Title: 1998 Annual Report on Opiate Use Among Arrestees.
Series: Research Report
Author(s): NIJ
Published: National Institute of Justice, April 1999
Subject(s): ADAM, drug abuse, drug testing
13 pages
29,000 bytes

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1998 Annual Report on Opiate Use Among Arrestees

ADAM
Arrestee Drug Abuse Monitoring Program

A Program of the National Institute of Justice
Research Report

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U.S. Department of Justice
Office of Justice Programs
810 Seventh Street N.W.
Washington, DC 20531

Janet Reno
Attorney General

Raymond C. Fisher
Associate Attorney General

Laurie Robinson
Assistant Attorney General

Noel Brennan
Deputy Assistant Attorney General

Jeremy Travis
Director, National Institute of Justice

Office of Justice Programs  
World Wide Web Site
http://www.ojp.usdoj.gov

National Institute of Justice
World Wide Web Site
http://www.ojp.usdoj.gov/nij

ADAM Program
World Wide Web Site
http://www.adam-nij.net

Justice Information Center
World Wide Web Site
http://www.ncjrs.org

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U.S. Department of Justice
Office of Justice Programs

National Institute of Justice
Jeremy Travis
Director

K. Jack Riley, Ph.D.
ADAM Director

NCJ 175657

The National Institute of Justice is a component of the Office of Justice
Programs, which also includes the Bureau of Justice Assistance, Bureau of
Justice Statistics, Office of Juvenile Justice and Delinquency Prevention,
and the Office for Victims of Crime.

-------------------------------

Acknowledgments

NIJ
K. Jack Riley, ADAM Director
Christine Crossland
Nora Fitzgerald

Tom Hay
Natalie Lu
Gerald Soucy
Bruce Taylor

Abt Associates
Dana Hunt, Project Director
Phyllis Newton, Project Manager
Kyla Carrigan
Sarah Kuck
Quentin McMullen
Carol Putnam
William Rhodes
Tom Rich
George Yacoubian
Sylvia Young

DBA Design
Patricia L. Blake
Pearl Jusem
Jude Menz

Contents

Acknowledgments
Introduction
Opiate Trends in ADAM Data, 1990-98
Regional Variation
Opiate Use by Age Cohort
Poly-Drug Use Among Opiate Users
Summary

Introduction

In 1998, the Arrestee Drug Abuse Monitoring (ADAM) program expanded
from 23 to 35 urban sites across the United States. These new sites include
Albuquerque, Anchorage, Des Moines, Laredo, Las Vegas, Minneapolis,
Oklahoma City, Sacramento, Salt Lake City, Seattle, Spokane, and
Tucson. For many of the new sites, this report represents the first look at
rates of opiate[1] use in their felony and serious misdemeanor arrestee
populations.

Across the 35 urban sites currently participating in ADAM in 1998, adult
male respondents tested positive for recent (within 72 hours) opiate use at
rates ranging from a high of 18.4 percent in Philadelphia to a low of 1.3
percent in Atlanta. For the 32[2] sites that collected data on female
arrestees during 1998, the proportion of arrestees testing positive for
opiates ranges from 27.0 percent in Chicago to no positive tests in Laredo.
Among the new sites, adult male opiate-positive rates range from 17.4
percent (Seattle) to 1.9 percent (Oklahoma City), indicating that ADAM's
new Western sites report rates consistent with the general distribution of
opiate-positive rates. For adult females in new sites, the opiate-positive
rate ranged from 17.2 percent in Seattle to no positive tests in Laredo.
Among all adult male arrestees, the median site rate of opiate positives
increased from 5.5 percent in 1997 to 6.0 percent in 1998. For females, the
site median decreased from 8.2 percent in 1997 to 7.4 percent in 1998.
Among the new sites, Seattle's adult male opiate-positive rate of 17.4
percent clearly exceeds all other new sites with the next highest rate in
Laredo (11.2 percent).

