Cincinnati, Ohio

Drug Abuse Patterns and Trends in Cincinnati (Hamilton County)—Update: January 2014

Jan Scaglione, Pharm.D., M.T., D.ABAT

Overview of Findings: The continued increases in indicators of heroin levels and consequences represented the most important drug trend in the Cincinnati area in this reporting period. Heroin surpassed marijuana as the predominant drug problem in Cincinnati in the first half of 2013. Indicators for heroin continued at a high level, with increases in most indicators during the first half of 2013, compared with the previous year. Exposures to heroin called in to poison control centers decreased by 13.4 percent during calendar year (CY) 2013, compared with the previous year, but they were 134 percent higher than in 2011. The amount of heroin seized and removed from Cincinnati streets by the Regional Enforcement Narcotics Unit (RENU) increased by 191 percent in 2013 from the previous year. Indicators for marijuana/cannabis in the Cincinnati region were consistently reported at high levels during the first half of 2013, compared with CY 2012 in available data sources (proportions of both treatment admissions and of drug reports among seized drug items analyzed by National Forensic Laboratory Information System [NFLIS] laboratories). In the first half of 2013, marijuana as a primary drug of abuse accounted for 29.4 percent of all treatment admissions and represented 34.2 percent of drug reports among drug items submitted and analyzed by NFLIS laboratories for the Cincin­nati area. Cocaine indica­tors, which steadied to a moderate level in 2011, continued to level off or declined slightly during the first half of 2013, compared with CY 2012. Methamphetamine indicators tended to be low relative to other drugs in Cincinnati, but a 159-percent increase in the number of clandestine laboratory seizures was recorded during fiscal year (FY) 2013, compared with the previous year (representing a 254-percent increase over 2011 values). While much of the methamphetamine found in the Cincinnati region is locally produced, law enforcement sources reported increased numbers of seizures of crystal methamphetamine during 2013. Indicators for MDMA (3,4-methylenedioxymethamphetamine) were low in Cincinnati. Other chemicals sold as MDMA included BZP (N-benzylpiperazine) and BCP (benocyclidine), according to NFLIS drug reports for the first half of 2013. Nonmedical use/abuse of prescription drugs, particularly benzodiazepines and opioid narcotics, continued to be a prominent drug issue in Cincinnati, according to the area representative. Indicators for syn­thetic designer drugs, specifically cannabimimetics and substituted cathinones, were low but variable in the first half of 2013, relative to the previous year.

Updated Drug Abuse Trends and Emerging Patterns

Cocaine/crack cocaine as the primary drug problem reported upon admission to substance abuse treatment programs accounted for 6.5 percent of all admissions during the first half of 2013, compared with 8.0 percent of total admissions in CY 2012. The Cincinnati RENU seized a combined total of more than 17,150 grams of cocaine/crack cocaine during CY 2013, representing an increase of nearly 694 percent over the previous year. In the first half of 2013, 15.3 percent of drug reports among items seized and analyzed by NFLIS laboratories were identified as cocaine, compared with 19.2 percent of total drug reports in CY 2012. In 2013, the Drug Enforcement Administration (DEA)’s regional office’s laboratory analyses for drug impurities detected phenyltetrahydroimidizothiazole (levamisole) impurities in 92 percent of the analyzed cocaine/crack cocaine samples.

Heroin indicators continued to increase in the Cincinnati region in the first half of 2013, compared with CY 2012. Primary heroin treatment admissions were combined with  admissions for prescription opioids/opiates other than heroin, with the combination accounting for 32.9 percent of total admissions in the first half of 2013, compared with 25.8 percent in CY 2012. The number of human exposure cases involving heroin called in to poison control centers decreased by 13.4 percent during 2013 from the previous year, but they were 134 percent higher than such exposure cases recorded in 2011. RENU seized a total of more than 15,500 grams of heroin in CY 2013; this was an increase of more than 190 percent from 2012. In the first half of 2013, 28.9 percent of  total drug reports among drug items seized and analyzed by NFLIS laboratories in Hamilton County that were identified as heroin; in CY 2012, heroin reports constituted 31.5 percent of total NFLIS drug reports. Heroin purity levels ranged widely (7.5–92.1 percent) in samples purchased off the street and analyzed by the DEA regional office during 2013. The Hamilton County Coroner’s office recorded 93 deaths in the first half of 2013 in which heroin was found in the decedent; there were 124 such deaths in all of 2012.

Prescription opioids/opiates other than heroin (narcotics): Oxycodone and hydrocodone remained the most prevalent opioid products abused in Cincinnati, based on numbers of human exposure cases called in to poison control centers and on numbers and proportions of drug reports among items analyzed by NFLIS laboratories in the first half of 2013. In CY 2013, 270 human exposure cases in the area poison control center were reported for oxycodone, and 268 were reported for hydrocodone. This compares with 273 human exposure cases for oxycodone and 330 for hydrocodone in 2012. Both oxycodone and hydrocodone ranked among the top 10 drugs identified in drug reports from items seized by law enforcement that were analyzed by NFLIS laboratories in Hamilton County in CY 2012 and in the first half of 2013. Oxycodone ranked fourth among drug reports, representing 2.0 percent of total drug reports, in the first half of 2013, compared with 2.9 percent of the total in CY 2012. Hydrocodone ranked sixth among the top 10 drugs in the first half of 2013 and accounted for 1.1 percent of the total drug reports; in CY 2012, 1.2 percent of total drug reports among analyzed items were identified as hydrocodone.

