Special Topic: The Impact of September 11

September 11 and Its Aftermath: Assessing the Impact on Drug Abuse+

As the Nation deals with the wideranging effects of the September 11 attacks and subsequent events, several data sources have begun to show the impact upon drug abuse. For example, according to data provided by NDCHealth (NYSE:NDC, an Atlantabased healthcare information services company), new prescriptions (retail and mail-order) for several categories of drugs increased sharply between early September and early October 2001: benzodiazepines increased 11 percent nationally, 14 percent in Washington, DC, and 23 percent in New York City; antidepressants increased 3 percent, 12 percent, and 18 percent, respectively, for the three areas; and sleep aids (nonbarbiturates, sedatives, and others) increased a dramatic 11 percent, 14 percent, and 26 percent, respectively.

In an effort to continue assessing the terrorist attacks' impact on drug abuse (short term and long term), ONDCP explored the issue during the 75 Pulse Check phone discussions conducted from late November 2001 through early January 2002. Sources in all but four cities—Billings, Chicago, Los Angeles, and Philadelphia—described combinations of diverse effects, such as disruptions in drug trafficking patterns, anxiety among patients already in treatment for drug abuse, increased treatment admissions among youth, and increased diversion and abuse of prescription drugs.

Loosely categorized, the described effects can be summarized in four overall findings:

• Availability of illegal drugs, particularly heroin, declined in 12 of the 20 Pulse Check cities: Baltimore, Columbia (SC), Denver, Detroit, El Paso, Honolulu, Memphis, Miami, New Orleans, New York, Seattle, and Sioux Falls. (Exhibit 1)
  
  
• Drug trafficking modes or routes have shifted in 6 of the 20 cities: Honolulu, Miami, New York, Portland (ME), St. Louis, and Seattle.
  
  
• Some short-term changes in local marketing strategies were noted in Boston, Miami, New York, and Washington, DC.
  
  
• Signs of increased drug abuse were described in 9 of the 20 cities: Boston, Columbia (SC), Honolulu, Miami, New York, Portland (ME), St. Louis, Seattle, and Washington, DC. These signs include increases in demand for treatment. (Exhibit 1)

Changes in Illegal Drug Availability, Trafficking Patterns, and Market Strategies

Heightened security since September 11 at U.S. airports, borders, and other points of entry may have caused declines in the availability of illegal drugs (especially heroin) on the streets of many Pulse Check cities:

• Baltimore, MD^E: During the period immediately after September 11, no changes in the illegal drug trade were observed; however, by late September, heroin started to "dry up on the street." Moreover, drugrelated violence increased during late September and early October due, in part, to declining heroin availability. The problem was reportedly compounded when law enforcement resources were shifted away from street drug activity and toward terrorist prevention activities.
  
  
• Columbia, SC^N,M: Heroin availability has declined, and prices have increased.
  
  
• Denver, CO^L,E: Heroin availability has declined slightly because fewer drugs are coming across the Mexican border, and heroin users are reportedly having more difficulty finding the drug on the street. Drug trafficking has also been slightly limited due to airport security. Furthermore, heroin and powder cocaine prices have increased, and their purities have declined.
  
  
• Detroit, MI^E: In general, drugs are less available.
  
  
• El Paso, TX^N: Because fewer people are smuggling heroin from Mexico due to increased border security since September 11, its availability has decreased.
  
  
• Honolulu, HI^L,E,M: The Honolulu drug trade's dependence on air traffic is evidenced by how drugs dried up on the street during the days following September 11, when all planes were grounded. Even through air travel has resumed, heroin and cocaine seizures and availability remain lower than pre-September 11 levels because, with heightened security, fewer people are smuggling the drugs via the airport. Additionally, methadone clinics report an increase in client intake since September 11, suggesting a decline in heroin availability on the street.
  
  
• Memphis, TN^L: Heroin, crack, and powder cocaine availability has declined, most likely because law enforcement officials have intercepted these drug shipments more often and because post offices and packages are more scrutinized since the anthrax threats began.
  
  
• Miami, FL^L,E: The law enforcement source suggests that increased airport security has led to reduced heroin trafficking activities. Reportedly, street-level heroin, crack, and powder cocaine have been harder to obtain since September 11, but marijuana continues to be widely available because much of it is produced locally. The Miami epidemiologic source concurs that clients in some treatment facilities have reported some shortages of illegal drugs.
  
  
• New Orleans, LA^N: Drug availability, in general, has declined.
  
