Drug Abuse Patterns and Trends in Maine—Update: January 2014

Marcella H. Sorg, Ph.D., R.N., D-ABFA

Overview of Findings: This report updates Maine drug abuse indicators for the 2013 reporting period (some indicators cover the full calendar year, and others cover the half-year from January through June). The increase in heroin and other illicit drugs in drug indicators is the key finding for this 2013 reporting period in the State of Maine. During the last decade, problems with illicit drugs were dwarfed by Maine’s problem with pharmaceutical misuse, usually in combination with other pharmaceuticals. This predominance of the nonmedical use of pharmaceuticals in drug indicators began to level off in 2011–2012. In 2012, all heroin indicators increased, and they continued to increase during 2013. However, the nonmedical use/abuse of pharmaceuticals continued to rank first in indicator volume among deaths, arrests, impaired driver urinalysis toxicology, and treatment admissions. Numbers of crack/cocaine arrests and the proportion of primary cocaine treatment admissions increased in this reporting period, as did numbers of methamphetamine clandestine laboratory incidents. Problems that emerged in 2011 related to synthetic (sub­stituted) cathinones marketed as “bath salts” have declined somewhat in 2012 and 2013 based on numbers of drug reports among items seized statewide by law enforcement and analyzed in Maine’s forensic laboratory.

Updated Drug Abuse Trends and Emerging Patterns

Cocaine levels were low and trends were mixed in 2013 in Maine, with increases in the number of crack arrests and proportions of primary cocaine treatment admissions. Deaths in 2012 with cocaine mentioned on the death certificate con­stituted 8 percent of all drug-related deaths in Maine; this proportion has been relatively stable since 2008. The proportion of cocaine arrests among all drug arrests decreased substantially from 46 percent of total arrests in 2007 to 16 percent in 2012. However, the proportion rose during 2013 to 19 percent of the total, with most of that increase due to arrests for crack cocaine. Although cocaine previously represented the largest single category of drug reports among items analyzed in Maine’s forensic laboratory, the proportion of  cocaine reports in Maine declined from 29 percent of all drug reports in 2011, to 23 percent in the 2013. Cocaine represented the same proportion of drug reports as heroin among analyzed items in 2013. Primary cocaine treatment admissions constituted 4 percent of total admissions in the first half of 2013; this was an increase from 3 percent in the previous year. The proportion of clients who reported smoking as a main route of cocaine administration increased from 28 percent of primary cocaine treatment admissions in 2010 to 55 percent in the first half of 2013. A corresponding decline was observed in cocaine injection, from 30 percent injecting in 2010 to 17 percent in the first half of 2013. During 2009, cocaine was present in 7 percent of impaired driver urinalyses among all drugs tested; this proportion gradually increased to 12 percent in 2012, but it dropped to 9 percent in 2013.

Heroin has re-emerged in drug indicators as a serious problem in the State of Maine, according to the area representative, with all indicators showing increases in both 2012 and 2013. Numbers of heroin/morphine drug-induced deaths declined to 4 percent of all drug-induced deaths in the State in early 2010, but they increased to 17 percent in 2012. The toxicological indicator of heroin presence, 6-monoacetyl-morphine (6-MAM), was analyzed in drug-related deaths from January 2011 through November 2013. In 2011, there were no cases with 6-MAM in the toxicology, but there were 8 in 2012 and 13 in 2013. The number of arrests for heroin, which had been stable for several years, rose from 40 arrests in 2010 (5 percent of all drug arrests), to 63 in 2012 (11 percent), and to 103 (17 percent) in 2013. Heroin reports as a percentage of drug items seized by law enforcement and identified by the Maine forensic laboratory increased substantially, from 9 percent in 2012 to 23 percent in 2013. Similarly, heroin/morphine was found to be present in 11 percent of impaired driver urinalyses in 2012, increasing to 15 percent in 2013. Primary heroin/morphine treatment admissions constituted 8 percent of all admissions in 2011, 11 percent in 2012, and 15 percent in the first half of 2013. Similar to results reported last year, clients admitted to substance abuse treatment in the first half of 2012 whose problem with heroin began within the 24 months prior to admission were more likely to be female than those whose problem started more than 24 months prior to admission (67 percent female versus 44 percent male, respectively). Primary heroin treatment clients (45 percent) whose problem began within 24 months prior to admission were also more likely to be younger (between the ages of 18 and 25) than clients whose problem began more than 24 months prior to admission (28 percent).