Benzodiazepines: Alprazolam continued to be the most frequently abused benzodiazepine, based on focus group interviews with drug users, numbers of poison control center calls for CY 2013, and proportions of NFLIS drug reports identified as alprazolam among analyzed drug items in the first half of 2013. Human exposure cases involving alprazolam and clonazepam reported to poison control centers decreased by 10 percent in 2013 from the previous year (declining from n=320 cases in 2012 to n=288 in 2013 for alprazolam and from n=354 cases in 2012 to n=318 in 2013 for clonazepam). In the first half of 2013, 1.0 percent of total drug reports from law enforcement seizures analyzed by NFLIS laboratories were identified as alprazolam (it ranked seventh among the top 10 drug reports), a proportion stable from CY 2012. The percentage of clonazepam reports among analyzed drug items was also stable, with the drug identified in 0.5 percent of total drug reports in CY 2012 and 0.6 percent of the total in the first half of 2013.

Methamphetamine indicators in Cincinnati were low relative to other drugs, but the number of reported methamphetamine clandestine laboratory seizures increased by 159 percent during FY 2013, compared with the previous year. Law enforcement attributed the increased number of methamphetamine laboratory and chemical findings to the increased use of the one-pot method for methamphetamine manufacture. Law enforcement also reported increased amounts of crystal methamphetamine seizures in 2013 from the previous year. Methamphetamine ranked ninth among the top 10 drugs identified in drug reports from items seized and analyzed in NFLIS laboratories in Hamilton County in the first half of 2013. In this reporting period, 0.7 percent of drug reports were identified as methamphetamine, compared with 0.6 percent of total drug reports among analyzed drug items in CY 2012.

Marijuana/Cannabis: Primary marijuana treatment admissions accounted for 29.4 percent of total admissions during the first half of 2013; this proportion was stable from CY 2012. Marijuana/cannabis was the drug most often identified in drug reports among items submitted to NFLIS laboratories and ana­lyzed during the first half of 2013, accounting for 34.2 percent of all drug reports. This proportion was a decline from 38.1 percent of the total drug reports in CY 2012. Human exposure cases for marijuana called in to poison control centers increased in number, however, from 69 cases in 2012 to 76 in 2013.

MDMA indicators remained at a relatively low level in Cincinnati during 2013 from the previous year. In the first half of 2013, some of the drug items submitted to NFLIS laboratories for analysis as MDMA were found to actually contain BZP and BCP. This was the first time BCP has been seen in the Cincinnati region, and the drug ranked ninth among the top 10 drug reports for the first half of 2013, representing 0.8 percent of total drug reports among seized drug items analyzed by NFLIS laboratories in Hamilton County.

Emerging Patterns: Synthetic drugs, including cannabimimetics and substituted cathinones, remained at a low level in the indicators, but they showed variability across different data sources. Human exposure cases called in to poison control centers decreased by approximately 38 percent for both cannabimimetics and substituted cathinones in 2013 from the previous year. A total of 15 drug reports among items analyzed by NFLIS laboratories were identified as various substituted cathinones or cathinones in the first half of 2013 (compared with n=16 drug reports in CY 2012). A total of 134 drug reports among items submitted were identified as cannabimimetics in the first half of 2013 (compared with n=11 reports in CY 2012). RENU also made seizures of both classes of drugs during 2013, removing 1,000 grams of substituted cathinone products and 714 pounds of cannabimimetics (there are no RENU data for these drugs prior to 2013).

Data Sources: Medical examiner data were obtained by the Hamilton County Coroner’s Office for drug-related deaths for the first half of 2013, for comparison with death data from CYs 2009 to 2012. Data resulted from positive toxicology evidence of drug or alcohol use found in decedents. Cases were classified as accidental, suicide, or homicide. Drug or alcohol findings were not necessarily recorded as cause of death. Drug purity data were provided by the DEA, Cincinnati Resident Office, for CYs 2009–2013. Treatment admissions data were pro­vided by the Hamilton County Mental Health and Recovery Services Board for FY 2009, CYs 2010–2012, and the first half of CY 2013. Data were provided for publicly funded substance abuse treatment programs within Hamilton County only. Primary drug problem at admission was determined through billing data submitted by reporting agencies for FY 2009 and CY 2010–2011. Data were captured by group classification and not necessarily by specific drug type or route of administration. Primary drug at time of admission for CY 2012 and the first half of 2013 was captured in admissions reported to the Ohio Department of Alcohol and Drug Addiction Services (rather than through billing data as with earlier years). Exposure cases called in to poison control centers were provided by the Cincinnati Drug and Poison Information Center for CYs 2009–2013. Two call “types” are recorded—either drug information or actual human exposure to a product. Most exposures involved intentional abuse/misuse/suspected suicide, but all were captured in the data set. All exposure cases are for human cases only; animal cases were excluded, as were “confirmed” nonexposure cases. Drug seizure data were provided by the Cincinnati RENU for CYs 2009–2013. Forensic laboratory data were provided by NFLIS, DEA, for the first half of 2013. Drug purity data were provided by the DEA laboratory analysis center in Chicago for the Cincinnati region. Qualitative data came from focus group interviews conducted for the Ohio Substance Abuse Monitoring Project, funded by the Ohio Department of Alcohol and Drug Addiction Services for the last half of 2012. Methamphetamine clandestine laboratory data were provided by the Ohio Bureau of Criminal Investigation for FYs 2009–2013.