High Intensity Drug Trafficking Area Research Articles

Evaluation of dispensaries’ cannabis flowers for accuracy of labeling of cannabinoids content

BackgroundCannabis policies have changed drastically over the last few years with many states enacting medical cannabis laws, and some authorizing recreational use; all against federal laws. As a result, cannabis products are marketed in dispensaries in different forms, most abundantly as flowers intended for smoking and sometimes vaping. All samples used in this study were obtained directly from law enforcement. The sample collection process was facilitated and funded by the National Marijuana Initiative (NMI), part of the High-Intensity Drug Trafficking Area (HIDTA) program. This initial report focuses on cannabis flowers. Similar studies with other cannabis products will be the subject of a future report.MethodsA total of 107 Δ9-THC cannabis flower samples were collected by law enforcement from adult commercial use cannabis dispensaries, located in three different states (Colorado, Oregon, and California) and analyzed in this study for cannabinoid concentration. Samples were analyzed by GC-FID following our previously published procedure.DiscussionThe label claims for total Δ9-THC content ranged from 12.04 to 58.20% w/w, while GC-FID results showed a concentration ranging from 12.95 to 36.55% w/w. Of the evaluated 107 products, only 32 samples have Δ9-THC content within ± 20% of the labeled content. However, the remaining 75 samples were found to be out of the ± 20% acceptance criteria. The degree of agreement for the tested samples using ± 20% tolerance with label claims was only 30%. The results of this study indicate that there is a need for more stringent regulations to ensure that product labeling is accurate, as 70% of the evaluated products did not meet the ± 20% acceptance criteria. This highlights the importance of healthcare professionals and patients being vigilant about the Δ9-THC content, as inaccurate labeling of cannabis products could potentially result in adverse health effects. Furthermore, there is a pressing need for more rigorous regulation of commercial cannabis products in the United States.

NIDA on dramatic increase of mushroom seizures

From 2017 – 2022, law enforcement seizures across the United States of mushrooms containing psilocybin increased dramatically, according to a new study funded by the National Institute on Drug Abuse (NIDA). The number of law enforcement seizures increased from 402 seizures in 2017 to 1,396 in 2022. In addition, the total weight of psilocybin mushrooms seized by law enforcement increased from 226 kg (498 lbs.) seized in 2017 compared with 844 kg (1,861 lbs.) in 2022. This analysis, published in Drug and Alcohol Dependence, was led by researchers at New York University (NYU) Langone Health in New York City, and the University of Florida, Gainesville. The data used for the analysis were collected through the High Intensity Drug Trafficking Areas (HIDTA) program, a grant program aimed at reducing drug trafficking and misuse administered by the Office of National Drug Control Policy. Though law enforcement seizures do not necessarily reflect prevalence of use, they represent an indicator of the availability of illicit drugs. “We are in the middle of a rapidly evolving cultural, media, and legal landscape when it comes to psychedelics, and we need data to help shape informed and appropriate public health strategies,” said NIDA Director Nora D. Volkow, M.D., in announcing the research publication last week. “Moving forward, we must continue to track data on the availability of psychedelics, patterns in use, and associated health effects to guide efforts in promoting accurate education and reducing potential harms among people who do plan to use psychedelic drugs.” Adverse effects of psilocybin mushrooms, such as “bad trips,” are marked by “distorted thinking, perceptual changes, putting oneself in physical danger, and intense feelings of fear, anxiety, and confusion,” according to NIDA. “People who take psychedelic drugs like psilocybin may also experience short‐term side effects such as raised blood pressure and heart rate, agitation, confusion, vomiting, or nausea, which may be severe and require medical attention.” Joseph J. Palamar, Ph.D., M.P.H., associate professor at the NYU Grossman School of Medicine, co‐investigator on the NIDA‐funded National Drug Early Warning System (NDEWS), and lead author on the paper, said “Research studies suggesting its effectiveness in treating mental health issues and extensive positive media coverage may lead some people to seek ‘shrooms’ outside of medical contexts. People who use psilocybin outside of medical supervision need to be educated about risks associated with use.”

