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National Drug Threat Assessment 2004
April 2004

Pharmaceuticals

The diversion and abuse of pharmaceuticals, including narcotics, depressants, and stimulants, pose an increasing threat to the country. Most pharmaceutical controlled substances abused in the United States are diverted by improper or illegal prescribing, forged prescriptions, doctor shopping, and theft; however, law enforcement agencies report that pharmaceuticals are increasingly being obtained from Mexico and through Internet pharmacies whose sources of supply often are in Mexico and other foreign countries.

Pharmaceutical narcotics such as  (Vicodin), oxycodone (OxyContin), hydromorphone (Dilaudid), and codeine are available and abused throughout the country. The demand, availability, and abuse of these drugs are high and appear to be increasing, but the abuse of hydrocodone and oxycodone drugs in particular poses the greatest threat.

The availability of depressants (including barbiturates and benzodiazepines) varies regionally. Alprazolam (Xanax) and diazepam (Valium) are among the most widely abused pharmaceutical depressants, particularly in the Southeast region.

Stimulants, particularly dextroamphetamine (Adderall) and methylphenidate (Ritalin), are widely available in most areas. Ritalin abuse is most noted in school settings, where some students with legitimate prescriptions often share the drug with friends. Many adolescents and young adults abuse these drugs, and overall abuse appears to be stable.

NDTS 2003 data indicate that 2.4 percent of state and local law enforcement agencies nationwide identified pharmaceuticals as their greatest drug threat. Regionally, more state and local law enforcement agencies in the Southeast (4.0%), Great Lakes (3.1%), and Northeast/Mid-Atlantic regions (3.0%) identified pharmaceuticals as the greatest drug threat than did their counterparts in the Pacific (0.7%), Southwest (0.7%), and West Central regions (0.0%).

NDTS data further reveal that 72.3 percent of state and local law enforcement agencies reported high or moderate availability of pharmaceuticals, a slight increase from 70.0 percent in 2002. The percentage of state and local law enforcement agencies reporting low availability also increased slightly, from 20.2 to 21.7 percent, during the same period. Just 2.8 percent of respondents indicated that pharmaceuticals are not available in their areas compared with 7.1 percent in 2002.

Pharmaceuticals were identified by 1.9 percent of state and local law enforcement agencies nationwide as the category of drugs most contributing to violent crime in their areas, according to the 2003 NDTS. Regionally, more law enforcement agencies in the Northeast/Mid-Atlantic (3.1%), Southeast (2.1%), and Great Lakes regions (2.1%) identified pharmaceuticals as such than did those in West Central (0.8%), Southwest (0.7%), and Pacific regions (0.3%).

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Narcotics

Pharmaceutical narcotics such as , oxycodone, hydromorphone, and codeine are commonly diverted and abused for the euphoric effects they produce. Federal, state, and local law enforcement agencies in every region of the country report an increase in availability as well as abuse.

The demand for narcotics is high throughout the country. MTF data indicate that past year use of narcotics other than heroin was 9.4 percent in 2002 and 9.3 percent in 2003 among twelfth graders. (No data were available for eighth or tenth graders.) ED mentions and treatment admissions for prescription narcotic abuse are increasing. The estimated number of DAWN ED mentions for narcotic analgesics rose 20 percent from 2001 (99,317) to 2002 (119,185). TEDS data reveal that treatment admissions for opiates other than heroin (including methadone, codeine, morphine, oxycodone, and hydromorphone) rose from 22,306 in 1999 to 25,839 in 2000 and accounted for nearly 2 percent of all TEDS admissions.

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Hydrocodone

The prescription narcotic hydrocodone possesses an analgesic property similar to or greater than that of morphine. Sold under names such as Lorcet, Lortab, Tussionex, and Vicodin, hydrocodone drugs are available in tablet, capsule, and syrup forms. DEA reports that approximately 20 tons of  products are used (legally and illegally) annually and that s are among the most abused drugs in 13 DEA Field Divisions throughout the country. Specifically, Lorcet, Lortab, and Vicodin are of particular concern in areas covered by the Philadelphia, Phoenix, San Diego, San Francisco, and Seattle Field Divisions. NDTS 2003 data reveal that 55.6 percent of state and local law enforcement agencies nationwide reported that  is a commonly diverted or illicitly abused pharmaceutical in their areas. More than three-quarters (76.5%) of law enforcement agencies in the Southeast reported that  is commonly diverted or abused, the highest percentage recorded in the country.

