Philadelphia, Pennsylvania

Drug Abuse Trends and Patterns in Philadelphia—Update: January 2014

Suet T. Lim, Ph.D.

Overview of Findings: This report updates data on drug abuse indicators for Philadelphia since the last CEWG report for this area in June 2013. The key finding in the first half of 2013 in Philadelphia was the continuing predominance of heroin among indicators, including primary treatment admissions and alcohol and/or drug intoxication deaths. Multiple drug combinations continue to be common, with benzodiazepines increasingly pervasive.

Updated Drug Abuse Trends and Emerging Patterns

The drugs/drug groups below are commented on in descending order of their impact in the Philadel­phia area. Unless otherwise noted, data are for the first 6 months of 2013, compared with prior periods from their respective data sources.

Alcohol use continued to be high, and alcohol was the most frequently mentioned primary drug in treatment admissions data. Alcohol constituted 39 percent of all primary treatment admissions in the first half of 2013 (compared with 42 percent of total primary treatment admissions in the first half of 2012). Deaths with the presence of alcohol in combination with other drugs (n=87) represented 24 percent of Medical Examiner’s Office (MEO) cases with the presence of drugs detected in the first half of 2013; these represented a decline from 27 percent in 2012. If this pattern continues through the second half of 2013, alcohol-in-combination will rank fourth among the most frequently detected substances in deaths with the presence of drugs. Marijuana, cocaine, and heroin were the most frequently mentioned secondary and tertiary drug problems among primary alcohol treatment admissions. More than 35 percent of youths admitted to treatment in the first half of 2013 reported alcohol as their primary drug problem. This is similar to the proportion of youths admitted to treatment in 2012. The use pattern described by youths in recent focus groups with clients in treatment held in Philadelphia supports the need for alcohol abuse treatment.

Marijuana/Cannabis continued to rank first in positive urinalysis tests among parolees tested for the first time by the Adult Probation and Parole Department (APPD). This is not congruent with the information provided by focus group participants, who indicated that synthetic cannabinoids (cannabimimetics) were more frequently used and abused among individuals on parole or probation than marijuana. Marijuana has continued to rank third among primary treatment admissions during the first half of 2013 (at 20.8 percent of all admissions). Marijuana/cannabis drug reports continued to rank first among all drug reports identified in items seized and analyzed by National Forensic Laboratory Information System (NFLIS) laboratories for Philadelphia, at 31.2 percent in the first half of 2013, despite a decrease from 34.6 percent in the first half of 2012, and a concurrent increase for cocaine (from 27.7 to 30 percent during that time). Participants in focus groups with clients in treatment reported the recent popularity of mixing cocaine powder with marijuana; this combination was referred to as “turbo.”

Heroin continued to appear frequently among drug indicators in Philadelphia, and indicators were mixed in this reporting period. Primary heroin treatment admissions represented 22 percent of total admissions in the first half of 2013; this represented an increase from the first half of 2012, when primary heroin treatment admissions constituted 20 percent of the total. For females, heroin had been the most common illicit drug problem reported by treatment admissions for the past 5 years, and data from the first half of 2013 indicated that this trend continued. The proportion of deaths among MEO cases with morphine/heroin detected was 37.0 percent in the first half of 2013, stable from 2012, but up from 2011 (32.4 percent). While morphine/heroin ranked second among all deaths reported with the presence of drugs, it was the top ranked drug among deaths caused by alcohol and/or drug intoxication. NFLIS drug reports identified as heroin increased slowly and continually as a proportion of all drug reports since 2010. Heroin drug reports ranked third among all drug reports from items analyzed by NFLIS laboratories in Philadelphia in the first half of 2013, at 14.4 percent of total drug reports (n=1,859). In the first half of 2012, heroin drug reports also ranked third among total drug reports, at 13.8 percent of the total (n=1,831). Cocaine continued to be the most frequent secondary or tertiary drug problem among primary heroin treatment admissions. Benzodiazepines were the second most frequently reported secondary or tertiary drug problem among primary heroin treatment admissions.

Cocaine: The proportion of primary admissions for cocaine increased slightly, to 12.4 percent of total admissions in the first half of 2013, from 11.1 percent in in the first half of 2012. Cocaine ranked fourth among primary drug problems among treatment admissions in the current reporting period. The proportion of deaths among MEO cases with cocaine detected was 39.7 percent for the first half of 2013; this was similar to 2012 (39.0 percent). Among deaths caused by alcohol and/or drug intoxication, however, cocaine ranked second, accounting for 27.0 percent of those deaths. Availability of cocaine remained high. Drug reports identified as cocaine among items analyzed by NFLIS laboratories ranked a very close second to marijuana, at 30.0 percent in the first half of 2013; cocaine drug reports constituted 27.9 percent of all drug reports in the first half of 2012. As in previous reports, the highest proportion primary cocaine treatment admissions was among older adults; 18.5 percent of clients age 35 and older reported cocaine as their primary drug of choice; this percentage was  twice that of 26–34-year-olds and four times that of 18–25-year-olds.