Among the veteran sites in 1998, six sites experience adult male
opiate-positive rates in excess of 10 percent: Philadelphia (18.4 percent),
Chicago (18.3 percent), New York City (16.2 percent), Portland (15.5
percent), New Orleans (12.9 percent), and St. Louis (10.9 percent). Adding
the new sites, Seattle (17.4 percent) and Laredo (11.2 percent), helps to
illustrate that the higher adult male opiate-positive rates occur across all
regions of the country. In 1998, six veteran ADAM sites show
opiate-positive rates greater than 10 percent for females, with 4 reporting
rates greater than 20 percent (Chicago, Detroit, New York City, and
Portland). Among female arrestees in the new sites, five sites
(Albuquerque, Las Vegas, Salt Lake City, Seattle, and Spokane) report
opiate-positive rates greater than 10 percent, but less than 20 percent.

In general, a higher proportion of female arrestees than male arrestees test
positive for opiates at both new and veteran sites. In 1998, male arrestees
show opiate-positive rates in excess of female arrestees by at least 5
percentage points in only 3 sites: two veteran (New Orleans and St. Louis)
and one new (Laredo). In Laredo, no female arrestees tested positive for
opiates. In 1990, female arrestees tested positive for opiate use at higher
proportions than their male counterparts in all sites. 

An examination of the two most recent years of ADAM data collection
results (1997 and 1998) indicates that combined male and female
opiate-positive rates have remained relatively stable with no change
greater than 5 percentage points in all 23 veteran sites. However, because
most sites reported low (less than 10 percent) opiate-positive rates, it is
difficult to determine the importance of slight increases or decreases (see
"Methodology," page 2). San Jose female arrestees experienced the
greatest decrease in opiate positives (6.7 percentage points) between 1997
and 1998, while Birmingham female arrestees experienced the greatest
increase (12.9 percentage points). Phoenix showed the greatest decrease of
3.7 percentage points in male opiate positives between 1997 and 1998.
Among male arrestees, Philadelphia was the only site with a notable
increase, reporting 10.9 percent in 1997 and 18.4 percent in 1998.

Because current sampling methods do not represent probability-based
sampling, we cannot determine whether the small shifts described above
are significant. In addition, the differences between 1997 and 1998 should
be viewed with extra caution because, as part of ADAM's current move
toward probability-based sampling at the county level, many sites have
begun the process of sampling in increasing numbers and facilities,
making comparisons difficult. For example, in New York City the
program is now operating in all five boroughs, rather than only Manhattan
as in all previous years. In Los Angeles, interviewing is conducted at
several outlying facilities in Los Angeles County that were not included in
1997.

Overall, analysis of opiate-positive arrestees participating in the ADAM 
program between 1990 and 1998 suggests that little has changed over the
course of the past nine years for this group of arrestees. The addition of 12
new ADAM sites in 1998 illustrates that opiate use among arrestees is not
an East Coast phenomenon. In general, female arrestees tend to use opiates
at higher rates than males, and older arrestees use opiates at higher rates
than younger arrestees. Opiate users also tend to be poly-drug users, with
cocaine being the other drug they are most likely to use. While poly-drug
opiate users tend not to use methamphetamine in high numbers, sites west
of the Mississippi River are much more likely than their Eastern
counterparts to have arrestees who test positive for methamphetamine in
addition to testing positive for opiates. These factors are discussed in more
detail after an overview of 1990-98 trends.

Opiate Trends in ADAM Data, 1990-98[4]

The Arrestee Drug Abuse Monitoring (ADAM) program has surveyed
more than 180,000 adult male and nearly 70,000 adult female arrestees
between 1990 and 1998. Before discussing opiate trends among ADAM
program participants, it is important to emphasize that opiates represent a
small portion of the drugs for which arrestees test positive. Between 1990
and 1998, Drug Use Forecasting (DUF)/ADAM arrestees have tested
positive for opiate use at relatively low rates compared to cocaine and
marijuana. Of the ten drugs for which arrestees are tested, they have been
most likely to test positive for cocaine (42.0 percent), followed by
marijuana at 27.2 percent and opiates at 8.5 percent. Of each of the
remaining drugs, less than 5 percent of all surveyed arrestees test 
positive.[5]

Tables 1 and 2 provide opiate trend information across sites by gender. In
general, the changes for male and female arrestees in each site from year
to year are small. In the 1990-98 period for veteran sites, 12 sites show
reductions in opiate rates among male arrestees and 10 show increases.
San Diego males show the greatest reduction, from 19.0 percent in 1990 to
9.3 percent in 1998. Rates for males in Chicago, Los Angeles, and San
Antonio have decreased more than five percentage points.