NFLIS data indicate that  accounted for only 0.94 percent of all drug items analyzed by state and local forensic laboratories in 2002. Regionally, forensic laboratories in the South (1.45%) reported the highest percent of  items analyzed, followed by the Midwest (0.65%), Northeast (0.57%) and West (0.54%).

Data regarding rates of use for  in general and individual types of s in particular are very limited; however, MTF data indicate that past year use of Vicodin appears to be trending upward. According to MTF, past year rates of use for Vicodin from 2002 to 2003 were 2.5 and 2.8 percent among eighth graders, 6.9 and 7.2 percent among tenth graders, and 9.6 and 10.5 percent among twelfth graders; however, none of the changes were significant. The consequences of  use are increasing. The estimated number of ED mentions for  increased overall from 21,567 in 2001 to 25,197 in 2002. Significant increases in the number of ED mentions for  were reported in Buffalo (115%) and Seattle (26%).

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Oxycodone

Oxycodone, marketed under the brands OxyContin, Percocet, and Percodan, is increasingly available in every region of the country. Most DEA Field Divisions and HIDTAs report increasing oxycodone availability, particularly OxyContin. Sources in 14 Pulse Check cities described OxyContin as an emerging problem in the first half of 2002. Chicago was the only city for which a Pulse Check source did not report OxyContin as an emerging problem between January 2001 and June 2002--a period that spans the three most recent Pulse Check reporting periods. According to NDTS 2003 data, 58.4 percent of state and local law enforcement agencies nationwide reported that oxycodone is a commonly diverted or illicitly used pharmaceutical. STRIDE reporting indicates that the number of oxycodone dosage units submitted for testing increased from 11,782.8 in 2000 to 12,921.6 in 2001 but decreased sharply to 5,670.9 in 2002.

NFLIS data show that oxycodone is among the 10 most analyzed drug items in state and local forensic laboratories; however, oxycodone represents only 0.98 percent of total analyzed drug items. Oxycodone was most frequently identified in the Northeast (1.47%), South (1.24%), Midwest (0.78%), and West (0.32%).

DAWN data indicate that the consequences of oxycodone use are trending upward. The estimated numbers of ED mentions specifically for oxycodone were 18,409 in 2001 and 22,397 in 2002, not a statistically significant change. DAWN data further indicate that the estimated number of ED mentions for oxycodone increased in five reporting cities, of which Detroit recorded the highest increase (249%).

OxyContin Diversion and Abuse

OxyContin is a controlled-release tablet that contains large amounts of oxycodone (10 to 80 mg) and is used legitimately to treat moderate to severe pain, but also is abused for its heroin-like effects. Some addicts crush the tablet to override OxyContin's controlled-release mechanism and either snort or inject the powder for a rapid high. OxyContin is prevalent in every region of the country. NDTS 2003 data indicate, however, that OxyContin was reported as a commonly diverted or illicitly used pharmaceutical by more state and local law enforcement agencies in the Southeast (83.9%) and Northeast/Mid-Atlantic regions (75.0%) than in the Great Lakes (65.4%), West Central (61.8%), Pacific (56.9%), and Southwest regions (28.6%). Other law enforcement reporting indicates that OxyContin availability has decreased in areas covered by the Appalachia HIDTA and the DEA Field Divisions in Detroit, Miami, and Philadelphia. In addition to increased efforts to control drug diversion, the low cost of heroin, which often is substituted for OxyContin, may be contributing to the decrease in OxyContin availability and abuse in these areas. CEWG sources in Baltimore, Honolulu, Miami, Philadelphia, Portland, and St. Louis report that OxyContin and heroin continue to be used as substitutes for one another.

