San Diego County, California

Drug Abuse Patterns and Trends in San Diego County—Update: January 2014

Karla D. Wagner, Ph.D.

Overview of Findings: The two key findings for San Diego for this reporting period are 1) increasing indicators for methamphetamine, after several years of mixed or declining indicators, and 2) continued gradual increases in all heroin indicators, accompanied by a growing local concern about overdose deaths involving heroin/morphine and transitions by users from prescription opioids to heroin. In the first half of 2013, most indicators for methamphetamine showed some signs of increasing, after several years of mixed or declining indicators. Primary treatment admissions for methamphetamine were up in terms of number (n=2,412 admissions in January–June 2013, compared with n=1,932 admissions in January–June 2012) and in proportion of total admissions (29 percent of total admissions in the first half of 2013, compared with 25 percent of admissions in the first half of 2012). Positive urinalysis tests for methamphetamine among adult arrestees also increased in calendar year (CY) 2012, compared with CY 2011, and overdose death rates involving amphetamines increased from 3.6 deaths per 100,000 population in the first half of 2012 to 4.8 per 100,000 in the first half of 2013. Heroin indicators continued a gradual upward trend that has been observed over the past several years. Primary heroin treatment admissions increased in both number (n=2,004 in the first half of 2013, compared with n=1,569 in the first half of 2012) and in proportion of total admissions (24 percent in the first half of 2013, compared with 22 percent in the first half of 2012). Overdose death rates involving heroin/morphine showed a small increase, from 4.1 deaths per 100,000 population in January–June 2012 to 4.5 per 100,000 in January–June 2013. The continuing increase in such deaths since 2010 is the subject of growing local concern about overdose deaths. Among arrestees, 27 percent of those who reported heroin use said that they had used prescription opioids before trying heroin, evidence of users transitioning from prescription opioids to heroin.

Updated Drug Abuse Trends and Emerging Patterns

Heroin: In the first half of 2013, heroin indicators appeared to be trending upwards. The proportion of primary heroin treatment admissions increased from 22 percent in the first halves of both 2012 and 2011 to 24 percent in the first half of 2013. The number of primary treatment admissions for heroin also increased, from 1,569 in the first half of 2012 to 2,004 in the first half of 2013. Preliminary medical examiner data suggest that the rate of overdose deaths involving heroin/morphine increased slightly, from 4.1 deaths per 100,000 population in the first half of 2012 to 4.5 per 100,000 in the first half of 2013, continuing a gradually increasing trend since 2010. In contrast to CY 2011, which saw decreases in the prevalence of arrestee heroin/opioid use, as measured by positive urinalysis test results in a random sample of adult male, adult female, and juvenile arrestees, heroin prevalence increased slightly in all three groups in CY 2012. Among adult males, 12 percent tested positive for heroin/opioids, compared with 9 percent in CY 2011. Among adult females, the prevalence of positive tests increased by 1 percentage point, from 9 percent in 2011 to 10 percent in 2012. Among juveniles, the prevalence of positive tests increased from 2 percent in CY 2011 to 3 percent in CY 2012. Primary, secondary, and tertiary drug reports among drug items analyzed in NFLIS laboratories identi­fied as heroin were up in the first half of 2013 (12 percent), compared with the first half of 2012 (9 percent). Heroin continued to rank fourth among all drug reports from drug items analyzed in NFLIS laboratories in the first half of 2013. Heroin prices were largely stable, with the exception of an increase in the price per pound, from $8,000–$12,000 per pound in July 2012 to $10,000–$14,000 per pound in July 2013.

Cocaine/crack indicators have been declining in San Diego for the past several years. In 2011, this decline started to show signs of leveling, a trend that continued into 2012. In the first half of 2013, indicators were mostly stable or slightly down, with the exception of an observed increase among adult male arrestees. Prevalence of arrestee cocaine use, based on positive urinalyses, increased from 6 percent among adult males in CY 2011 to 8 percent in CY 2012; by contrast, prevalence among adult females declined from 7 percent in CY 2011 to 5 percent in CY 2012. This was the first year in which more males than females tested positive for cocaine. Among juvenile arrestees, cocaine prevalence increased by 1 percentage point, from 2 percent in CY 2011 to 3 percent in CY 2012. The proportion of primary cocaine treatment admissions was stable in the San Diego area, representing 4 percent of total admissions in 2013 for the third half-year period in a row, compared with 5 percent of total admissions in the first half of 2010. There was no change in the proportion of drug reports from drug items analyzed in NFLIS laboratories in the first half of 2013, compared with the first half of 2012, with 12 percent testing positive for cocaine. Cocaine again ranked third among all drugs identified in drug reports from analyzed NFLIS drug items for San Diego County. The price of cocaine was mostly stable in July 2013. The price of 0.2 grams of crack cocaine has been steadily declining, from a high of $80 in July 2010 to $10–$20 in July 2013.