Prescription opioids/opiates other than heroin continued to lead other drugs in magnitude in indicators in Maine, but the trend lines have stopped increasing. The number of pharmaceutical opioid-induced deaths declined slightly to 101 deaths in 2012, compared with 105 in 2011. Specific opioid drugs showed variable patterns, however, with methadone-induced deaths decreasing from 42 deaths in 2011 to 32 in 2012 and oxycodone-induced deaths increasing from 36 deaths in 2011 to 45 in 2012. The number of impaired drivers with one or more opioids detected in their urinalysis screens has remained stable since 2009 at 59 percent, with a slight increase to 60 percent in 2012 and a slight decrease to 58 percent in 2013. Arrests for pharmaceutical narcotics have similarly been relatively stable, with 222 such arrests (40 percent of all drug arrests) in 2012 and 226 arrests (37 percent of total arrests) in 2013. For the first time in more than a decade of increasing proportions, primary treatment admissions for prescription opioids/opiates other than heroin decreased, from 37 percent of total admissions in 2012 to 27 percent in the first half of 2013. Pharmacy robberies (robberies specifically demanding opioids) doubled statewide in 2012 (n=56), but they then dropped by one-half in 2013. Oxycodone, buprenorphine, and hydrocodone were among the top 10 drugs identified in drug reports among drug items seized by law enforcement and analyzed by the Maine forensic laboratory in 2013, continuing the trend of previous years.

Benzodiazepines continued to play a substantial role in Maine drug problems, usually as co-intox­icants with prescription opioids/opiates other than heroin (narcotics). They were present in combination with one or more narcotics in 40 percent of all 2013 impaired driver urinalyses, dropping from 60 percent in 2012. However, benzodiazepine-induced deaths, also frequently found as narcotic co-intoxicants, decreased from a peak of 34 percent of all drug-induced deaths in 2010 to 20 percent in 2012, with no 2013 data available for this update.

Methamphetamine indicators were mixed but mostly increasing, although numbers remained relatively small. Manufacturing using the one-pot method was on the rise in Maine. Arrests for methamphetamine totaled 32 (6 percent of all drug arrests) in 2012 and numbered 51 (8 percent) in 2013. Three percent of drug reports (n=42 reports) among drug items seized and analyzed in the Maine forensic laboratory were identified as methamphetamine in 2013; this proportion represented an increase from 2012, when methamphetamine reports represented just over 2 percent (n=36 reports) of total analyzed drug reports. Numbers of clandestine laboratory incidents increased from 5 to 12 between 2011 and 2012, and increased again in 2013 to 20 incidents. The vast majority of these were in Aroostook County, a very rural area. Maine’s pharmacy industry now monitors purchase of pseudoephedrine in real time, but local methamphetamine manufacturers still mobilize multiple buyers to purchase what they need. Primary methamphetamine treatment admissions numbered 17 in the first half of 2013; this represented a slight decline from 46 admissions in CY 2012.

