Denver and Colorado

Drug Abuse Patterns and Trends in Colorado and the Denver/Boulder Metropolitan Area—Update: January 2014

Bruce Mendelson, M.P.A.

Overview of Findings: The most important finding for this reporting period in the Denver/Colorado CEWG area was the upward trend in indicators for methamphetamine, heroin, and prescription opioids/opiates other than heroin. Although indicators showed some mixed trends, marijuana continued to be a major drug of abuse in Colorado and in the Denver/Boulder metropolitan area, based on treatment admissions data, hospital discharges, availability, and the National Survey for Drug Use and Health (NSDUH). However, percentages of marijuana drug seizures and testing declined both in Colorado and in the Denver/Boulder area, as legalization has been accompanied by reduced arrests and court cases. Among Colorado and Denver/Boulder area indicators, methamphetamine showed small increases in proportions of treatment admissions and drug-related deaths and hospital discharge rates. Colorado and Denver/Boulder area cocaine indicators reflected downward trends, including treatment admissions, drug-related mortality, and hospital discharges. However, cocaine continued to rank first among National Forensic Labora­tory Information System (NFLIS) drug reports in Denver in the first half of 2013. Heroin indicators increased, based on treat­ment admissions data, availability, and drug-related mortality. Statewide and in the Denver/Boulder area, prescription opioids/opiates other than heroin represented a smaller but increasing percentage of treatment admissions relative to other drugs. Indicators for prescription opioids/opiates other than heroin also showed upward trends in indicators, including hospital discharges and drug-related mortality. Beyond illicit drugs, alcohol remained Colorado's most frequently abused substance and accounted for the most treatment admissions, poison control center calls, drug-related hospital discharges, and highest drug-related mortality in this reporting period.

Updated Drug Abuse Trends and Emerging Patterns

Cocaine: Primary cocaine treatment admissions in Colorado continued to gradually decline statewide and represented a new low of 5.5 percent of total admissions (including alcohol) in the first half of 2013. This is a decline from the first half of 2012, when cocaine admissions represented 7.3 percent of total admissions. Denver area primary cocaine admissions decreased from 14 percent of total admissions in the first half of 2008, to 10 percent in the first half of 2010, to 9.4 percent (including alcohol) in the first half of 2012, and to 7.1 percent in the first half of 2013. Cocaine ranked third (behind mari­juana and prescription opioids/opiates other than heroin) in 2012 in Denver substance abuse-related hospital discharges, exclud­ing alcohol (n=1,179; rate per 100,000 population=188). Both the number and rate of hospital discharges decreased somewhat from 2011 (n=1,338; rate per 100,000 population=216). Cocaine was the second most common drug behind alcohol in Denver alcohol and drug-related deaths reportable to the Denver Office of the Medical Examiner (DOME) in 2011 (n=55, or 28.9 percent of total alcohol and drug-related reportable deaths). In 2012, however, cocaine declined to the fourth most common cause of death among total alcohol and drug-related deaths (n=25, or 17 percent). Overall, from 2004 through 2012, the cocaine death rate in Denver declined from 9.5 deaths per 100,000 population to 4.0 per 100,000. Cocaine was the most commonly reported drug among items seized and submitted for testing by law enforcement in calendar year (CY) 2011, CY 2012, and in the first half of 2013 in Arapahoe, Denver, and Jefferson Counties, based on NFLIS data. However, statewide in Colorado, cocaine was the second most common drug reported among items seized and submitted for testing by law enforcement in CY 2011 (marijuana was first), in CY 2012 (marijuana was first), and in the first half of 2013 (methamphetamine was first). The Drug Enforcement Administration (DEA), Denver Field Division, indicated that the once stable supply, price, and purity levels of cocaine in 2011 shifted to a sporadic supply, with higher prices and lower quality in 2012 and 2013. Much of Colorado’s cocaine is still cut with levamisole.