NIDA: Psilocybin mushroom seizures rose significantly

A National Institute on Drug Abuse (NIDA)‐funded study published in the journal Drug and Alcohol Dependence titled “National and Regional Trends in Seizures of Shrooms (Psilocybin) in the United States, 2017‐2022” reported a significant increase in law enforcement seizures of psilocybin mushrooms, also known as “magic mushrooms” or “shrooms,” in the United States from January 2017 to December 2022. The study is based on data from the White House Office of National Drug Control Policy's (ONDCP) High Intensity Drug Trafficking Areas (HIDTA) program, which tracks law enforcement seizures in hotspots across the country. Key findings include:

National and regional trends in seizures of shrooms (psilocybin) in the United States, 2017–2022

BackgroundPsilocybin, the principle psychoactive component in “shrooms”, is regaining acceptance in therapeutic settings, leading to media coverage of medical benefits associated with use. Possession is also becoming increasingly decriminalized throughout the United States. There is a lack of data on prevalence of shroom use, but trends in law enforcement seizure data can provide one indicator of shroom availability in US communities. We determined whether seizures of shrooms have shifted between 2017 and 2022. MethodsThis study examined national and regional trends in counts and total weight of shroom seizures reported to High Intensity Drug Trafficking Areas in the US between 2017 and 2022 (N=4526). ResultsThere were 402 seizures in 2017 compared to 1396 in 2022 with the plurality occurring in the Midwest (36.0%), followed by the West (33.5%). Between 2017 Quarter 1 (Q1) and 2022 Quarter 4 (Q4), the number of seizures increased by 368.9% (AQPC=7.0; 95 CI: 5.9–8.1) and there were significant increases in all four regions. In terms of weight, 226.0kg was seized in 2017 vs. 844.0kg in 2022, and the greatest total weight in seizures was in the West (1864.2kg, 42.6%), followed by the South (1831.9kg, 41.8%). Between 2017 Q1 and 2022 Q4, the total weight seized in the US increased by 2749.7% (AQPC=6.2, 95% CI: 0.3–12.4) and there were significant increases in all four regions. ConclusionsSeizures of shrooms have increased, suggesting that availability may be escalating; thus, increases in prevention efforts and harm reduction education are warranted.

Sexual Violence and Substance Use Diagnosed in Emergency Department Discharges in Hawaii, 2005–2014

Substance use (SU) and sexual violence (SV) present unique challenges when contextualizing their relationship due to underreporting of SU and SV. Both are significant public health concerns with a large magnitude and expense to the overall U.S. and to the state of Hawaii, which is identified as a high-intensity drug-trafficking area. Since substance users have a higher risk for sexual violence than the general public, this study aims to analyze the proportion and demographics of emergency department (ED) visit individuals reporting sexual violence with or without substance use disorder and examine how the number of ED visits of individuals diagnosed with SV and SU disorder compare to all individuals. Data from the Healthcare Cost and Utilization Project was used to examine the relationship between SV and SU. The database contained 3.5 million observations for 24 Hawaii hospitals from 2005-2014. The data was summarized in descriptive statistics and Chi-square tests were run to assess statistical significance for variables of interest. A greater proportion of individuals reporting sexual violence also reported substance use disorders compared to the general population of individuals. While 8% of all ED visits were related to SU, 17% of ED visits involving SV were also related to SU, demonstrating a statistically significant association between SV and SU. There is a greater need to further understand the complexity of the relationship between substance use and sexual violence. Sexual violence and substance use disorders share a complex relationship; survivors of sexual abuse may develop a substance use disorder, and those who use drugs and alcohol may be at an increased risk for sexual violence. Results from this study demonstrate visits for individuals reporting sexual violence have a greater proportion of substance use disorder than visits for the general population.

Supply-side predictors of fatal drug overdose in the Washington/Baltimore HIDTA region: 2016-2020.