Eight sites show reductions greater than five percentage points in the rates
of females who tested positive for opiates. San Diego females have
experienced the greatest decrease, dropping over the 9-year period from
22.3 percent in 1990 to 6.7 percent in 1998. There are increases of greater
than five percentage points in two sites among females testing positive for
opiates, with Birmingham showing the greatest increase (6.9 percentage
points). In general, female opiate data are based on a small number of
cases, and thus small percentage point changes may not be significant.

Regional Variation

Opiate-positive rates among recent arrestees tend to vary by region of the
country. For comparison purposes, we have assigned each ADAM site to
one of five geographic regions: Northwest, West/Southwest, Midwest,
South, and Northeast. The highest opiate-positive rate increases occur in
the Midwest, South, and Northeast, and the smallest in the
West/Southwest. 

The findings suggest that opiate use among all arrestees in recent years
appears to be highest in the Northwest and Northeast regions of the United
States. Each region, however, is likely to have at least one large city where
opiate rates are substantially higher than the regional average. 

Chicago's 1998 opiate-positive rate for males is 18.3 percent, substantially
higher than other Midwest sites collecting male data, whose rates range
from an overall low of 1.8 percent to a high of 10.9 percent. Similarly,
New Orleans's overall male opiate-positive rate (12.9 percent) exceeds
other positive rates in the South. Chicago's opiate-positive rate for females
is 27.0 percent and Detroit's rate is 21.5 percent, both substantially higher
than other Midwest sites collecting female data. Similarly, Birmingham's
overall female opiate-positive rate (17.6 percent) well exceeds other
positive rates in the South. In the West/Southwest, three new sites report
female rates for opiates greater than 10 percent: Albuquerque, Las Vegas,
and Salt Lake City.

In short, while region appears to make some difference in opiate patterns,
with the Northeast and Northwest showing much higher opiate-positive
rates, major U.S. cities outside the Northeast and Northwest (including
Birmingham, Chicago, Detroit, New Orleans, and St. Louis) also show
high rates of opiate use. 

Opiate Use by Age Cohort

Changes in drug-use patterns among age groups, or cohorts, often provide
a window on the future of overall drug use. If use rates increase among
younger arrestees, communities may feel the impact of this increase for the
collective duration of the drug users' careers. All other factors equal,
younger drug users have more time left in their drug using careers than
older drug users. To examine how age might relate to opiate use, five age
categories (15-20, 21-25, 26-30, 31-35, and 36 and older) were created and
compared along opiate use. Table 3 shows six sites where the overall male
opiate-positive rate in 1998 exceeds 10 percent. Table 4 shows similar
results for females in the six sites where overall opiate positives in 1998
exceed 10 percent. For 1998, veteran sites with trend data available show
the older users (31 and older) have the highest prevalence rate in 18 of 23
sites for males and 18 of 22 sites for females. 

From 1990 to 1998, the proportion of adult male opiate positives
decreased more than five percentage points among the oldest arrestees (36
and older) in 11 sites. Of these, 5 sites (Detroit, Los Angeles, San Antonio,
San Diego, and San Jose) registered decreases greater than 10 percentage
points in male opiate positives from 1990 to 1998 among older users.
During the same time period, none of these 11 sites experienced an
increase in the youngest male age cohort. Detroit, Los Angeles, San
Antonio, and San Jose all experienced fluctuations in the adult male
opiate-positive rates for 15- to 20-year-olds from 1990 to 1998, but overall
their 1998 rates do not differ from their 1990 rates.

Over the 9-year period, the proportion of adult male opiate positives
increased more than 5 percentage points among the youngest arrestees
(15-20 year olds) in 4 sites (Houston, New Orleans, Philadelphia, and St.
Louis). Of these, New Orleans and St. Louis registered increases greater
than 9 percentage points. In contrast, Chicago showed a decrease in opiate
prevalence among young adult males of more than 5 percentage points.