Heroin: In the first half of 2013, heroin ranked fourth in statewide treatment admissions (the same as in the first half of 2012) and increased to 9.1 percent of total admissions (including alcohol) from 7.6 percent in the first half of 2012. Denver area primary heroin treatment admissions also increased, from 10.9 percent of the total (including alcohol) in the first half of 2012 to 12.7 percent in the first half of 2013. This increase resulted in a change in rank for heroin from fourth in the first half of 2012 (behind alcohol, marijuana, and methamphetamine) to third in the first half of 2013 (behind alcohol and marijuana but ahead of methamphetamine). There has been a growing concern about an increase in new heroin users, including young adults who have switched from abusing prescription opioids to heroin due to availability and cost. Her­oin increased from being present in 4.0 percent of alcohol and drug-related deaths reportable to the DOME (n=6) in 2004 to 27.9 percent (n=41) in 2012 (some of this is due to better detection of heroin by the DOME). Overall, the reportable heroin death rate in Denver increased from 1.1 per 100,000 population in 2004 to 6.5 per 100,000 in 2012. Heroin lagged behind cocaine, marijuana/cannabis, and methamphetamine in drug reports among items seized and submitted for testing by law enforcement in CY 2011 and in CY 2012 in Denver, Arapahoe, and Jefferson Counties, based on NFLIS data. However, in the first half of 2013 in these same counties, heroin rose to third behind cocaine and methamphetamine, surpassing marijuana. The DEA reported that both Mexican black tar and Mexican brown powder were encountered in the Denver Field Division. The Denver DEA reported that heroin availability was moderate and stable in Denver in this reporting period.

Prescription opioids/opiates other than heroin (i.e., narcotic analgesics) ranked sixth in statewide treatment admissions (including alcohol) in the first half of 2012 (behind alcohol, marijuana, methamphetamine, heroin, and cocaine), but they increased to fifth in the first half of 2013 (surpassing cocaine). Among greater Denver treatment admissions (including alcohol), prescription opioids/opiates other than heroin ranked sixth in the first halves of both 2012 and 2013. Statewide, primary admissions for prescription opioids/opiates other than heroin rose from 2.6 to 7.3 percent of total treatment admissions from 2004 through the first half of 2013. Similarly, in the Denver area, the percentage of primary prescription opioids/opiates other than heroin admissions increased from 3.3 to 6.4 percent of total admissions from 2004 through the first half of 2013. Prescription opioids/opiates other than heroin ranked second in Denver substance abuse-related hospital discharges in 2011, excluding alcohol (n=1,516; rate per 100,000 population=244); both the number and rate of discharges increased in 2012 (n=1,654; rate per 100,000=263). Prescription opioids/opiates other than heroin were the most common type of drug in Denver alcohol and drug mortality reportable to the DOME in 2012 (representing 48.3 percent of reportable deaths). Overall, the mortality rate for prescription opioids/opiates other than heroin in Denver rose from 5.4 to 11.3 per 100,000 population between 2003 and 2012. Oxycodone (1.9 percent of total drug reports identi­fied) and hydrocodone (0.9 percent) were among the top 10 drug reports among drug items seized and analyzed in NFLIS laboratories in the first half of 2013 in Arapahoe, Denver, and Jefferson Counties (approximately the same as in calendar year 2012). Throughout 2013, local law enforcement continued to see well-organized and sophisticated opioid trafficking and reported very high levels of illegally diverted controlled prescription drugs in the region. Combined 2010 and 2011 NSDUH data indicated that the rate of past-year nonmedical use of prescription pain relievers among people age 12 or older in Colorado was in the top quintile and ranked second in the country at 6.0 percent; this was higher than the national average of 4.6 percent.

Benzodiazepines and other sedative hypnotics (including the categories of "benzos," barbiturates, clonazepam, other seda­tives, and tranquilizers) represented less than 1.0 percent of Denver metropolitan and State treatment admissions in both the first halves of 2012 and 2013. However, benzodiazepines increased sharply both in the number and proportion of alcohol and drug-related deaths in Denver reportable to the DOME. There were only 15 benzodiazepine-related deaths, representing 10.8 percent of total reportable alcohol and drug-related deaths in Denver (almost always in combination with other drugs) in 2003; these grew to 68 in number (33 percent of reportable deaths) by 2009. That number declined to 29 such deaths in 2010, increased to 47 in 2011, and declined to 32 in 2012. Overall, the rate of benzodiazepine deaths in Denver rose from 2.7 per 100,000 in 2003 to 5.1 per 100,000 in 2012. In addition, alprazolam (1.0 percent of total drug reports identi­fied) and clonazepam (0.7 percent of total reports) were among the top 10 drugs reported among drug items seized and analyzed in NFLIS laboratories in the first half of 2013 in Arapahoe, Denver, and Jefferson Counties (about the same as in all of 2012).  