Prescription Opioids/Opiates Other Than Heroin: Prescription opioids (most frequently oxycodone) continued to be detected in Philadelphia mortality data in the first half of 2013. While 3 prescription opioids continued to appear among the top 10 drugs detected among decedents with the presence of drugs in the first half of 2013, there were decreases in volume rank among the top 10 detected drugs in MEO mortality data. Oxycodone drug reports continued to rank fourth among all drug reports from items analyzed in NFLIS laboratories in the first half of 2013, with very little change from the previous year. Oxycodone reports represented 4.8 percent of all drug reports in the first half of 2013, compared with 4.9 percent in the first half of 2012. Drug reports among analyzed NFLIS items identified as codeine ranked ninth among all drug reports in the first half of 2013. Buprenorphine reports tied for 10th place among all NFLIS drug reports in the first half of 2013, with 0.5 percent of total reports. Hydrocodone, which had previously ranked among the top 10 drug reports in Philadelphia, fell to 14th place during this reporting period. Opioid detection in positive urinalyses among first time individuals on parole or probation continued to increase, with the highest percentage of positive urinalyses for opioids detected since 2009 (at 9.1 percent, compared with 6.7 percent in 2009 and 8.2 percent in 2012).

Benzodiazepines continued to appear frequently among drug indicators in Philadelphia in this reporting period. Benzodiazepines were the most frequently mentioned secondary and tertiary drug problems for primary marijuana treatment admissions. Benzodiazepines also appeared in the top 3 drug problems where heroin was primary, as reported by clients admitted to treatment. While alprazolam drug reports continued to rank fifth among drug reports from items analyzed by NFLIS laboratories, the number of drug reports identified as alprazolam (n=612, compared with n=546 in the first half of 2012) was very close to the number of drug reports for fourth-ranked oxycodone (n=618). Four benzodiazepines were in the top 10 drugs detected by the MEO among decedents with the presence of drugs in the first half of 2013. The volume of detections increased sharply for all four benzodiazepines from 2012 to the first half of 2013. Respective changes over the period were as follows: alprazolam, 31.1 percent in the first half of 2013 (up from 22.6 percent in 2012); aminoclonazepam, 13.5 percent (an increase from 8.4 percent); oxazepam, 12.7 percent (up from 8.0 percent); and diazepam, 12.7 percent (an increase from 10.6 percent). Nearly 8 percent of probationers or parol­ees tested positive for benzodiazepines in the first half of 2013; this represented an increase from 6.7 percent in 2012. Focus group participants indicated that alprazolam and clonazepam were often taken as a “booster” for other drugs.

PCP (Phencyclidine): Detected at low levels, PCP has consistently appeared in Philadelphia drug indicators. Primary PCP treatment admissions constituted 1.0 percent (n=43) of total admissions in the first half of 2013, compared with 1.5 percent in the first half of 2012. While PCP remained among the top 5 secondary or tertiary drug problems for treatment admissions with primary marijuana problems, it dropped to fourth place (n=42) in the first half of 2013, compared with the first half of 2012 (n=67) when it was in first place. Drug reports identified as PCP ranked seventh among the top 10 drug reports from items analyzed in NFLIS laboratories in the first half of 2013, with 269 drug reports representing 2.1 percent of the total. This rank and proportion were stable from the first half of 2012. The number of decedents with PCP detected by the MEO was stable in the first half of 2013 (n=35 in the first half of 2013, compared with n=37 in 2012), but this bears watching, according to the area representative, as focus group participants in the fall of 2013 indicated that PCP use may be on the rise.

Methamphetamine: Methamphetamine and other amphetamines have been very low relative to other drugs in Philadelphia drug indicators for several reporting periods and remained low in the first half of 2013. Primary methamphetamine and other amphetamine treat­ment admissions represented 0.1 percent of total admissions (a stable proportion from the first half of 2012). Only 1.0 percent of probationers and parolees tested urinalysis positive for the methamphetamine in the current reporting period or in the first half of 2013 (representing a slight increase from 0.3 percent testing urinalysis positive in the first half of 2012).

Other Drugs: Synthetic cannabinoids (cannabimimetics) appeared rarely or at low levels in current indicator data in Philadelphia. During the first half of 2012, the number of drug reports identified as AM-2201 (1-(5-fluoropentyl)-3-(1-naphthoyl)indole) ranked eighth (n=122 drug reports) among total drug reports from items identified by NFLIS laboratories, but there were no drug reports of this substance in the first half of 2013. All cannabimimetics combined constituted 0.2 percent of total drug reports (n=21 drug reports) among items analyzed by NFLIS in the first half of 2013.

Drug Combinations: Beginning in 2013, the MEO stopped testing urine; this appeared to impact the count of drug-positive decedents being reported for the first half of 2013. The number of decedents with the presence of drugs was considerably lower (n=370) in the first half of 2013 than for the same time period in 2012 (n=484). Of these 370 cases, the average number of drugs detected was 4.0, a decrease from 4.6 in 2012. The decrease in the average number of drugs detected may also be due in part to the change in testing protocols by the MEO.

Data Sources: Treatment admissions data for the uninsured and/or underinsured population were collected by the Philadelphia Department of Behavioral Health and Intellectual disAbility Services, Behavioral Health Special Initiative. Data on deaths with the presence of drugs were provided by Philadelphia Department of Public Health, Medical Examiner’s Office. Forensic laboratory data came from NFLIS, Drug Enforcement Administration. Criminal justice data provided by the APPD consists of urinalysis results of first-time tests of individuals on probation or parole. Qualitative data came from focus groups with individuals in treatment conducted by the by the Philadelphia Department of Behavioral Health and Intellectual disAbility Services.