  
• New York, NY^L,E: The law enforcement source suggests that since September 11 cocaine has been harder to obtain. Additionally, according to street researchers, prices for heroin, crack, powder cocaine, and marijuana have remained level with pre-September 11 prices, but the quantity of drugs sold per sale has declined. Moreover, the cost of diverted prescription drugs, such as Elavil® (amitriptyline, an antidepressant), has increased from $2–$3 to $5. Increases in security and police activity have disrupted the flow of drugs from suppliers to dealers to users: suppliers cannot get their normal supply of drugs; dealers' supplies are in turn restricted; and users are paying more because their bags contain reduced amounts.
  
  
• Seattle, WA^M: Due to increased border security, heroin and cocaine availability has declined. Furthermore, when users cannot obtain the drugs, they often go to treatment, and admissions to the methadone clinics have increased since September 11.
  
  
• Sioux Falls, SD^L: Undercover operations with high-level methamphetamine dealers suggest that drugs are harder to obtain due to increased U.S. border control, and prices for larger amounts of the drug have increased. However, the number of small local methamphetamine labs has increased recently, perhaps to compensate for the lower levels of methamphetamine entering the United States.

In addition to reduced availability of illegal drugs, heightened security at U.S. points of entry may have altered drug trafficking modes or routes in many Pulse Check cities:

• Honolulu, HI^L,E: Law enforcement efforts are beginning to focus more on mail and marine smuggling because fewer people are smuggling heroin and cocaine via the airport.
  
  
• Miami, FL^E: Some drug trafficking has shifted from air to sea via cruise ships.
  
  
• New York, NY^L: Trafficking shipments planned for the city prior to September 11 have shifted to other cities, such as Seattle (via vehicle from Canada) or Baltimore (via air).
  
  
• Portland, ME^L,E and Seattle, WA^L: Heroin and cocaine traffickers are making fewer trips across the Canadian border due to increased law enforcement security, but they are smuggling larger amounts of drugs per trip.
  
  
• St. Louis, MO^L: Drug smugglers are more often using trains and buses to transport drugs than they were before September 11; according to sellers in custody, traffickers are avoiding air transport due to heightened airport security.

New anti-terrorist laws may affect illegal drug marketing practices. St. LouisL: New wiretap laws are affecting how illegal drug dealers are using cell phones. They are being more cautious, "dropping" phones more frequently, changing phones, using several different phones, and watching what they say over the phones.

Some drug trafficking shifts immediately after September 11 were just short term. In Detroit, for example, according to the law enforcement source, the supply of illegal drugs from Canada declined because of increased security at the border a few weeks after the September 11 attacks, but has returned to previous levels. Similarly, in El Paso, according to the epidemiologic source, the drug supply declined on the streets, even for crack, due to heightened border control measures immediately after September 11; however, soon thereafter, it was "business as usual." In Portland (ME) according to the law enforcement source, shortly after the September 11 attacks, the influx of drugs declined, but by December, the supply of illegal drugs resumed to pre-September 11 levels. Even in Washington, DC, where local drug dealers were more cautious about bringing drugs in shortly after September 11 due to heightened security at entry points, by December, the local drug trade returned to pre-September 11 levels.

The September 11 terrorist attacks also had short-term effects on local illegal drug market strategies, such as price gouging, as reported in several Pulse Check cities:

• Boston, MA^E: Two weeks after the attacks, the purity levels of heroin and powder cocaine dropped sharply, and a few dealers blamed this drop on the attacks.
  
  
• Miami, FL^E: In a few cases, dealers have been trying to price gouge, but not because of any apparent major drug shortage.
  
  
• New York, NY^E: According to street researchers, immediately after September 11, drug dealers (especially heroin dealers) took advantage of the situation and operated openly in the street. One user commented that, "the day of the disaster, it was like a super-sale day." This pattern continued in some areas. Moreover, several days after the disaster, a street researcher in The Bronx observed heroin users waiting in line in the street to purchase their drugs.
  
  
• Washington, DC^E: Heroin and crack availability and purity declined for about 4–6 weeks after the attacks. Marijuana, methamphetamine, and ecstasy were also less available for a week or two, possibly due to transportation difficulties.

Changes in Illegal Drug Use Patterns and Demand

Because heroin availability has declined in many Pulse Check cities since September 11, heroin users are increasingly substituting diverted prescription drugs for heroin in some cities:

• Baltimore, MD^E: An emergency department nurse noticed more overdoses from drugs other than heroin, particularly OxyContin® and other prescription opiates. This source suggests that the shift is related to the decline in heroin availability after September 11.
  
  
• Columbia, SC^M: Diverted OxyContin® use has increased due to the declining availability of heroin.
  