Rising rates of fentanyl- and polydrug-involved drug overdose deaths have prompted inquiry into the role of drug supply in fatal overdose outcomes in the United States. To date, however, there have been few empirical investigations of drug enforcement strategies on fatal overdose rates, despite knowledge that both drug use and supply are often geographically distributed. To address this limitation, we examined measures of drug enforcement as predictors of next-year fatal overdose rates in the Washington/Baltimore High Intensity Drug Trafficking Area (W/B HIDTA). We conducted mixed-effects models to examine the role of drug seizures and disruption in drug trafficking organizations (DTOs) and money laundering organizations (MLOs) on fatal overdose rates over a 5-year period (2016-2020) across 45 local jurisdictions in the W/B HIDTA region. Outcomes included any, opioid-involved, and fentanyl-involved fatal overdose. Adjusting for covariates, both the total number of drug seizures and amount of cocaine seized (in dosage units per capita) positively predicted next-year opioid- and fentanyl-involved fatal overdose rates. Disruption to DTO and MLO operations did not significantly predict next-year fatal overdose rates for any outcome. Supply-side enforcement activities alone may have limited impact on reducing fatal overdose rates, but may serve as important markers to identify communities at high risk of fatal overdose and facilitate targeted intervention. Our findings underscore the importance of comprehensive law enforcement approaches that extend beyond drug enforcement to integrate prevention, linkage to treatment, and harm reduction strategies as needed to address the overdose epidemic.

Trends in seizures of powders and pills containing illicit fentanyl in the United States, 2018 through 2021

BackgroundPrevalence of fentanyl-laced counterfeit prescription pills has been increasing in the US, possibly placing a wider population at risk for unintentional exposure. We aimed to determine whether there have been shifts in the number of fentanyl seizures and in the form of fentanyl seized in the US. MethodsWe examined quarterly national seizure data from High Intensity Drug Trafficking Areas to determine the number of drug seizures in the US containing fentanyl from January 2018 through December 2021. Generalized additive models were used to estimate trends in the number and weight of pill and powder seizures containing fentanyl. ResultsThere was an increase both in the number of fentanyl-containing powder seizures (from 424 in 2018 Quarter 1 [Q1] to 1539 in 2021 Quarter 4 [Q4], β = 0.94, p < 0.001) and in the number of pill seizures (from 68 to 635, β = 0.96, p < 0.01). The proportion of pills to total seizures more than doubled from 13.8% in 2018 Q1 to 29.2% in 2021 Q4 (β = 0.92, p < 0.001). Weight of powder fentanyl seizures increased from 298.2 kg in 2018 Q1 to 2416.0 kg in 2021 Q4 (β = 1.12, p = 0.01); the number of pills seized increased from 42,202 in 2018 Q1 to 2,089,186 in 2021 Q4 (β = 0.90, p < 0.001). ConclusionsSeizures of drugs containing fentanyl have been increasing in the US. Given that over a quarter of fentanyl seizures are now in pill form, people who obtain counterfeit pills such as those disguised as oxycodone or alprazolam are at risk for unintentional exposure to fentanyl.

Using Surveillance With Near-Real-Time Alerts During a Cluster of Overdoses From Fentanyl-Contaminated Crack Cocaine, Connecticut, June 2019.

In 2019, Connecticut launched an opioid overdose-monitoring program to provide rapid intervention and limit opioid overdose-related harms. The Connecticut Statewide Opioid Response Directive (SWORD)-a collaboration among the Connecticut State Department of Public Health, Connecticut Poison Control Center (CPCC), emergency medical services (EMS), New England High Intensity Drug Trafficking Area (HIDTA), and local harm reduction groups-required EMS providers to call in all suspected opioid overdoses to the CPCC. A centralized data collection system and the HIDTA overdose mapping tool were used to identify outbreaks and direct interventions. We describe the successful identification of a cluster of fentanyl-contaminated crack cocaine overdoses leading to a rapid public health response. On June 1, 2019, paramedics called in to the CPCC 2 people with suspected opioid overdose who reported exclusive use of crack cocaine after being resuscitated with naloxone. When CPCC specialists in poison information followed up on the patients' status with the emergency department, they learned of 2 similar cases, raising suspicion that a batch of crack cocaine was mixed with an opioid, possibly fentanyl. The overdose mapping tool pinpointed the overdose nexus to a neighborhood in Hartford, Connecticut; the CPCC supervisor alerted the Connecticut State Department of Public Health, which in turn notified local health departments, public safety officials, and harm reduction groups. Harm reduction groups distributed fentanyl test strips and naloxone to crack cocaine users and warned them of the dangers of using alone. The outbreak lasted 5 days and tallied at least 22 overdoses, including 6 deaths. SWORD's near-real-time EMS reporting combined with the overdose mapping tool enabled rapid recognition of this overdose cluster, and the public health response likely prevented additional overdoses and loss of life.