Methamphetamine has accounted for the third highest proportion of treatment admissions statewide (including alcohol) over the past several years. Proportions of primary methamphetamine treatment admissions peaked during the second half of 2005 and gradually decreased through 2008. They remained fairly stable (between 14 and 16 percent) from 2008 through 2012. In the first half of 2013, methamphetamine admissions represented 16.7 percent of all statewide treatment admissions (an increase from 14.3 percent of total statewide admissions in the first half of 2012). In the greater Denver area, methamphetamine reached a high of 15 percent of total admissions (including alcohol) in the first half of 2007, but the proportion of such admissions declined to 12 percent by the first half of 2013; this was slightly higher than the proportion in 2012 (11.3 percent). Methamphetamine could not be identified separately, but rather it was included in the stimulants category in Colorado drug-related hospital discharge data. In 2012, stimulants ranked fourth (behind marijuana, prescription opioids/opiates other than heroin, and cocaine) in Denver drug-related hospital discharges, excluding alcohol (n=599; rate per 100,000 population=95); both the number and rate of discharges increased somewhat from 2011 (n=466; rate per 100,000=75). Methamphetamine-related deaths reportable to the DOME increased overall from 2004 (n=7, 4.6 percent of total reportable deaths) to 2012 (n=12, 8.2 percent of reportable deaths). In 2011, there were 20 methamphetamine-related deaths (representing 10.5 percent of reportable deaths), which was the highest number in the 2004–2012 time period. Methamphetamine was the second most common drug (after cocaine) among drug reports from items seized and analyzed by forensic laboratories in the first half of 2013 in Arapahoe, Denver, and Jefferson Counties, based on NFLIS data. This is in contrast to CY 2011 and CY 2012, when methamphetamine ranked third (after cocaine and marijuana) among drug reports from items analyzed in NFLIS laboratories. DEA and local law enforcement reported that methamphetamine was readily available, with very high purity levels consistently over 90 percent. The DEA Denver Field Division continues to rank methamphetamine as its top drug threat.

Marijuana/cannabis continued to be the primary drug of abuse statewide and in the greater Denver area, excluding alcohol. During the first half of 2013, primary admissions for marijuana represented 18.8 percent of total drug treatment admissions in Colorado and 18.1 percent of treatment admissions in the Denver area (including alcohol). However, both of these proportions are small declines from the first half of 2012, when marijuana accounted for 19.2 and 19.8 percent of treatment admissions for Colorado and the Denver metropolitan area, respectively. Marijuana ranked first in Denver drug-related hospital discharges in 2012, excluding alcohol (n=1,774; rate per 100,000 population=282); both the number and rate of such discharges increased from 2011 (n=1,698; rate per 100,000=274). Marijuana/cannabis was the fourth most common drug reported among drug items seized and analyzed in forensic laboratories in the first half of 2013 in Arapahoe, Denver, and Jefferson Counties, based on NFLIS data. This is a substantial decline from CY 2012, however, when marijuana/cannabis was second among the most commonly reported drugs based on NFLIS data in Arapahoe, Denver, and Jefferson Counties. Combined 2010 and 2011 NSDUH data indicated that Colorado ranked in the top quintile for the following: marijuana use in the past year among people age 12 or older, youth age 12–17, people age 18–25, and people age 26 or older; marijuana use in the past month among people age 12 or older, youth age 12–17, people age 18–25, and people age 26 and older; and first use of marijuana among people age 12 or older, youth age 12–17, and people age 18–25. Colorado was among five States with the lowest proportions of individuals who perceived smoking marijuana once a month as a great risk; this is observed for respondents in all age groups, including people age 12 or older, youth age 12–17, people age 18–25, and people age 26 and older. The supply and demand for marijuana continued to be very high. High potency marijuana has been increasingly grown under the guise of medical marijuana. The DEA reported that there was a significant amount of high-grade indoor grown marijuana being trafficked out of State. There also were several large-scale outdoor mari­juana grow operations seized in Colorado national forests, as Mexican drug trafficking organizations continued to cultivate marijuana in remote areas of Colorado. Denver area substance use treatment providers have reported an overall climate in which marijuana is much more accessible and less stigmatized. The large influx of medical marijuana care centers may be contributing to the quality, high availability, and increased use of marijuana. The implications of medical marijuana and its impact on substance use disorder treatment will need continued monitoring. Colorado also recently passed Amendment 64, which legalized the possession of less than 1 ounce of marijuana for people older than 21. Medical marijuana centers in Colorado began selling recreational marijuana on January 1, 2014. Marijuana is still illegal under Federal law.

