Seattle, Washington

Drug Abuse Patterns and Trends in Seattle, Washington—Update: January 2014

Caleb Banta-Green, T. Ron Jackson, Cynthia Graff, Steve Freng, Robyn Smith, Michael Hanrahan, John Ohta, Mary Taylor, and Richard Harruff

Overview of Findings: The key finding in the Seattle area in this reporting period was the increase in heroin indicators, particularly among young adults, based on numbers of primary heroin treatment admissions, numbers and proportions of drug reports identified as heroin among drug items seized and analyzed by National Forensic Laboratory Information System (NFLIS) laboratories, and numbers of drug-caused deaths involving heroin in the first half of 2013. Overall, the 6 months of data reported for the first half of 2013 were inad­equate for trend analyses other than preliminary ones due to the short period of time and relatively small numbers. Of note, however, in addition to the continuing increases in heroin indicators, was an increase in drug-caused deaths involving methamphetamine and a slight decrease in mortality indicators for prescription opioids/opiates other than heroin in the first half of 2013, compared with the previous 4 years.

Updated Drug Abuse Trends and Emerging Patterns

Cocaine: Primary cocaine treatment admissions continued to slowly decline for most age groups in the first half of 2013, compared with previous reporting periods. For example, the proportion of primary cocaine admissions in the 30–44 age group declined from 11 percent of all admissions in that age group in 2011, to 10 percent in 2012, and to 8 percent in the first half of 2013. The proportion of primary cocaine treatment clients also declined from 18 percent of all treatment clients age 45–54 in 2011, to 17 percent in 2012, and to 16 percent in the first half of 2013. Reports identified as cocaine among drug items seized and analyzed by NFLIS laboratories decreased from 17.1 percent of total drug reports (n=217) in the first half of 2012 to 14.6 percent of the total (n=123) in the first half of 2013. Levamisole, a potentially dangerous adulterant, contin­ued to be detected in many reports identified as cocaine, according to a local area crime laboratory chemist. While drug-caused deaths attributed to cocaine were down from a peak of 54 such deaths in the first half of 2006, the number of drug-caused overdose deaths involving cocaine continued to be a concern. These deaths increased from 24 deaths in the first half of 2012 to 35 deaths in the first half of 2013.

Heroin was the most commonly identified drug in reports from drug items seized by law enforcement and analyzed by NFLIS laboratories in the first half of 2013, as it was in the first half of 2012, when it increased substantially from the previous reporting periods. Reports identified as heroin constituted 22.6 percent of all drug reports in the first half of 2013, compared with 17.9 percent in the first half of 2012. Overall, primary heroin treatment admissions in the Seattle area increased from 15.3 percent of total admissions in 2011, to 20.5 percent of admissions in 2012. Primary heroin admissions in the first half of 2013 represented 21.1 of all admissions. Of particular importance, according to the area representative, is that young adults age 18–29 were the fastest growing, and represented the largest, age group, in both primary treatment admissions and drug-caused death data in the current reporting period. Thirty percent of primary heroin treatment admissions in the first half of 2013 in the Seattle area were in the 18–29 age group; this represented an increase from 21 percent of primary heroin admissions in 2011 and 27 percent of admissions in 2012. In the first half of 2013, 21 percent of heroin primary treatment admissions were age 30-44 and 19 percent in the 45-54 age group. Drug-caused deaths involving heroin have increased, from 32 deaths in the first half of 2011, to 43 such deaths in the first half of 2012, and to 50 deaths in the first half of 2013. An analysis of mortality data from July 2005 through June 2013 showed a statistically significant (p<0.01) association between heroin-only drug-caused deaths and age—with the proportion of drug-caused deaths involving only heroin increasing as age among decedents decreased. For instance, among decedents age 16–20, the proportion of heroin-only drug-caused deaths was 55 percent, compared with 11 percent for decedents age 51–55. Concerns about increases in heroin use and morbidity and mortality are being voiced across Washington State, according to the area representative.