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Hydromorphone

Hydromorphone (Dilaudid) also is commonly diverted in the United States but generally is abused less frequently than  or oxycodone drugs. Although Dilaudid is abused in every region of the country, abuse and availability were noted in only two DEA Field Divisions (New Orleans and New York) and five HIDTAs (Appalachia, Atlanta, Gulf Coast, New England, and Philadelphia/Camden). STRIDE data indicate that 22,698.9 hydromorphone dosage units (du) were submitted for testing in 2000, 3,134.4 in 2001, and 17,870.0 in 2002. Most dosage units submitted for testing in 2002 were seized in Alabama (17,247.0 du), followed by Texas (157.0 du), Montana (154.0 du), West Virginia (100.5 du), Arkansas (73.5 du), Florida (97.0 du), Virginia (23.0 du), Mississippi (2.0 du), and Washington (1.0 du). NDTS 2003 data indicate that Dilaudid is reported as being commonly diverted or illicitly abused by more state and local law enforcement agencies in the Southeast region (46.5%), followed by the West Central (26.6%), Great Lakes (26.3%), Northeast/Mid-Atlantic (21.1%), Southwest (18.6%), and Pacific regions (11.5%).

Data regarding hydromorphone use and the consequences of use are not available.

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Codeine

Codeine is available and abused throughout the country; however, law enforcement and public health agency reporting regarding codeine is limited. Codeine was reported as available in six DEA Field Divisions (Los Angeles, New York, Philadelphia, Phoenix, San Francisco, and Seattle) and six HIDTAs (Arizona, Hawaii, Houston, Milwaukee, Philadelphia/Camden, and Southeast Michigan). CEWG reports that codeine cough syrup continues to be abused, and its use is spreading, particularly in Texas. TCADA, Gulf Coast Addiction Technology Transfer Center (GCATTC), and local law enforcement agencies report that codeine cough syrup is becoming increasingly popular among young adults, particularly in West Texas. According to the NDTS 2003, 63.2 percent of state and local law enforcement agencies in the Southwest indicated that codeine was a commonly diverted or illicitly used pharmaceutical. STRIDE data indicate that there were no codeine submissions in 2001 or 2002. NFLIS data indicate that codeine submissions represented 0.20 percent of the total analyzed drug items. The drug was identified most frequently in the Midwest and South at 0.23 percent, followed by the Northeast (0.16%) and West (0.15%).

The consequences of codeine use appear to be increasing. The estimated number of DAWN ED mentions for codeine increased sharply from 3,720 in 2001 to 4,961 in 2002.

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Depressants

Depressants, particularly benzodiazepines, are widely available and abused in all regions of the country. Depressants are prescribed for legitimate purposes; they are abused primarily for their sedative and euphoric effects as well as to enhance the intoxication of ethanol, to modulate the euphoric effects of opioids, and to modulate the adverse consequences of stimulant abuse. The abuse of the benzodiazepines alprazolam (Xanax) and diazepam (Valium) is mentioned frequently in law enforcement reporting; however, the abuse of barbiturates is rarely reported. Eight DEA Field Divisions and 13 HIDTAs report that benzodiazepines are abused in their areas. Xanax is of particular concern in four DEA Field Divisions (Caribbean, Dallas, Houston, and Philadelphia) and seven HIDTAs (Arizona, Central Florida, Gulf Coast, Hawaii, New England, Northeast Florida, and South Florida). According to STRIDE, most Xanax dosage units submitted for testing in 2002 were seized in Texas (99,470.3 of 123,159.5 du). Valium availability and abuse also are high in most regions of the country, but only the DEA Field Divisions in El Paso and Houston and the Arizona, Chicago, Hawaii, and New England HIDTAs report availability in their areas. STRIDE data indicate that, of the Valium samples submitted for testing in 2002, the highest number of dosage units were seized in Texas (88,074.7 du), followed by Hawaii (8,457.5 du), California (4,265.4 du), Arkansas (2,950.0 du), and Michigan (1,780.0 du).