MDMA (3,4-methylenedioxymethamphetamine) accounted for 0.4 percent of total State treatment admissions (including alcohol) in the first half of 2012 (n=76 admissions) and 0.5 percent in the first half of 2013 (n=76 admissions). The purity of MDMA seizures has declined over recent years, to approximately 50 percent pure. MDMA was not among the top 10 NFLIS drug reports; however, there were 47 MDMA drug reports among drug items analyzed in NFLIS laboratories in CY 2012 in Arapahoe and Denver Counties; there were 30 MDMA drug reports in the first half of 2013 (placing it just out of the top 10 in 11th place). The DEA Denver Field Division reported that most MDMA came from California, the Pacific Northwest, or Canada. “Molly,” a powder form of MDMA, was found to be increasingly available.

Other Drugs: BZP (1-benzylpiperazine) was not identified by any of the most common drug indica­tors, but it has typically been combined with MDMA and TFMPP (1-[3-(trifluoromethylphenyl]piperazine). BZP was made a Schedule I controlled substance in Colorado as of July 1, 2009, which may explain the decrease in reports of BZP by the Denver Crime Laboratory (DCL). Synthetic cannabinoids (cannabimimetics) marketed as “Spice,” “K2,” and “Black Mamba” and synthetic (substituted) cathinones (“bath salts,” often labeled as “Cloud Nine,” “Vanilla Sky,” and “White Dove”) have been a recent growing concern. However, there are few indicators that have the ability to isolate and capture the data, making it difficult to determine actual usage levels. Numbers of syn­thetic cannabinoid human exposure poison control center calls remained stable from 2010 to 2011, according to the Rocky Mountain Poison and Drug Center (RMPDC) data. Additionally, there were 44 calls to the RMPDC related to synthetic (substituted) cathinones in 2011. The DCL reported an increase in synthetic (substituted) cathinones mixed with other drugs (e.g., MDMA, Foxy methoxy [5-methoxy-N,N-diisopropyltryptamine or 5-MeO-DIPT], or heroin). These are the most recent data available. Synthetic cannabinoids (cannabimimetics) were recently scheduled in Colorado, which may limit future availability and use.

HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) Update: Cumulative AIDS data through Sep­tember 2013 indicated that cases related to injection drug use remained stable.

Data Sources: Treatment data were provided by the Colorado Department of Human Services, Office of Behavioral Health (OBH). Drug/Alcohol Coordinated Data System (DACODS) data from client admissions to all OBH-licensed treatment providers as of November 28, 2013, from January 2008 to June 2013, were included in the data set. Forensic laboratory data were provided by NFLIS, DEA, for the first half of CY 2013 (January–June) for Denver, Jefferson, and Arapahoe Counties; however, due to staffing issues, the Jefferson County Laboratory had no data for January–June 2012. While NFLIS data are described, they cannot be compared with data prior to 2011, as a new methodology renders them not comparable. Hospital discharge data were obtained from the Colorado Hospital Association for the city and county of Denver. These data represent CY 2012. Mortality data were obtained from the DOME and represent CY 2012. Poi­son and drug control center call data were obtained from the RMPDC. NSDUH data were obtained from the Center for Behavioral Health Statistics and Quality, 2012, Results from the 2011 National Survey on Drug Use and Health: Summary of national findings (NSDUH Series H-44, HHS Publication No. SMA 12-4713, Rockville, MD: Substance Abuse and Mental Health Services Administration). Intelligence and qualitative data were obtained from members of the Denver Epidemiology Work Group (DEWG), including law enforce­ment, treatment, research, public health, and street outreach agencies, as well as from the Proceedings of the DEWG. Intelligence data, information on drug seizure quantities, drug price data, and purity data were obtained from the U.S. Department of Justice, DEA Denver Field Division, Rocky Mountain High Intensity Drug Trafficking Area (HIDTA), Office of National Drug Control Policy, Drug Market Analysis 2011. HIV/AIDS data were obtained from the Colorado Department of Public Health and Environment (Human Immunodeficiency Virus/Sexually Transmitted Dis­eases [HIV/STD] Surveillance Program, Disease Control and Environmental Epidemiology).