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Using Data to Document the Need for Methamphetamine Services Jane C. Maxwell, Ph.D. Center for Excellence in Drug Epidemiology Gulf Coast Addiction Technology.

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Presentation on theme: "Using Data to Document the Need for Methamphetamine Services Jane C. Maxwell, Ph.D. Center for Excellence in Drug Epidemiology Gulf Coast Addiction Technology."— Presentation transcript:

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2 Using Data to Document the Need for Methamphetamine Services Jane C. Maxwell, Ph.D. Center for Excellence in Drug Epidemiology Gulf Coast Addiction Technology Transfer Center

3 Data Sources Treatment admission records Overdose death certificates & Medical Examiner Reports Poison Control Center cases Emergency room data Price, purity, supply, trafficking data Surveys (National & State) Forensic laboratory tests (Police & ME Labs) AIDS cases (Health Department) Community Epidemiology Work Group (NIDA)

4 http://www.utexas.edu/research/cswr/gcattc/excellentEpidemiology.html

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9 http://www.nida.nih.gov/about/organization/CEWG/CEWGHome.html

10 CEWG Reports Divided into sections by drug types: Cocaine/Crack, Heroin, Other Opiates/Narcotics, Methamphetamine, Marijuana, Club Drugs, Alcohol, Benzodiazepines/ Barbiturates, Tobacco Discusses each drug type by all available data: Treatment Data, ED Data, Mortality Data, Other Health-Related Data (e.g., Helpline, poison control), Law Enforcement Data (e.g., NFLIS, arrest data), Survey Data, Qualitative Data (e.g., key informant, focus groups)

11 Texas Overdose Deaths, Treatment Admissions, Poison Control Center Calls & DPS Lab Exhibits for Methamphetamine & Amphetamine

12 http://www.samhsa.gov

13 Survey Data

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15 NSDUH State and Substate Reports Substate Substance Abuse Estimates from the 1999-2001 NSDUH http://oas.samhsa.gov/substate2k5/toc.cfm Alcohol, cocaine, marijuana and tobacco by substate regions State Estimates of Substance Use from the 2003-2004 National Surveys on Drug Use and Health http://oas.samhsa.gov/2k4State/toc.htm Past Month Illicit Drug Use, Past Year Marijuana, cocaine, non medical pain reliever Use, perception of great risk of smoking marijuana, average annual rate of first use of marijuana, past month alcohol use, past month binge alcohol use, perception of great risk of drinking 5 or more drinks once or twice a week, past month tobacco and cigarette use, perception of great risk of smoking one or more packs per day, past year dependence, abuse and treatment for illicit drugs and alcohol, needing but not receiving treatment, serious psychological distress, past month alcohol use and binge drinking by minors Methamphetamine Use, Abuse, and Dependence: 2002, 2003, and 2004 http://oas.samhsa.gov/2k5/meth/meth.htm Shows the states by rates of methamphetamine use.

16 Methamphetamine Use in Past Month Among Persons Ages 12 or Older, by Dependence and Abuse: NSDUH 2002, 2003, 2004 597 607 583

17 Methamphetamine Use in Past Year Among Persons Ages 12 or Older, by Gender and Age: NSDUH 2002, 2003, 2004

18 Methamphetamine Use in Past Year Among Persons Ages 12 or Older, by Race/Ethnicity: NSDUH 2002, 2003, 2004

19 Treatment Data Use TEDS Data and also talk to local program providers to get information as to their perceptions of meth treatment need, difficulty in treating, characteristics of clients. Check with rural programs.

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21 Route of Administration of Methamphetamine/Amphetamine: US TEDS Treatment 1992-2003

22 Routes of Administration of Methamphetamine of Clients in Texas Programs: 1988-2005

23 Characteristics of Clients Entering Treatment with a Primary Problem with Methamphetamine/Amphetamine: US TEDS 1993-2003

24 Self-Reported Reasons for Starting Methamphetamine Use R. Rawson, Methamphetamine: Clinical Challenges and Critical Populations

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28 Trends in Methamphetamine/ Amphetamine Admissions to Treatment: 1993-2003 http://oas.samhsa.gov/2k6/methTx/methTX. htm Admission rates/100,000 for each state: 1993-2003

29 > 58 35 - 58 < 12 12 - 35 No data Primary Amphetamine/Methamphetamine TEDS Admission Rates: 2003 (per 100,000 aged 12 and over)

30 Residence of Texas Clients Entering Treatment with Problem with Methamphetamine / Amphetamine:1997-2005* *DSHS BHIPS Data

31 Other Treatment Data Sources Medicaid data Hospital discharge data Local emergency room data

32 2005 Motor Vehicle Drivers Age 15+ Involved in Accidents with Injuries--Data from Austin Brackenridge Hospital Trauma Center Amphetamines7% Benzodiazepines29% Cocaine14% Opiates31% THC46% None35% BAC 0.1%-0.2%16% BAC >0.2%20% Letter from Dr. Patrick Crocker to Mayor Will Wynn, March 1, 2006.