Longitudinal Opioid Surveillance Project Involving Toxicologic Analysis of Postmortem Specimens from 9 Counties in Michigan Suggests the Discovery of New High-Intensity Drug Trafficking Areas.

Acetyl fentanyl (AF) is a Schedule I fentanyl analog that has been increasingly seen in heroin and fentanyl polydrug toxicity overdoses in Michigan (MI). Drug users are often unaware of the presence of AF in their drugs because it is often sold mixed into or disguised as heroin. High levels of AF in heroin drug products can cause increased incidence of overdose. This article describes data from a longitudinal opioid surveillance program and details 102 decedents in MI who were found to have evidence of heroin in their postmortem blood. A large portion of these decedents were also found to have evidence of fentanyl and AF. Our data further show significant overlap in incidence rates of AF and heroin-related overdose deaths in several MI counties, suggesting that AF is becoming enmeshed in heroin trafficking. Furthermore, we report unprecedented high incidence rates of AF and heroin-related overdose deaths in Calhoun county, and we propose that it is a high-intensity drug trafficking area. Highways US-131 and US-31 are likely used to transport these drugs. More study is needed into the drug trafficking trends in MI to ascertain drug sources and monitor the ever developing and dangerous polydrug heroin combinations.

Marijuana, Methamphetamine Confiscations Rose During COVID-19 Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessMarijuana, Methamphetamine Confiscations Rose During COVID-19 PandemicTerri D'ArrigoTerri D'ArrigoSearch for more papers by this authorPublished Online:28 Apr 2021https://doi.org/10.1176/appi.pn.2021.5.9AbstractDrug seizures by law enforcement dipped in the early days of the pandemic, then rebounded last summer.iStock/iKaleb KroetschLaw enforcement confiscation of illegal drugs dipped early in the COVID-19 pandemic, then began to rise, according to a study in Drug and Alcohol Dependence. These changes were most pronounced for marijuana and methamphetamine, where seizures of these drugs exceeded pre-COVID-19 numbers in August of last year.“While drug seizures aren’t a great indicator of drug use, they can serve as an indicator for drug availability,” said lead author Joseph J. Palamar, Ph.D., M.P.H., an associate professor in the Department of Population Health at New York University Langone Medical Center.Palamar and colleagues analyzed law enforcement seizures of illegal drugs in five key regions in the Office of National Drug Control Policy’s High Intensity Drug Trafficking Areas Program: Chicago, Ohio, New Mexico, North Florida, and Washington, D.C./Baltimore. They examined monthly seizure trends in confiscations of cocaine, fentanyl, heroin, marijuana, and methamphetamine from March 2019 (one year before the COVID-19 pandemic) to September 2020.The overall number of seizures was less in April 2020 compared with March 2019, and then began to climb. In August 2020, there were 2,088 drug confiscations overall compared with 1,777 in June 2019, the peak of pre-pandemic seizures.Drug confiscations should not be taken as an indication of drug use, but of drug availability, says Joseph J. Palamar, Ph.D., M.P.H.New York University Langone Health“I wasn’t surprised that the number of seizures decreased early in the pandemic, but I was a bit surprised that seizures in late summer of 2020 surpassed peaks in 2019,” Palamar told Psychiatric News. “It makes me wonder whether drug availability has really increased that much or if law enforcement merely caught up from [re]laxed activity earlier in the pandemic.”Marijuana and methamphetamine seizures drove the overall increase in drug confiscations. Marijuana confiscations climbed to 665 in August 2020, compared with a pre-pandemic high of 614 in March 2019. Law enforcement seized 11,194 kg of marijuana in August 2020, compared with the highest pre-COVID weight of 4,744 kg in December 2019. Methamphetamine seizures also increased after an initial decline early in the pandemic. In August 2020 there were 476 methamphetamine confiscations, compared with 385 in June 2019. However, the weight of methamphetamine seized did not significantly change. Before the pandemic hit, marijuana and methamphetamine confiscations had been declining, but the rebound in confiscations of both drugs in the summer of 2020 were enough to derail the downward trend.Fentanyl seizures dipped in April 2020 and then rebounded. However, the April decline was not enough to disrupt an overall upward trend in confiscations from the beginning of the study, leading the researchers to conclude that fentanyl confiscations have increased over time. Cocaine and heroin seizures dipped at the start of the pandemic and then rebounded, but confiscations of both drugs declined over time.Palamar emphasized that drug confiscations should not be considered an indication of illicit drug use. However, some of the data in this study may dovetail with those of studies that track use.“Some studies suggest that a lot of people who already used marijuana increased use during the pandemic. If this is the case, then there may be higher demand, even if the increase in demand is based on the same people who [used marijuana before the pandemic],” he said. “Methamphetamine use has [also] been increasing again in recent years, especially among people who use heroin.”This study was supported by the National Institute on Drug Abuse. ■“Shifts in Drug Seizures in the United States During the COVID-19 Pandemic” is posted here. ISSUES NewArchived

