Drug Abuse Patterns and Trends in the San Francisco Bay Area, California: June 2013

Alice A. Gleghorn, Ph.D.

Summary of Key Findings for the 2012 Reporting Period:

  • There was an earlier and continuing decline in heroin-involved ED reports and heroin purity levels, which had declined from 5.7 percent in 2010 to 3.9 percent in 2012.
  • However, the proportion of primary heroin treatment admissions was stable from 2011 to 2012, while the sharp increase in nonfatal overdose episodes in spring 2012 suggested a possible trend change.
  • There was an increase in indicators for prescription drugs.

Drug Seizures

Methamphetamine ranked first and marijuana ranked second among items seized and analyzed by NFLIS, followed by cocaine (third), heroin (fourth), and MDMA (3,4-methylenedioxymethamphetamine) (ninth). .Various opiate, sedative hypnotic, and stimulant pharmaceuticals were frequently prescribed throughout the five Bay Area counties, and they appeared with increasing frequency in reports of drugs seized and analyzed by the Drug Enforcement Agency, National Forensic Laboratory Information System (NFLIS). When these drugs were combined, they accounted for 10.6 percent of the identified samples.

Emergency Department visits

With the exception of methadone, many of these same pharmaceutical drugs individually showed significant long- and shorter-term increases in nonfatal emergency department (ED) visits, as reported by the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network (DAWN), in 2011 as compared with 2004, 2009, or 2010 (methadone -related visits decreased by 17 percent from 2009 to 2011). Alcohol, cocaine, heroin, methamphetamine, gamma hydroxybutyrate (GHB), and lysergic acid diethylamide (LSD) also showed similar ED visit decreases during the same time comparisons.  However, marijuana rates rose 146 percent from 2004 to 2011, slowing to a 40-percent increase between 2009 and 2011.

Treatment Admissions

Alcohol continued to dominate treatment admissions, ranking as the most frequent primary drug in bay area treatment admissions, particularly among males older than 35. Methamphetamine ranked second as the primary drug at admission, followed in order by heroin, cocaine, marijuana, and prescription drugs. Smoking was the primary route of administration for methamphetamine, cocaine, and marijuana, while injection was used mainly with heroin and methamphetamine. Prescription drugs were chiefly administered orally, while infrequently heroin, methamphetamine, and cocaine were inhaled.

Overdose Deaths

Opiate-related deaths reported by the DAWN Medical Examiner report decreased from 2009 (n=133) to 2010 (n=120), but opiates ranked first among drug-related deaths, followed by cocaine, alcohol, stimulants, and benzodiazepines. Field reports found “bath salts” (substituted cathinones) and cocaine present in drug-involved deaths.

Additional Findings

Heroin price and purity continued to decline, reaching $1.40 per milligram pure, with purity only at 3.9 percent. AIDS (acquired immunodeficiency syndrome) incidence and mortality have dropped to baseline levels, with approximately 18 percent of cases including injection drug use as a transmission factor. Laboratory analysis of a drug sold as “gunpowder heroin” indicated the primary contents as heroin, lidocaine, codeine, and morphine.

For inquiries regarding this report, contact Alice Gleghorn, Ph.D., County Alcohol and Drug Administrator, Community Behavioral Health Services, San Francisco Department of Public Health, 1380 Howard Street, Room 423, San Francisco, CA 92103, Phone: 415–255–3722, Fax: 415–255–3529, E-mail: Alice.Gleghorn@SFDPH.org.