33 The National Survey of Substance Abuse Treatment Services (N-SSATS) is designed to collect data on the location, characteristics, services offered, and number of clients in treatment at alcohol and drug abuse facilities (both public and private) in each state. Data are available on-line for 2002-2004. Good way to show changes in treatment capacity. Combine with 2003-2004 NSDUH State Estimates.

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35 NFLIS Toxicological Data (Law Enforcement Tox Lab Results) Google for NFLIS Do labs in your state report to NFLIS? They can easily run the reports by year for you. If not in NFLIS, check with local law enforcement tox labs and state police labs for # meth items identified by year

36 4 Most Frequently Identified Drugs by NFLIS Toxicology Laboratories

37 Drugs Identified by NFLIS Laboratories by Region: 2005

38 Methamphetamine Identified by NFLIS Laboratories in Selected Metro Areas: 2003- 2005 Percent

39 20% 17% 12% 0% 24% 1% 7% 35% 4% 10% 18% 42% % of Substances Identified by DPS Labs That Were Methamphetamine & Amphetamine: 2001

40 30% 18% 0.5% 26% 1% 11% 38% 4% 16% 28% 41% 55% % of Substances Identified by DPS Labs That Were Methamphetamine: 2005

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42 Drug Abuse Warning Network: Emergency Departments

43 Characteristics of DAWN ED Stimulant Patients: 2003-2006 *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

44 Ages of DAWN ED Stimulant Patients: 2003-2006 *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

45 Route of Administration of Stimulants of DAWN ED Patients: 2003-2006 *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

46 Specific Type of Case Reported by DAWN ED Stimulant Patients: 2003-2006 *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 1/13/2006) *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

47 Disposition of Stimulant Patients Seen in DAWN ED: 2003-2006 *The unweighted data are from all U.S. EDs reporting to DAWN. All DAWN cases are reviewed for quality control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change. SOURCE: DAWN, OAS, SAMHSA, downloaded 2/26/2006)

48 Drug Abuse Warning Network: Medical Examiners

49 Check DAWN Medical Examiner Death Data from 122 Areas and 6 States on SAMHSA’s web site under Statistics and Data

50 Stimulant Deaths Reported for Selected Metro Areas in DAWN: 2003

51 Local Medical Examiners Number of deaths with “amphetamine” or “methamphetamine” mentioned on the death certificate. Trend by year Trend by race/ethnic and gender Most death certificates won’t say which drug “caused” the death but will indicate drugs found in the body.

52 Poison Control Center Data

53 Poison Control Centers Poison Control Centers receive data on confirmed human exposure cases, animal poison exposures, human and animal non-exposures, and informational calls. For tracking patterns of drug use, request confirmed human exposures, as well as the age, age group, and gender, along with the county the call came from and the date. Also request the fields describing the substance used, including the field with the slang term name. Ask for Intentional. An intentional misuse is one resulting from the intentional improper or incorrect use of a substance for reasons other than the pursuit of a psychotropic or euphoric effect. Intentional abuse is an exposure resulting from the intentional or incorrect use of a substance where the victim was likely to be attempting to achieve an euphoric or psychotropic effect. All recreational use of substances for any effect are included in this category.

54 Worrisome Trends in Texas. Similar in Other States?

55 Methamphetamine Lab Seizure and Purity Data: Dallas DEA Field Division

56 Changes in Price of a Pound of Ice in Houston from 1 st Half 2004 to 2 nd Half of 2005

57 Effects of Methamphetamine on Others Need protocols to involve CPS, law enforcement, health, etc. Drug Endangered Children’s Units—but don’t forget Adult Protective Services—they may be cooking at granny’s house. EMS—managing agitated and aggressive patients ER—meth patients have intentional self-injury or assaults—older, longer hospital stays, cost more. Violent, need to be detoxed. With burns victims, need drug screens to ID meth use to manage Secondary contamination to ED personnel. Police, fire, social workers need certification in hazardous materials (HAZMAT) handling. $5000 to clean up a lab. Increase in hepatitis with injecting drug use. Change when Ice moves in?

58 Effects on Communities EMS—managing agitated and aggressive patients ER—meth patients have intentional self-injury or assaults—older, longer hospital stays, cost more. Violent, need to be detoxed. With burns victims, need drug screens to ID meth use to manage Secondary contamination to ED personnel. Police, fire, social workers need certification in hazardous materials (HAZMAT) handling. $5000 to clean up a lab. Increase in hepatitis with injecting drug use. Change when Ice moves in?

