Minneapolis and St. Paul, Minnesota

Drug Abuse Trends in Minneapolis and St. Paul, Minnesota: January 2014 Update

Carol Falkowski

Overview of Findings: The most important findings during this reporting period in the Minneapolis/St. Paul area were the continuing increase in heroin indicators of consequences, based on primary treatment admissions, deaths, and National Forensic Laboratory Information System (NFLIS) data, and the increase in methamphetamine indicators (primary treatment admissions and NFLIS data). The number of deaths from accidental opiate overdose increased markedly in Hennepin County in 2013; there were 69  such deaths in the first half of 2013, compared with 84 in calendar year (CY) 2012. Primary heroin treatment admissions accounted for a record-high 13.6 percent of all treatment admissions in the first half of  2013, compared with 12.9 percent of total admissions in 2012. Primary admissions for prescription opioids/opiates other than heroin (mostly prescription painkillers) accounted for 10.1 percent of all treatment admissions in the first half of 2013, compared with 9.0 percent in 2012. Together, 23.7 percent of all treatment admissions in the first half of 2013 were for heroin and prescription opioids/opiates other than heroin, second only to admissions for alcohol (44.2 percent). Numbers of heroin-involved hospital emergency department (ED) visits nearly tripled from 2004 to 2011, and narcotic analgesic-involved ED visits more than doubled. Proportions of primary methamphetamine treatment admissions and drug reports identified as methamphetamine from drug items seized by law enforcement and analyzed in NFLIS laboratories increased in the first half of 2013, compared with CY 2012. In June 2013, in Ramsey County, there was an accidental death of a 30-year-old male from probable 25I-NBOMe (2C-I-NBOMe) toxicity, a synthetic hallucinogen that is a derivative of the phenethylamine 2C-I. LSD (lysergic acid diethylamide) exposures reported to the Hennepin Regional Poison Center tripled from 2012 to 2013 (from n=15 to n=45), while exposures for substituted cathinones ("bath salts") and cannabimimetics (known as synthetic cannabinoids or synthetic THC [tetrahydrocannabinol]) declined during the 2-year period.

Updated Drug Abuse Trends and Emerging Patterns

Cocaine: Primary cocaine treatment admissions fell in the first half of 2013, accounting for 4.1 percent of total admissions, compared with 5.2 percent of the total in both 2012 and 2011. In Hennepin County, there were 16 cocaine-related deaths in the first half of 2013, compared with 18 in CY 2012. There were four cocaine-related deaths in Ramsey County in the first half of 2013, compared with three in 2012. Proportions of cocaine-involved visits at Minneapolis/St. Paul (Twin Cities) hospital EDs declined by 36.7 percent from 2006 to 2011. Cocaine was noted as a primary, secondary, or tertiary drug in 20.6 percent of the total drug reports from law enforcement drug item seizures that were analyzed by NFLIS laboratories in the first half of 2013 in the Twin Cities, compared with 17.9 percent in CY 2012.

Heroin and Prescription Opioids/Opiates Other Than Heroin: Heroin and other opiate addiction indicators steadily increased in the Twin Cities over the past decade, and in 2013, these substances remained issues of growing magnitude and consequence. Primary heroin treatment admissions accounted for a record-high 13.6 percent of all admissions in the first half of 2013, compared with 12.9 percent of total admissions in 2012 and 10.7 percent in 2011. Admissions related to prescription opioids/opiates other than heroin (mostly prescription painkillers) accounted for 10.1 percent of all admissions in the first half of 2013, compared with 9.0 percent of the total in 2012 and 9.5 percent in 2011. Together, primary treatment admissions for heroin and prescription opioids/opiates other than heroin constituted 23.7 percent of all treatment admissions in the first half of 2013 (compared with a combined proportion of 21.5 percent in the first half of 2012); this proportion was second only to primary treatment admissions for alcohol (44.2 percent of all admissions). In Hennepin County, there were 69 opiate-related deaths from January through June 2013, compared with 84 in CY 2012. Of these deaths, 31 involved heroin. The Ramsey County Medical Examiner reported 22 opiate-related deaths in the first half of 2013, compared with 45 in 2012. Heroin-involved hospital ED visits nearly tripled from 2004 to 2011 (from n=1,189 to n=3,493 visits), increasing by 54.8 percent from 2010 to 2011. ED visits for "total narcotic analgesics" more than doubled from 2004 to 2011 (from n=1,940 to n=4,836 visits). Heroin was noted in 10.6 percent of drug reports from law enforcement seizures analyzed by NFLIS laboratories in the first half of 2013, compared with 10.2 percent of the total in CY 2012. From 2012 to 2013, numbers of heroin exposures reported to the Hennepin Regional Poison Center increased from 127 to 147. Hydrocodone with acetaminophen was the most frequently dispensed drug reported in the Minnesota Prescription Monitoring Program in November 2013. It accounted for 19.8 percent of all prescriptions; oxycodone hydrochloride constituted 9.1 percent; and oxycodone with acetaminophen represented 7.8 percent.

Marijuana/Cannabis and Cannabimimetics: Past-year marijuana use among 11th grade public school students was reported by 31 percent of males and 24 percent of females in the metropolitan area, according to the 2013 Minnesota Student Survey. Marijuana as the primary substance problem accounted for 16.0 percent of total treatment admissions in the first half of 2013, compared with 16.3 percent of the total in 2012 and 16.6 percent in 2011. Nearly one-third of these clients (30.0 percent) were younger than 18, while 13.3 percent were age 35 or older. Law enforcement agents seized more than 5,500 marijuana plants in a large-scale outdoor grow operation in July 2013, in Hinckley, Minnesota, located 78 miles north of the Twin Cities. The estimated value of the plants was $4.1 million. Marijuana/cannabis was noted in 7.9 percent of drug reports from law enforcement seizures analyzed by NFLIS laboratories in the first half of 2013, compared with 17.8 percent of total drug reports in 2012. Cannabimimetic substances, also known as synthetic cannabinoids or synthetic THC, are a large family of synthetically produced cannabinoid compounds that are functionally similar to THC, the main active ingredient in marijuana. Known as “K2” or “Spice,” and other brand names, the herbal mixtures are sold as "herbal incense.” The Hennepin Regional Poison Center reported 28 cannabimimetic exposures in 2010, 149 in 2011, 157 in 2012, and 110 in 2013.