Prescription Opioids/Opiates Other Than Heroin:  Indicators for prescription opioids/opiates other than heroin have leveled off in this reporting period, although these drugs continued to be the most common drug type identified in drug-caused deaths. Proportions of primary treatment admissions for prescription-type opioids have stabilized. Admissions for these drugs were most common among clients age 18–44 in the first half of 2013. For the first time, from January to June 2013, drug-caused deaths involving oxycodone exceeded those involving methadone. This was the result of a decline in drug-caused deaths involving methadone (from n=28 deaths in the first half of 2012 to n=20 in the first half of 2013) and an increase in drug-caused deaths involving oxycodone (from n=20 deaths in the first half of 2012 to n=27 in the first half of 2013). Oxycodone continued to be the most common type of pharmaceutical opioid identified in drug reports among drug items analyzed by NFLIS laboratories. Oxycodone was identified in 5.7 percent of total drug reports (n=48) in the first half of 2013, compared with 3.5 percent of the total (n=45) in the first half of 2012.  

Benzodiazepines continued to be reported in indicators in combination with other drugs; benzodiazepines were almost always identified in combination with other substances in drug-caused deaths. Alprazolam and clonazepam were the most commonly identified benzodiazepines identified in drug reports among items seized and analyzed by NFLIS laboratories, with fairly consistent, relatively low, numbers since 2009.

Methamphetamine: Methamphetamine continued to be prevalent in indicators in the Seattle area in the first half of 2013, based on primary treatment admissions and mortality data. Law enforcement reported that most methamphetamine in the Seattle area came from Mexico and had high purity. Drug-caused deaths involving methamphetamine in the first half of 2013 totaled 21, up substantially compared with the first half of 2011, when there were 7 such deaths.

Marijuana/cannabis continued to be prevalent in drug indicators in the first half of 2013. Treatment admissions with marijuana as the primary drug of abuse continued at high levels for youth, with the proportion of treatment admissions declining as client age increased. Marijuana/cannabis reports among drug items analyzed by NFLIS laboratories reached a new low in the first half of 2013, with 61 reports (7.2 percent of the total), compared with 123 (9.7 percent of all drug reports) in the first half of 2012, and 927 reports (23.5 percent of all reports) in calendar year (CY) 2009.

Other drugs, including hallucinogens, other stimulants, synthetic cannabinoids (cannabimimetics such as “Spice” or “K2”), and synthetic (substituted) cathinones (e.g., “bath salts”) were documented at very low levels in law enforcement evidence (numbers of drug reports from drug items analyzed by NFLIS laboratories) and were not identified in drug-caused deaths in the first half of 2013.  According to NFLIS data, none of six different synthetic cannabinoids that were detected in either 2011 or 2012 were detected among primary, secondary, or tertiary drug reports in the first half of 2013. Methylone, a substituted cathinone, was identified in eight NFLIS reports in the first half of 2013 and may be in products sold as “ecstasy” or “Molly,” often in powder form. Reports for BZP (1-benzylpiperazine), which was sold in tablets as “ecstasy,” declined to 2 drug reports in the first half of 2013, compared with 13 reports in the first half of 2012 (and n=62 drug reports  in CY 2009). Between CY 2009 and the first half of 2013, drug reports for TFMPP (1,3-[trifluoromethylphenyl]piperazine) among items seized and analyzed by NFLIS laboratories declined from 27 drug reports to none, while reports for MDMA (3,4-methylenedioxymethamphetamine) declined from 81 to 9 drug reports. 

Data Sources: Fatal drug overdose data (drug-caused death data) were obtained from the King County Medical Examiner, Public Health—Seattle & King County, for the first halves (January–June) of 2012 and 2013. Data on drug reports from items seized and sub­mitted for analysis were obtained from NFLIS, Drug Enforcement Administration, for the first halves  of 2012 and 2013 and CY  2009; these include primary, secondary, and tertiary reports for each drug item analyzed. Drug testing results for law enforcement seizures in King County were reported by the county where the drug was seized. Observations of a chem­ist in the Seattle crime laboratory are included. Drug primary treatment admissions data were provided by Washington State Department of Social and Health Services, Division of Alcohol and Substance Abuse, Treatment Report and Generation Tool, from 1999 through June 2013. Treatment modalities included outpatient, intensive inpatient, recovery house, long-term residential, and opiate substitution admissions. Only publicly funded treatment admissions are included.