Shifts in drug seizures in the United States during the COVID-19 pandemic

BackgroundLittle is known regarding how the COVID-19 pandemic has affected patterns of drug use in the United States. Because drug seizures can serve as a proxy for drug availability, we examined shifts in drug seizures in the US during the pandemic. MethodsWe examined trends in seizures of marijuana, cocaine, methamphetamine, heroin, and fentanyl within five High Intensity Drug Trafficking Areas—Washington/Baltimore, Chicago, Ohio, New Mexico, and North Florida. Trends were examined for number and total weight of seizures from March 2019 through September 2020 using Joinpoint regression. ResultsSignificant decreases in seizures involving marijuana (β = −0.03, P = 0.005) and methamphetamine (β = −0.02, P = 0.026) were detected through April 2020, and then seizures of marijuana (β = 0.10, P = 0.028) and methamphetamine (β = 0.11, P = 0.010) significantly increased through September 2020. The number of seizures involving marijuana and methamphetamine peaked in August 2020, exceeding the highest pre-COVID-19 number of seizures. Fentanyl seizures increased overall (β = 0.05, P < .001), but did not significantly drop during the start of COVID-19, and significant changes were not detected for cocaine or heroin. We also detected a significant increase in weight of marijuana seized from April through September 2020 (β = 0.40, P = .001). The weight of marijuana seized in August 2020 exceeded the highest pre-COVID-19 weight. ConclusionThe COVID-19 pandemic was associated with an immediate decrease in marijuana and methamphetamine seizures, and then increases throughout 2020 with some months exceeding the number (and weights) of seizures from the previous year. More research is warranted to determine the extent to which these seizures reflect changes in drug use.

Local Health Department Partnerships to Address Opioid Use and Overdose Prevention.

Local Health Department Partnerships to Address Opioid Use and Overdose Prevention.

Opioid Seizures by Law Enforcement in Relation to Emergency Room Visits

Opioid Seizures by Law Enforcement in Relation to Emergency Room Visits

Neonatal Abstinence Syndrome (NAS) in Southwestern Border States: Examining Trends, Population Correlates, and Implications for Policy.

Introduction Neonatal abstinence syndrome (NAS) is withdrawal syndrome in newborns following birth and is primarily caused by maternal drug use during pregnancy. This study examines trends, population correlates, and policy implications of NAS in two Southwest border states. Materials and Methods A cross-sectional analysis of Hospital Inpatient Discharge Data (HIDD) was utilized to examine the incidence of NAS in the Southwest border states of Arizona (AZ) and New Mexico (NM). All inpatient hospital births in AZ and NM from January 1, 2008 through December 31, 2013 with ICD9-CM codes for NAS (779.5), cocaine (760.72), or narcotics (760.75)were extracted. Results During 2008-2013 there were 1472 NAS cases in AZ and 888 in NM. The overall NAS rate during this period was 2.83 per 1000 births (95% CI 2.68-2.97) in AZ and 5.31 (95% CI 4.96-5.66) in NM. NAS rates increased 157% in AZ and 174% in NM. NAS newborns were more likely to have low birth weight, have respiratory distress, more likely to have feeding difficulties, and more likely to be on state Medicaid insurance. AZ border region (border with Mexico) had NAS rates significantly higher than the state rate (4.06 per 1000 births [95% CI 3.68-4.44] vs. 2.83 [95% CI 2.68-2.97], respectively). In NM, the border region rate (2.09 per 1000 births [95% CI 1.48-2.69]) was significantly lower than the state rate (5.31 [95% CI 4.96-5.66]). Conclusions Despite a dramatic increase in the incidence of NAS in the U.S. and, in particular, the Southwest border states of AZ and NM, there is still scant research on the overall incidence of NAS, its assessment in the southwest border, and associated long-term outcomes. The Healthy Border (HB) 2020 binational initiative of the U.S.-Mexico Border Health Commission is an initiative that addresses several public health priorities that not only include chronic and degenerative diseases, infectious diseases, injury prevention, maternal and child health but also mental health and addiction. The growing opioid epidemic and rise in NAS cases in the Southwest border, as partially shown in this study, provides another opportunity to track health illnesses and outcomes in the Southwest border, especially because there are targeted resources through High Intensity Drug Trafficking Areas (HIDTA) funding.