Over the 9-year period, the proportion of adult female opiate positives
decreased more than 5 percentage points among the oldest arrestees (36
and older) in 13 sites. Of these, 6 sites (Atlanta[6], Los Angeles, New
Orleans, San Antonio, San Jose, and Washington, D.C.) registered
decreases greater than 10 percentage points, and San Diego's female
opiate-positive rate decreased by more than 30 percentage points. The
corresponding results for the 15-20 age cohort were mixed. New Orleans,
San Antonio, and Washington, D.C. all experienced fluctuations in the
adult female opiate-positive rates for 15- to 20-year-olds from 1990 to
1998, but overall their 1998 rates do not differ from their 1990 rates. In the
same age category, Los Angeles's opiate-positive rate for females is up 3.7
percentage points from 1.6 percent in 1990 to 5.3 percent in 1998. San
Jose has experienced a decrease in the youngest female users of greater
than 5 percentage points from 1990 to 1998.

From 1990 to 1998, two sites (Detroit and Portland) showed an increase in
opiate prevalence among the oldest female users of more than 5 percentage
points, while Birmingham and Omaha reported increases of more than 10
percentage points. Interestingly, Detroit and Portland reported decreases in
their youngest female users (15-20) of more than 5 percentage points;
Birmingham's opiate-positive rate for 15-20 year old females fluctuated
but resulted in no net change.

In summary, in 1998 older arrestees were more likely to test positive for
opiate use. There are a few sites in which a growing number of young
users appear. Areas such as New Orleans and St. Louis have an increasing
number of younger opiate users, but there is little evidence of more
widespread growth in opiate use among arrestees, particularly in recent
years.

Poly-Drug Use Among Opiate Users

Opiate users in the ADAM sites frequently test positive for other drugs 
in addition to opiates, most often cocaine. In the years from 1990-1998,
68.8 percent of all arrestees who test positive for opiates also test positive
for cocaine. In addition, opiate-positive arrestees test positive for
marijuana (23.0 percent), benzodiazepines (16.2 percent), and methadone
(10.2 percent), but rarely for methamphetamine (4.1 percent), barbiturate
(2.4 percent), PCP (2.2 percent), and propoxyphene (Darvon) (1.8
percent). The types of drugs opiate users consumed also varied across
sites. Table 5[7] provides the percentage of opiate-positive male and
female arrestees who also test positive for cocaine, marijuana,
benzodiazepines, or methamphetamine for selected sites.

Three sites (Chicago, New York City and Washington, D.C.) showed
levels of cocaine use among opiate-using arrestees greater than 70 percent
for virtually every year between 1990 and 1998. In 1990, 19 of 23 male
sites and 15 of 21 female sites showed concurrent cocaine/opiate user rates
greater than 50 percent. In 1997, 15 of 23 male sites and 15 of 21 female
sites showed concurrent cocaine/opiate user rates greater than 50 percent.
In 1998, 19 of 23 male sites and 16 of 21 female sites witnessed similarly 
high levels of cocaine/opiate use.

In an effort to determine whether these high cocaine-positive rates
represent powder or crack cocaine use, arrestees' self-report of whether
they had used powder or crack cocaine within the past 72 hours was
examined.[8]  Table 6[9] presents the percentage of opiate positive
arrestees who report using powder cocaine, crack, or both powder cocaine
and crack for select sites. During the years 1990-98, the proportion of
opiate-using arrestees who reported using powder cocaine declined and the
proportion who reported using crack cocaine increased. Opiate-using
arrestees reported powder use more frequently than crack use in the
1990-96 period. However, beginning in 1997, self-reported crack cocaine
use began to dominate. Throughout, less than 10 percent of opiate-positive
arrestees reported using both powder and crack cocaine within the past 72
hours.

