San Francisco Bay Area, California

Drug Abuse Patterns and Trends in the San Francisco Bay Area—Update: January 2014

Alice A. Gleghorn, Ph.D.

Overview of Findings: The two key findings for San Francisco for this reporting period were 1) the continuing dominance of methamphetamine in indicators (with increases in the number of primary methamphetamine treatment admissions and in the proportion of methamphetamine reports among drug items seized and analyzed by National Forensic Laboratory Information System [NFLIS] laboratories) and 2) the continuing decline in cocaine indicators (including decreases in the number of primary treatment admissions and in the proportion of cocaine reports among drug items analyzed in NFLIS laboratories in the first half of 2013). San Francisco is riding the crest of an economic boom created in part by an influx of technology businesses opening in the city and by tech workers who live in the city and commute to nearby industries outside the city. The State and local budget scenarios are focused on allocating surplus and unanticipated revenues. However, the result of a growing economy is skyrocketing housing costs, and nonprofits are losing leases or facing increased rents. During this reporting period, methamphetamine indicators increased. Heroin indicators were mixed in this reporting period, with some indicators relatively stable and some very slightly increasing. Marijuana indicators show that while numbers of primary treatment admissions remained high for clients age 18 and younger, primary marijuana treatment admissions overall were stable. However, reports identified as marijuana/cannabis among drug items analyzed by NFLIS laboratories declined slightly from the first half of 2012 to the first half of 2013. Alcohol indicators remained high but continued to show some signs of decline, and cocaine indicators continued to decline. Indicators for prescription opioids/opiates other than heroin were stable.

Updated Drug Abuse Trends and Emerging Patterns

Methamphetamine indicators increased in the first half of 2013. Treatment admissions in which methamphetamine was the primary drug problem  rose across the bay area, from 4,450 admissions in fiscal year (FY) 2011–2012 to 4,936 in FY 2012–2013. The proportion of reports identified as methamphetamine among drug items seized and analyzed by NFLIS laboratories increased from 32.1 percent in the first half of 2012 to 37.8 percent in the first half of 2013, and methamphetamine reports accounted for the largest proportion of drug reports in both time periods. In 2011, Drug Abuse Warning Network (DAWN) estimates of drug-involved emergency department (ED) visit rates for methamphetamine were 139.5 per 100,000 population for San Francisco, compared with 33 per 100,000 in the United States overall.

Alcohol: Alcohol continued to rank first among treatment admis­sions in bay area programs, although these numbers have been declining over the past 4 years beginning in FY 2008–2009. While remaining high, primary alcohol treatment admissions continued to decline from FY 2011–2012 (n=7,112) to FY 2012–2013 (n=6,883). DAWN rates of alcohol-involved ED visits for San Francisco in 2011 (328.3 per 100,000 population) far exceeded those for the United States overall (134.6 per 100,000).

Cocaine: Primary cocaine treatment admissions continued to decline across the five bay area counties, from 3,580 admissions in FY 2011–2012 to 3,184 in FY 2012–2013; cocaine admissions accounted for approximately 14 percent of the total in FY 2012–2013. Cocaine continued to rank fourth behind alcohol, methamphetamine, and heroin in the bay area among treatment admissions in FY 2012–2013. Among drug reports from drug items seized and analyzed by NFLIS laboratories, cocaine declined in the five San Francisco Metropolitan Statistical Area counties in the first half of 2013, to 15.0 percent of total drug reports from 18.4 percent in the first half of 2012.

Heroin: Heroin indicators were mixed in this reporting period. Primary heroin treatment admissions were relatively stable, representing 16.4 percent of all admissions in the bay area in FY 2011–2012 and 17.5 percent in FY 2012–2013. Equal proportions of 18–25-year-olds and 26–35-year-olds showed the highest admission proportions for heroin as a primary drug problem among age groups. San Francisco rates of heroin-involved ED visits were low relative to U.S. rates (40.7 and 83.0 per 100,000 population, respectively) in 2011. Heroin showed a slight increase in the proportion of drug reports among drug items seized and analyzed by NFLIS laboratories in the bay area in the first half of 2013; 6.4 percent of total drug reports in the first half of 2013 were identified as heroin, compared with 5.2 percent of the total in the first half of 2012.

Prescription Opioids/Opiates Other Than Heroin: Indicators for prescription opioids/opiates other than heroin were stable in this reporting period. Primary treatment admissions for oxycodone were stable between FY 2011–2012 (n=463) and FY 2012–2013 (n=466) in the five bay area counties. A higher percentage of young adults (age 18–25) reported prescription drugs as their primary drug problem at treatment admission than other age groups. There was a very slight increase in hydrocodone reported as a proportion of total drug reports among drug items seized and analyzed by NFLIS labo­ratories from the first half of 2012 (3.6 percent) to the first half of 2013 (3.8 percent), while the proportions of oxycodone and methadone reports decreased between the two reporting periods. Oxycodone drug reports declined from 3.5 to 2.7 percent, and methadone reports declined slightly from 1.3 to 1.1 percent. Reports for morphine were stable between the first halves of 2012 and 2013 (at 1.2 percent in the first half of 2012 and 1.1 percent in the first half of 2013).

Marijuana/Cannabis and Synthetic Cannabinoids (Cannabimimetics): Marijuana/ cannabis indicators continued to be mixed. Marijuana was the most common drug reported at admission as the primary drug problem for clients younger than 18 in FY 2012–2013, but it continued to rank fifth in treatment admissions overall across the bay area (with n=2,172 admissions in FY 2011–2012 and n=2,223 in FY 2012–2013). There was a slight decrease in the proportion of NFLIS drug reports iden­tified as marijuana/cannabis among drug items seized and analyzed by forensic laboratories (from 20.8 percent in the first half of 2012 to 18.6 percent in the first half of 2013). While DAWN ED data suggest that rates of synthetic cannabinoids for the United States (9.2 per 100,000 population) exceeded rates for San Francisco in 2011, a recent community report suggested the presence of one cannabimimetic (XLR-11) in several driving under the influence (DUI) and criminal justice cases in the first half of 2013.

Other Drugs: Reports from the San Francisco Medical Examiner (ME) in the first half of 2013 indicated the initial detection of several drugs not previously seen in bay area forensic settings. In addition to the XLR-11 found in DUI cases, these detections included one case of desomorphine found in a sample from an arrestee submitted by the San Francisco Police Department (SFPD) and one case involving 4-methyl-5-thiazole ethanol, a viscous, oily liquid used as a sedative and hypnotic. Reduced access to opiates through prescriptions may be increasing the numbers of young heroin users and former users returning to injecting heroin. Increased access to naloxone may impact death rates for heroin and prescription drug users.

Data Sources: Treatment admissions data were available for five San Francisco Bay Area counties for FYs 2007–2012 and were provided by the California Department of Health Care Services using the CalOMS (California Outcome Monitoring System) system. DAWN, Substance Abuse and Mental Health Services Administration, pro­vided metropolitan estimates of drug-involved ED Visits: San Francisco - San Francisco Division, 2011. Reports of drugs from items seized and analyzed were provided by NFLIS Data Query System (DQS) December 12, 2012 (January–June 2012) and December 12, 2013 (January–June 2013); data and include primary, secondary, and tertiary reports for each drug item analyzed. The San Francisco DOPE (Drug Overdose Preven­tion Education) Project provided data on overdose reversals and naloxone distribution. Data on DUI samples were provided by the San Francisco ME, who runs tests on DUI samples from arrests at the request of the SFPD.