Patterns and trends in accidental poisoning death rates in the US, 1979–2014

ObjectivesThe purpose of this study was to examine US accidental poisoning death rates by demographic and geographic factors from 1979 to 2014, including High Intensity Drug Trafficking Areas. MethodsCrude and age-adjusted death rates were formed for age group, race, sex, and county for accidental poisonings (ICD 9th revision: E850–E869; ICD 10th revision: X40–X49) from 1979 to 2014 using the Mortality and Population Data System housed at the University of Pittsburgh. Rate ratios were calculated comparing rates from 2014 to 1979, overall, by sex, age group, race, and county. Joinpoint regression detected changes in trends and calculated the average annual percentage change (AAPC) as a summary measure of trend. ResultsDrug poisoning mortality rates have risen an average of 6% per year since 1979. Increases are occurring in all ages 15+, and in all race–sex groups. HIDTA counties with the highest mortality rates were in Appalachia and New Mexico. Many of the HIDTA border counties had lower rates of mortality. ConclusionsThe drug poisoning mortality epidemic is continuing to grow. While HIDTA resources are appropriately targeted at many areas in the US most affected, rates are also rapidly rising in some non-HIDTA areas.

Developing a Multicenter Randomized Trial in Criminology: The Case of HIDTA

In criminal justice, as in other fields, an experimental study conducted ata single site does not offer a solid basis upon which to make strong publicpolicy recommendations. To date, criminal justice researchers have reliedupon two general approaches to overcome the limitations of single-siteexperimental research. The first, termed ``meta-analysis,” seeks tocombine independent studies to identify consistent effects across criminaljustice settings or contexts. The second, sometimes termed “replicationstudies,” seeks to replicate investigations in multiple criminaljustice jurisdictions. In this paper we describe a related approachdeveloped in clinical studies in medicine and examine its applicabilityin criminal justice settings. Termed a “multicenter clinicaltrial,” this method demands the implementation ofa single experimental protocol at multiple sites. We contrast themulticenter approach with other methods and provide a substantiveexample of an ongoing multicenter criminal justice study. We begin byexamining the specific limitations of current approaches and solutionsoffered by multicenter studies to overcome these. We then turn to anapplication of the multicenter clinical trial in a criminal justicesetting. Using the example of the HIDTA (High-Intensity Drug TraffickingAreas) evaluation of drug treatment programs currently being conducted atmultiple sites, we illustrate components of the multicenter approach aswell as potential drawbacks researchers are likely to face in itsapplication in crime and justice studies.

Drug use in the high intensity drug trafficking area of the US Southwest border.

This paper examines the prevalence of alcohol, tobacco and illicit drug use in the Southwest border region of the United States. Based on the seriousness of drug trafficking in the area, the Southwest border has been designated a "High Intensity Drug Trafficking Area." Yet there is little quantitative data on the nature and magnitude of drug use in the Southwest border region. This paper examines the prevalence of drug use in the area by extracting data from the National Household Survey on Drug Abuse. The data show that drug use rates in the Southwest border area are very similar to those found throughout the remainder of the United States. Hispanics, who constitute about 41% of the Southwest border population, have lower prevalence rates for most classes of drugs than non-Hispanics. The border Hispanics exhibit even lower prevalence rates than Hispanics in the remainder of the United States. However, many of these differences are attributable to the lower levels of drug use among women, and youth and older adults. As these demographic subgroups become increasingly acculturated, their drug use could come to more closely resemble that of their peers in the remainder of the United States.

Drug use in the high intensity drug trafficking area of the US Southwest border

Drug use in the high intensity drug trafficking area of the US Southwest border