Methamphetamine: Primary methamphetamine treatment admissions have gradually increased in the Minneapolis/St. Paul area since 2011. They accounted for 9.4 percent of total treatment admissions in the first half of 2013, compared with 7.4 percent in CY 2012 and 6.4 percent in CY 2011. In Hennepin County, there were 7 methamphetamine-related deaths in the first half of 2013, compared with 14 such deaths in CY 2012. There were four deaths related to methamphetamine in Ramsey County in the first half of 2013, compared with seven in 2012. Methamphetamine was identified in 31.5 percent of total drug reports from items seized by law enforcement and analyzed by NFLIS laboratories in the first half of 2013 in the Twin Cities, compared with 22.6 percent of total drug reports in 2012.

Other Synthetic Drugs include a broad range of synthetically produced chemical compounds. Nineteen exposures to MDMA (3,4-methylenedioxymethamphetamine or ecstasy) were reported to the Hennepin Regional Poison Center in both 2012 and 2013. LSD exposures reported to the poison center tripled from 2012 to 2013 (from n=15 to n=45). Substances sold as "bath salts" often contain substituted cathinones, which are synthetically produced chemicals including MDPV (3,4-methylenedioxypyrovalerone), mephedrone, and methylone. There were 144 “bath salt” exposures reported to the Hennepin Regional Poison Center in 2011, 87 in 2012, and 50 in 2013. “Molly” is a new term for allegedly "molecular" MDMA (although without laboratory analysis, accurate identification of ingredients is not possible). Some capsules of alleged Molly have actually contained methylone, a common ingredient found in “bath salts." Methylone was noted in 28 of the 2,343 drug reports from drug items seized by local law enforcement and analyzed by NFLIS laboratories in the first half of 2013, compared with 13 such reports in 2012. The 2C-series phenethylamines, especially 2C-E (2,5-dimethoxy-4-ethylphenethylamine), 2C-B (4-bromo-2,5-dimethyl-oxyphenethylamine), and  2C-I (2,5-dimethyoxy-4-iodophenethylamine), are consumed for their stimulant and hallucinogenic effects and typically sold online as “research chemicals” that are “not intended for human consumption.” Thirty-five exposures to 2C-E and related analogs were reported to the Hennepin Regional Poison Center in 2013, compared with 24 in 2012. The Hennepin Regional Poison Center reported six cases of 25-I exposure in 2013. In Ramsey County, there was an accidental death of a 30-year-old male from probable 25I-NBOMe (2C-I-NBOMe) toxicity in June 2013. The term “N-bomb,” which is also known as “legal acid,” “smiles,” or simply “25-I," is used in reference to any of these closely related synthetic hallucinogens (phenethylamines): 25I-NBOMe, 25C-NBOMe, or 25B-NBOMe. BZP (1-benzylpiperazine), abused for its amphetamine-like effects, was identified in 24 drug reports from drug items seized and analyzed by NFLIS laboratories in the first half of 2013 (1.0 percent of total drug reports) and 97 drug reports in 2012 (1.6 percent of the total).

Alcohol use in the past year, according to the 2013 Minnesota Student Survey, was reported by 41 percent of metropolitan area 11th grade males and 42 percent of 11th grade females. Less than one-half (44.2 percent) of primary admissions to addiction treatment programs for all ages were for alcohol in the first half of 2013, compared with 46.5 percent of the total in 2012 and 49.2 percent in 2011. 

Data Sources: Mortality data on drug-related deaths for the first half of 2013 (January–June 2013) are from the Ramsey County Medical Examiner and the Hennepin County Medical Examiner. Hennepin County cases include accidental overdose deaths in which drug toxicity or mixed drug toxicity was the cause of death and those in which the recent use of a drug was listed as a significant condition contributing to the death. Ramsey County cases include accidental overdose deaths in which drug toxicity or mixed drug toxic­ity was the cause of death. Addiction treatment data regarding clients admitted to addiction treatment programs in the five-county Twin Cities metropolitan area are from the Drug and Alcohol Abuse Normative Evaluation System (DAANES) of the Minnesota Department of Human Services (January–June 2013). Hospital ED drug-involved visit data for 2004–2011 are from the Drug Abuse Warning Network, Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Poison control center data on drug exposures are from the Hennepin Regional Poison Center, Hennepin County Medical Cen­ter, Minneapolis, as reported on the American Association of Poison Control Centers, National Poison Data System (through CY 2013). Crime laboratory data for the first half of 2013 are from NFLIS, U.S. Drug Enforcement Admin­istration (DEA), and include primary, secondary, and tertiary drug reports identified from items seized by law enforcement in the seven-county Twin Cities metropolitan area and analyzed by NFLIS laboratories. Data from the St. Paul Police Department Laboratory are excluded after May 2012. Pre­scription drug data are from the Minnesota Prescription Monitoring Program, of the Minnesota Board of Pharmacy, for November 2013. Student survey data on drug use among 11th grade public school students in the seven-county metropolitan area are from the 2013 Minnesota Student Survey of the Center for Health Statistics, Minnesota Department of Health.