Marijuana/Cannabis indicators were mixed in this reporting period, partly due to Maine’s medical marijuana law and a recent vote to legalize small amounts of the drug for personal use in Maine’s largest city, Portland. In 2013, 51 percent of Maine’s impaired drivers had a positive urinalysis toxicology screen for marijuana; this was an increase from 36 percent of the total in 2012. Marijuana drug arrests declined from 17 percent of all drug arrests in 2012 to 5 percent in 2013. The decline is attributed largely to limited resources and their allocation in the face of the increase in heroin trafficking. Marijuana/cannabis reports among drug items seized and identified by the Maine forensic laboratory declined from 11 percent of total drug reports in 2011, to 7 percent in 2012, and to 4 percent in 2013. Proportions of primary marijuana treatment admissions reached a plateau of 9 percent of total admissions from 2009 through 2012. During the first half of 2013, the proportion of primary marijuana admissions dropped slightly to 8 percent of all admissions.

Emerging issues include continued problems with a large variety of synthetic (substituted) cathinones, as indicated by the substances found in drug reports among drug items seized by law enforcement and analyzed by the Maine forensic laboratory in 2013. Alpha-PVP (alpha-pyrrolidinophentiophenone) was included for the first time in the top 10 list of drug reports in 2013 (ranking 5th, with 4.3 percent of total reports), but MDPV (3,4-methylenedioxypyrovalerone) was no longer in the top 10 list of drugs (MDPV had ranked 10th, with 2.2 percent of reports, in 2012). Among impaired drivers tested, 6 percent of urinalyses tested positive for alpha-PVP and MDPV in 2012; this proportion declined to 2 percent in 2013. In 2012, two deaths were caused by alpha-PVP. Fifty-three (9 percent) Maine drug arrests were for substituted cathinones in 2013; this represented an increase from 6 percent of drug arrests in 2012. In 2013, the Maine forensic laboratory identified 80 drug reports for cathinones, 9 reports for synthetic cannabinoids (cannabimimetics), 24 reports for 2C phenethylamines, 4 reports for piperazines, and 4 reports for tryptamines among analyzed drug items.  

Data Sources: Data sources updated in this report for the 2013 reporting period include the following sources. Primary treatment admissions data for the first half of 2013 (January–June) were provided by the Maine State Office of Substance Abuse, including all admissions for any programs that receive State funding. These totals include admissions for shelter and detoxification, as well as opiate replacement therapy. Beginning with 2010 data analysis, alcohol has been included in the denominator, and percentages were retrospectively recalculated back to 2000. Forensic laboratory data through 2013 were provided by the Maine State Health and Environmental Testing Laboratory, which tests drug items seized statewide and reports these results to NFLIS.  Note that numbers and proportions of NFLIS drug reports in this update brief are for CY 2013, while NFLIS data reported in cross-area tables and figures in the January 2014 Highlights and Executive Summary Report are for the first half of 2013 only. Roundng differences and those related to the time of drawdown for NFLIS surveillance or real-time data may result in small differences in CY 2012 data as reported here and in the relevant CEWG  report for June 2013. The Maine Health and Environmental Testing Laboratory also provided urinalysis data for impaired drivers through 2013; these were compared with data since 2006. Arrest data for 2013 were provided by the Maine Drug Enforcement Agency, which directs eight multijurisdictional task forces covering the State, generating approximately 60 percent of all Uniform Crime Report drug-related offenses statewide. Data for 2013 were compared with previous years since 2003. The statewide total for pharmacy robberies for 2008–2013 was provided by the Maine Department of Public Safety. Mortality data for 2012, including toxicology test data through November 2013, were provided by the Office of Chief Medical Examiner; annualized comparisons were done from 1997 onward. That office investigates all suspected overdose cases statewide, including complete forensic testing (screening and quantification) for a broad panel of abused and therapeutic drugs. Pharmacy robbery data through 2013 were provided by the Maine Department of Public Safety Public Information Service.

For inquiries concerning this report, please contact Marcella H. Sorg, Ph.D., R.N., D-ABFA, Research Associ­ate Professor and Director, Rural Drug & Alcohol Research Program, Margaret Chase Smith Policy Center, University of Maine, Building 4, 5784 York Complex, Orono, ME 04469, Phone: 207–581–2596, Fax: 207–581–1266, E-mail: Marcella.Sorg@umit.maine.edu.