  
• El Paso, TX^N: Heroin addicts are increasingly substituting Rohypnol® (flunitrazepam) for heroin because it has been easier than heroin to smuggle across the Mexican border since September 11 and is, thus, more accessible.
  
  
• New York, NY^M: An in-house staff survey in the large program where the Pulse Check methadone treatment source is situated showed notable increases since September 11 in the abuse of prescription drugs, in people seeking more medications while in treatment, and in people requesting prescriptions for such medications. Additionally, increases were noted in secondary use of substances such as cocaine.

The number of treatment admissions or requests for services increased in the following cities after the September 11 attacks, suggesting a possible increase in drug use, a decline in drug availability on the street, or both:

• Columbia, SC^N,M
• Honolulu, HI^M
• New York, NY^E
• Seattle, WA^N,M
• Washington, DC^N

Increases in Treatment Demand: A Closer Look New York, NYE: An outreach worker states that since September 11 the number of people reporting for detoxification has increased markedly. Most detoxification programs in the city have become full. Seattle, WAN: Requests for mental health services increased 35 percent since September 11, with 20 percent of these for substance abuse treatment.

Additional indicators of increased demand or declining drug availability include an increased number of calls from those in need of drug treatment in Columbia (SC) (according to the methadone treatment source) and an increase in treatment program retention rates in El Paso (according to the epidemiologic source).

Many Pulse Check sources report increases in drug use, sometimes among people who are self-medicating for anxiety or depression associated with the September 11 attacks:

• Boston, MA^M: Since September 11, clients in treatment report to have increasingly combined heroin and cocaine in "speedballs."
  
  
• Columbia, SC^M: Use of all illicit drugs has increased, and the general mood of illicit drug users is that "they're going for broke," and that since the attacks they "have nothing to lose."
  
  
• Miami, FL^E: According to anecdotal information from pharmacists and mental health and treatment professionals, both legitimate and illegal use of prescription drugs have increased since September 11, mostly involving people seeking benzodiazepines and sleep aids in an attempt to self-medicate and deal with added stress.
  
  
• Portland, ME^N: Depression and hopelessness have intensified among older clients who were already depressed before September 11, and whatever drugs those clients were using, they tended to use more of them after September 11. In some cases, the events triggered users to seek substance abuse treatment.
  
  
• St. Louis, MO^N: Use of methamphetamine, diverted OxyContin®, ecstasy, and alcohol has increased and may be due to people seeking to self-medicate after the events on September 11.

Pulse Check sources also report an increase in social and psychological problems among drug treatment clients following September 11. Treatment sources in many cities, including Boston, Billings, Portland (ME), and Washington, DC, report increased levels of anxiety, depression, and hopelessness among treatment clients. Additionally, sources in Boston, Columbia (SC), Detroit, El Paso, Portland (ME), Seattle, and Washington, DC, also mention increases since September 11 in the numbers of relapses among chronic drug users.

Effects on Youth Who Use Drugs: Los Angeles, CAL: Club drug seizures have increased, as has the popularity and number of raves. "It is plausible that adolescents and young adults are using club drugs and attending raves in order to shake off September 11." Portland, MEN: Younger clients associate the events of September 11 with taking ecstasy: "We hate the world we’re growing into, so we might as well party." Sioux Falls, SDE: In a school district with more than 18,000 middle school and high school students, the number of adolescents (13–17 years) admitted to inpatient settings for substance abuse treatment (typically involving methamphetamine or heavy marijuana use) has increased sharply since September 11. Many of these admissions are court ordered, but many youth are also voluntarily coming forward. Thus, it is difficult to determine whether youth have increased their drug use or are getting caught more frequently. Additionally, since September 11, an increase has been noted among youth in suicidal thoughts and depression issues in conjunction with their substance abuse.

How have availability of and demand* for illegal drugs reportedly changed** across the 20 Pulse Check cities since September 11?

	Availability of illegal drugs declined and demand* increased
	Availability of one or more illegal drugs (typically includes heroin) declined
	Demand* for illegal drugs increased
	No changes reported in availability of or demand for illegal drugs

*"Increased demand," in this case, reflects any increases in the number of treatment admissions, requests for services, and attempts to self-medicate for anxiety or depression.
**Changes do not reflect any short-term effects that disappeared within the first few weeks after September 11.

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+ The following symbols appear throughout this chapter to indicate type of respondent: ^LLaw enforcement respondent, ^EEpidemiologic/ethnographic respondent, ^NNon-methadone treatment respondent, and ^MMethadone treatment respondent.