Xanax and Valium are among the drugs most frequently identified in drug samples submitted for testing in state and local laboratories, according to NFLIS data. In 2002 Xanax represented 1.12 percent of all drug items analyzed in NFLIS reporting laboratories. Regionally, the drug was identified most often in the South (1.73%) but also in the Midwest (0.88%) and Northeast (0.88%). Valium represented 0.94 percent of all drug items analyzed in NFLIS reporting laboratories in 2002. NFLIS also reports that Valium was identified most often in the South (0.77%), followed by the Midwest (0.39%), Northeast (0.39%), and West (0.34%).

NDTS 2003 data indicate that 72.8 percent of state and local law enforcement agencies nationwide identified Valium as a commonly diverted or illicitly abused pharmaceutical. The proportions of agencies across all regions identifying it as such ranged from 64.5 percent (Northeast/Mid-Atlantic) to 83.3 percent (Southeast). NDTS data indicate that Xanax was identified as being commonly diverted or illicitly abused by 65.7 percent of state and local law enforcement agencies nationwide. Regionally, more agencies identified Xanax as a commonly diverted or illicitly abused pharmaceutical in the Southeast (86.7%) than in the West Central (69.8%), Great Lakes (60.7%), Northeast/Mid-Atlantic (60.2%), and Pacific regions (41.5%).

The most recent data regarding the consequences of pharmaceutical depressant abuse, albeit limited, indicate that ED mentions for benzodiazepines are trending upward, while treatment admissions are mixed. The estimated number of DAWN ED mentions for benzodiazepines trended upward, although not significantly, from 103,972 in 2001 to 105,752 in 2002. Increases in ED mentions were not evident for any specific benzodiazepine except Xanax. ED mentions for Xanax increased from 25,644 in 2001 to 27,659 in 2002. TEDS data indicate that treatment admissions for benzodiazepines trended upward slightly from 4,321 in 1999 to 4,383 in 2000 but trended downward slightly for barbiturates (1,064 to 1,011) during the same period.

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Stimulants

Pharmaceutical stimulants are used primarily to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), obesity, and narcolepsy because of their effectiveness in increasing concentration, alertness, and energy. Pharmaceutical stimulants also are diverted and abused by those seeking such effects, particularly increased energy and concentration. The availability of the most commonly abused stimulants--dextroamphetamine (Dexedrine and Adderall) and methylphenidate (Ritalin, Methylin, and Concerta)--is stable. However, the diversion of Adderall and Ritalin appears to be increasing, largely because of an increasing number of patients selling their legitimately prescribed supplies to abusers. NDTS 2003 data indicate that state and local law enforcement agencies nationwide more frequently identified Ritalin (51.1%) than Adderall (11.4%) as a commonly diverted or abused pharmaceutical in their areas. Law enforcement reporting indicates that Ritalin abuse is most notable among high school and college students. Abuse is not limited to these age groups, however, as younger adolescents also abuse the drug. STRIDE data indicate that the number of methylphenidate dosage units submitted for testing dropped from 825.0 in 2001 to 234.3 in 2002.

NFLIS data for 2002 indicate that methylphenidate is among the 25 most frequently identified drugs in samples submitted to state and local forensic laboratories, representing approximately 0.10 percent of the total analyzed drug items submitted to forensic laboratories in that year. Methylphenidate estimates were highest in the Northeast (0.13%), closely followed by the Midwest (0.12%), South (0.10%), and West (0.06%).

Stimulant abuse appears to be relatively stable. MTF data indicate that Ritalin use was relatively stable from 2002 to 2003 among eighth (2.8% and 2.6%), tenth (4.8% and 4.1%), and twelfth graders (4.0% in both years). NSDUH data for 2002 show that approximately 1.2 million individuals aged 12 and older used a pharmaceutical stimulant within the past year. The percentage of past year use was highest among 18- to 25-year-olds (3.7%), followed by those aged 12 to 17 (2.6%) and 26 or older (0.8). DAWN data indicate that the estimated number of methylphenidate ED mentions was relatively stable from 2001 (1,279) to 2002 (1,245).


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