Methamphetamine: In contrast to previous years that showed mixed indicators, methamphetamine indicators were mostly trending upwards in the first half of 2013. The proportion of primary treatment admissions for methamphetamine had been in decline since 2007 and reached a low of 25 percent in the first half of 2012. In the first half of 2013, however, primary methamphetamine treatment admissions returned to the 2010–2011 level of 29 percent, representing 2,412 primary admissions. Among arrestees, the prevalence of urinalysis test results positive for methamphetamine increased among adult males (from 26 percent in CY 2011 to 31 percent in CY 2012) and adult females (from 39 percent in CY 2011 to 47 percent in CY 2012). The prevalence of urinalysis positive test results for methamphetamine among juveniles was stable at 4 percent from 2011 to 2012. The number and rate of overdose deaths involving amphetamine have risen since 2008, and preliminary medical examiner data for the first half of 2013 showed that the rate of overdose deaths involving amphetamine continued to increase, from 3.6 deaths per 100,000 population in the first half of 2012 to 4.8 per 100,000 in the first half of 2013; this 2013 rate represented 76 deaths. Methamphetamine continued to rank first among drug reports from items analyzed in NFLIS laboratories. In the first half of 2013, drug reports identified as methamphetamine accounted for 42 percent of all (primary, secondary, and tertiary) reports, compared with 38 percent for the first half of 2012. Street prices for methamphetamine decreased for large quantities, from $10,000–$15,000 per pound in July 2012 to $4,000–$12,000 in July 2013.

Marijuana/cannabis indicators were mostly decreasing or stable in the first half of 2013, although an increase was observed among adult male arrestee positive urinalyses for cannabis. Primary marijuana treatment admissions represented 18.4 percent of all admissions in the first half of 2013 (n=1,541), compared with 19.6 percent in the first half of 2012 (n=1,378), and 18.8 percent in the first half of 2011 (n=1,348). Marijuana use prevalence among adult arrestees in CY 2012 was up by 3 percentage points for males (42 percent in CY 2012, compared with 39 percent in CY 2011) and down by 1 percentage point for females (30 percent in CY 2012, compared with 31 percent in CY 2011). The prevalence of positive urinalysis tests for marijuana among juve­nile arrestees also decreased, from 51 percent in CY 2011 to 48 percent in CY 2012. The proportion of drug reports identified as marijuana/cannabis among drug items analyzed by NFLIS laboratories decreased, with marijuana/cannabis accounting for 13 percent of all primary, secondary, and tertiary drug reports in the first half of 2012, compared with 19 percent in the first half of 2012 and 29 percent in CY 2011. Marijuana ranked second among drug reports from items analyzed in NFLIS laboratories in the first half of 2013.

Prescription Opioids/Opiates Other Than Heroin: Treatment admissions for prescription opioids/opiates other than heroin (narcotic analgesics) remained low in the first half of 2013, representing 4.5 percent of all admissions. This compares with 4.0 percent of total treatment admissions in the first half of 2011 and 4.8 percent in the first half of 2012. Among adult arrestees in the San Diego Substance Abuse Monitoring program, the proportion reporting any illegal use of prescription drugs (including prescription opioids) decreased, from 42 percent in CY 2011 to 39 percent in CY 2012. Among juvenile arrestees, the proportion reporting any illegal use of prescription drugs increased from 37 percent in CY 2011 to 44 percent in CY 2012.

MDMA: As in previous years, MDMA (3,4-methylenedioxymethamphetamine or ecstasy) indicators were relatively low. MDMA accounted for less than 1.0 percent of all San Diego treatment admissions in the first half of 2013. Prevalence of self-reported lifetime use of MDMA increased by 1 percentage point among adult arrestees, from 27 percent in CY 2011 to 28 percent in CY 2012. Self-reported lifetime use decreased among juvenile arrestees, from 47 percent in CY 2011 to 34 percent in CY 2012. MDMA reports ranked 18th among total drug reports from items analyzed by NFLIS laboratories in the first half of 2013, representing less than 1.0 percent of reports, down from 10th place in the first half of 2012.

Data Sources: Arrestee data were from the San Diego Association of Governments' Substance Abuse Monitoring program, a regional continuation of the Federal Arrestee Drug Abuse Monitoring program that was discontinued in 2003. This report presents data for calendar year 2012, for both adult (n=854) and juvenile (n=120) arrestees, compared with 2011 data. Forensic laboratory data were from NFLIS, Drug Enforcement Administration. There were 6,103 primary, secondary, and tertiary drug reports provided by Federal, State, and local forensic laboratories between January and June 2013. Treatment data came from the San Diego County Department of Alcohol and Drug Programs (ADP). Tables were made using the California Outcomes Measurement System (CalOMS). CalOMS is a statewide client-based data collec­tion and outcomes measurement system for alcohol and other drug (AOD) prevention and treatment services. Submission of admission/discharge information for all clients is required of all counties and their subcontracted AOD providers, all direct contract providers receiving public AOD funding, and all private-pay licensed narcotic treatment providers. Data for this report include admissions in San Diego County for the period January–June 2013. Note that CalOMS was implemented in early 2006, replacing the earlier California Alcohol and Drug Data System (CADDS) system. Therefore, data reported for periods prior to July 2006 may not be comparable to more recent periods. Mortality data were obtained from the Emergency Medical Services Medical Examiner Database, which is maintained by the County of San Diego Health and Human Services Agency. This report contains preliminary data on drug overdoses from January to June 2013. Street drug price data for July 2013 came from the San Diego Law Enforcement Coordination Center Street Drug Price List.