetamine reports ranked 22nd among total drug reports from items analyzed in NFLIS laboratories in the first half of 2013; methamphetamine drug reports totaled 77 in 2009, 97 in 2010, and 62 in both 2011 and 2012.
Marijuana/Cannabis indicators were mixed at varied levels, with some stable, some declining, and some increasing. From FY 2002 to FY 2013, the proportion of primary marijuana treatment admissions remained stable (between 4 and 5 percent). The proportion of unique-person treatment admissions citing marijuana as the primary, secondary, or tertiary drug of abuse decreased from 21 percent in FY 2010 to 17 percent in FY 2013; this was the lowest level in 13 years of reported data. From 2011 to 2012, the proportion of Class D drug arrests (mainly marijuana) was stable at 18 percent. Marijuana/cannabis drug reports ranked highest among all drug reports from items analyzed by NFLIS laboratories in the first half of 2013. The proportion of marijuana/cannabis drug reports among analyzed items increased from 21 to 27 percent of drug reports between 2009 and 2012. Preliminary NFLIS data for the first half of 2013 show marijuana/cannabis ranking highest among drug reports, and accounting for 33 percent of total drug reports. In 2013, 42 percent of public high school students in Boston reported using marijuana during their lifetime (an increase from 40 percent in 2011), and 26 percent reported using marijuana during the past 30 days (a decrease from 27 percent in 2011).
Data Sources: Hospital unintentional drug overdose data and unique individual drug dependence and abuse patient data for FYs 2002–2012 (October 1, 2001, through September 30, 2012) include inpatient, observation, and emergency room care of Boston City residents age 12 and older. Data were provided by the Massachusetts Center for Health Information and Assessment, 2013. State-funded substance abuse treatment admissions data for City of Boston residents age 12 and older for FYs 2001–2013 (July 1, 2000, through June 30, 2013) were provided by the Massachusetts Department of Public Health, Bureau of Substance Abuse Services. Drug arrest data within the city of Boston for 2009 through 2012 were provided by the Boston Police Department, Drug Control Unit and Office of Research and Evaluation. Forensic laboratory data for the Boston Metropolitan Statistical Area for 2009 through the first half of 2013 were provided by the Drug Enforcement Administration’s (DEA’s) NFLIS. An ongoing criminal investigation involving a State laboratory technician allegedly falsifying drug testing results between 2003 and 2012 likely impacted State drug laboratory report totals over time. Additionally, two of three State laboratories have not reported data since September 2012 and January 2013, respectively. As a result, laboratory report totals for the first half of 2013 are considered substantial undercounts. Public high school student drug use data were provided by the Youth Risk Behavior Survey (YRBS), Boston Public School Department, and the Centers for Disease Control and Prevention (CDC), 2013.
For inquiries concerning this report, please contact Daniel P. Dooley, Director, Analysis and Surveillance, Boston Public Health Commission, 1010 Massachusetts Avenue, Boston, MA 02118, Phone: 617-534-2360, Fax: 857-288-2212, E-mail: email@example.com.
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