The rate at which arrestees who use opiates also tested positive for
marijuana has risen fairly consistently since 1990, from an average of 15.2
percent in 1990 to an average of 29.7 percent in 1998. In 18 sites, the
percentage point change between 1990 and 1998 for opiate positive males
was 5 percent or greater. In 15 sites, the marijuana-positive rate for opiate
positive females increased 5 percent or greater. In New Orleans, the
frequency of opiate users also testing positive for marijuana nearly
doubled, rising from 28.6 percent in 1990 to 56.3 percent in 1998 for adult
males, and 16.2 percent in 1990 to 30.8 percent in 1998 for adult females.
Ten of the veteran and 5 of the new sites showed more than 30 percent of
opiate users also testing positive for marijuana in 1998, while only
Portland had a level of combined use that high in 1990. Male arrestees in
two veteran sites (Portland and San Jose) witnessed a decrease in
marijuana-positive rates among opiate-positive arrestees; female arrestees
in three veteran sites (Indianapolis, Portland, and San Jose) witnessed
decreases, with Birmingham decreasing slightly by 1998.

Opiate-positive arrestees also tested positive for benzodiazepines, though
at lower levels than for cocaine or marijuana. From 1990 to 1998, the
average benzodiazepine-positive rate for opiate-positive arrestees hovered
around 18 percent, from an average low of 15.5 percent in 1995 to an
average high of 19.8 percent in 1991. 

Methamphetamine use among opiate users was generally quite low.
However, the average percentage of opiate users who also test positive for
methamphetamine among new sites was 12.0 percent in 1998, compared
to an average methamphetamine rate of 4.4 percent for all veteran sites. In
1998, 25 percent or more of opiate users in Las Vegas (males), San Diego
(males and females), San Jose (females), and Spokane (males and females) 
tested positive for methamphetamine. 

Some sites report unusually high levels of specific drugs among their
opiate users. For example, Western sites that have higher rates of
methamphetamine positives in general have higher rates of combined
opiate/methamphetamine use as well. On the other hand, New York City
reports that in 1998 more than 30 percent of its opiate-positive arrestees
also test positive for methadone. These findings suggest that there is value
to analyzing the data at the local level to better understand the context of
local drug use patterns.

Summary

Our review of opiate use among ADAM participants suggests that opiate
use among arrestees has remained fairly stable during the past nine years.
However, rates of testing positive for opiates vary considerably from site
to site each year. Several sites have witnessed reductions in the rate of
opiate positives among their arrestee populations, while one site
(Philadelphia) has witnessed a notable an increase in the proportion of
arrestees testing positive for opiates.

In general, a higher proportion of female arrestees than male arrestees test
positive for opiate use. Similarly, older arrestees are more likely than
younger arrestees to test positive for opiates. However, New Orleans and
St. Louis have experienced age shifts in the last few years; in these sites
the youngest as opposed to the oldest age categories are more likely to test
positive for opiates. Moreover, opiates are found throughout the U.S.,
somewhat more frequently in the Northeast and Northwest. 

Many opiate users also use other drugs; from 1990-1998 almost 70 percent
of arrestees testing positive for opiates also test positive for cocaine and
nearly 25 percent test positive for marijuana use. Although, in general,
opiate-using arrestees do not use methamphetamine, sites with high rates
of methamphetamine also find users combining opiates and
methamphetamine.

In the coming years, it will be important to monitor whether additional
sites begin to see a shift among opiate-positive arrestees to younger age
cohorts as well as the extent to which opiate-using arrestees continue to
use other drugs. There has been some concern in recent years that, as the
price of heroin decreases and purity increases, there will be a resurgence of
use similar to that seen in the late 1960s and early 1970s. That trend, to
date, does not seem to be widely reflected among ADAM arrestees.

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METHODOLOGY

To gauge drug use trends in urban areas, the National Institute of Justice
established the Drug Use Forecasting (DUF) program in 1987. A modified
version of DUF, the Arrestee Drug Abuse Monitoring (ADAM) program,
was initiated in 1997. To date, 35 jurisdictions participate in ADAM.
ADAM involves administration of a survey instrument, which measures
historical and current drug use patterns among arrestees, and collection of
a urine sample which is tested for 10 drugs. A more detailed overview of
data collection methods can be found in the 1998 Annual Report on Drug
Use Among Adult and Juvenile Arrestees.[3] This box discusses how data
collection methods have affected reporting methods and two significant
reporting changes that will appear in next year's reports. 

The first and most important change relates to sampling. Data collected
after the mid-point of 1999 in all sites will be collected under probability
sampling plans. This means that confidence intervals can be attached to
estimates derived from ADAM data which in turn means that analysts can
assess whether year-to-year changes in drug prevalence rates are
significant. For example, this year in New York City, the cocaine
prevalence for males fell from 57.6 percent in 1997 to 47.1 percent in
1998. ADAM cannot report that as a statistically significant decline
because of limits to the current sampling plans. The 1999 reports will
introduce reporting on standard errors and confidence intervals.

The second important change relates to weighting the data. Each case
collected represents similar respondents (age, race, and booking charge to
name a few characteristics of interest) that were not selected for interview.
If a certain category of offender is represented out of proportion to the
actual occurrence in the arrest population, weighting can be used to correct
the disproportionality. There are numerous factors that introduce
disproportion into the data. The jails included in the program have
changed over time, most recently as a result of standardizing site
catchment areas at the county level. In addition, the DUF program
operated according to a charge priority system that emphasized
interviewing and testing felony offenders over misdemeanants. Drug
offenders, who are more likely to test positive for drugs than their
non-drug-offending counterparts, were limited to 20 percent of the total
sample to prevent drug offenders from dominating the data. Traffic
offenses (e.g., DUI and DWI) were generally excluded from the sample.
These practices were revised in the second quarter of 1998 data collection
so that all arrestees, regardless of charge, are eligible for inclusion in the
ADAM study. 

This year's data, as well as data collected during previous years, could be
weighted by local arrest data to adjust for the data collection methods. We
chose not to weight the data for two reasons. First, there may be additional
changes in the data collection protocol this year that would change the
weighting process, forcing us to revise the entire weighted data series.
Second, since confidence intervals and quantification of uncertainty
cannot be applied to the data series until next year, it seemed appropriate
to do all of the design and reporting changes in one year. 

It is important that the current analysis be read with an understanding that
the weighting and sampling issues limit presentation and interpretation. In
particular, small changes from year to year in prevalence figures should
not be viewed as definitive. It should be stressed that the arrestee
population is a difficult one to access, and one not adequately covered in
other data collection efforts that, for example, target households, schools,
or treatment populations. The data are most informative over multiple
years when longer term trends can be discerned.

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Notes

1. Current drug screening methods cannot distinguish heroin from the
larger opiate class of drugs to which it belongs. More expensive
confirmation testing is required to determine if heroin was used. Other
drugs in the opiate class include codeine and morphine. Thus, drug testing
results in this report are for opiate, not heroin, positives. Preliminary
results from an opiate-confirmation project indicate that more than 97
percent of ADAM opiate positives are from heroin use.

2. Atlanta had too few female cases for analysis purposes in 1998.

3. National Institute of Justice. (1999). "ADAM: 1998 Annual Report on
Drug Use Among Adult and Juvenile Arrestees." Washington, D.C.:
National Institute of Justice.

4. Because it is not possible to calculate standard errors for samples at this
time, we offer these trend data for descriptive purposes only. It is also
important to bear in mind that while we use the term "arrestees," we are in
fact reporting on arrest events. Because the data collection includes no
identifying information, duplication across quarters can occur.

5. The positive rates for the remaining drugs include: 4.8 percent for
benzodiazepines (including Valium), 4.4 percent methamphetamine, 1.8
percent PCP, 1.5 percent methadone, 0.7 percent barbiturates, 0.5 percent
propoxyphene (Darvon), and 0.0 percent methaqualone.

6. Atlanta's data for females are from 1990-1997. There were insufficient
female cases in 1998 for analysis.

7. Sites were selected for illustrative purposes to demonstrate patterns of
poly-drug use across all regions of the country. They include at least one
site from each region and have a reasonable distribution of opiate-positive
arrestees showing other drug positives.

8. In general, arrestees under-report drug use, although this pattern has
changed slightly in 1998 when the ADAM procedures began to require
interviewers to inform arrestees at the onset of the interview of the need to
provide a urine sample.

9. Sites were selected to illustrate regional patterns of self-report crack and
powder cocaine use in conjunction with opiate use. At least one site was
selected from each region.

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