59 Other Data Sources HIV/STD outreach and testing programs (% having used meth, race/ethnic, gender, reasons for use) Narcotics officers (what’s on the street, price, purity, source, new users, different forms of meth) Bartenders and bouncers in clubs. CPS workers. EMS workers.

60 Areas to Watch Use of meth on the job (Work Force needs) Truckers, day laborers, people working long hours and boring jobs. Risky sexual behaviors Heterosexuals & homosexuals. Party people Immigrants/migrants away from home and families. Increasing criminal distribution Traffickers following the migrant trail. More organized and criminal gangs.

61 1998 Miami DMP Samples Southwest Asian2.1 % Pure Southeast Asian 2.3 % Pure South American 19.2 % Pure Heroin

62 Heroin Sources and Supply Routes

63 Sources of Heroin Seized in US Based on Net Weight:1989-2003 DEA Heroin Signature Program

64 Average Purity of Heroin Samples in the US: 1992-2003 DEA Heroin Signature Program

65 50% 31% 11% 10% 51% 48% 34% 16% 14% 24% 16% 41% 14% 39%28% 43% 28% 52% 16% West Average Purity: 26% Mexican East Average Purity: 42% So. American Heroin Purity: 2004 25% 53%

66 Age & Ethnicity of Texas Deaths with a Mention of Heroin:1990-2004

67 OTHER OPIATES Hydrocodone (such as Vicoden) is larger problem than oxycodone or methadone in Texas Problem with methadone pain pills (as compared to diskettes and syrup used in narcotic treatment programs). Diversion and abuse of OxyContin has created new demand for narcotic treatment in many states. Watch for diversion of buprenorphine.

68 Google ARCOS to get amount of prescription controlled substances shipped from manufacturer to final dispensing site by state and by zip code

69 Quantities of Hydrocodone and Oxycodone Distributed to Retail Registrants: ARCOS 1997-2004

70 24 or more 6-9 <6 Incomplete data 12-15 Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1993 KEY YEAR: 1993 10-11 16+

71 24 or more 6-9 <6 Incomplete data 12-15 Other Opiate Treatment Admissions per 100,000 by State, TEDS: 1997 KEY YEAR: 1993 10-11 16+

72 16 or more < 6 6-9 Incomplete data 12-15 Other Opiate Treatment Admissions per 100,000 by State, TEDS: 2003 KEY YEAR: 1992 10-11

73 “SYRUP” in Texas  Codeine cough syrup continues to be abused.  Sold in baby bottles, measured in ounces.  Pint sells for $200-$300.  Cut with Karo syrup and put in 3 liter soft drink bottle to drink. Pineapple Soda Water and “Lean”  Rap music on syrup continues.

74 COCAINE Still Around— with New Users

75 Characteristics of Texas Clients Admitted to DSHS-Funded Treatment with a Primary Problem of Cocaine: 2005 Crack Powder Cocaine Powder Smoke Inject Inhale % of Cocaine Admits 64%6%307% Lag-1st Use to Tmt- 12169 Average Age37 35 29 % Male51%60%48% % Employed14%14%34% % Homeless16%12%4%

76 Race-Ethnicity of Texas Cocaine Admissions: 1993 v. 2005

77 Age & Ethnicity of Texas Cocaine Overdose Deaths: 1992-2004

78 % Texas Secondary Students Who Had Ever Used Powdered Cocaine and Crack, by Grade: 2004

79 DOWNERS Barbiturates (phenobarbital), benzos (diazepam-Valium, alprazolam-Xanax, clonazepam-Klonopin, lorazepam-Ativan, chlordiazepoxide-Librium). Potentiate low-quality heroin (and seen in heroin overdoses) Come down from speed or cocaine trips Dependence among females

80 Benzodiazepines Identified by Texas DPS Labs: 1998-2005

81 Marijuana Reefer Sadness

82 % Texas Secondary Students Who Had Used Any Illicit Drug in the Past Month, by Ethnicity: 1988-2004

83 Addiction Severity Index Problems of Texans Treated with Primary Marijuana Problem: 2005

84 Secondary Problem Drug for Clients Entering Treatment with a Primary Problem with Cannabis: 2005

85 # Days Used Drugs in Month Prior to Admission: 2005

86 Alcohol

87 Characteristics of Alcohol Clients at Admission to Texas Programs: 1988 v 2005

88 2 nd Drug of Abuse of Texas Alcohol Clients: 1988 v. 2005

89 Club Drugs Problems identified early: MDMA in 1985, GHB in 1990,Ketamine in 1991, Rohypnol in 1993, but slow responses. Research studies underway but are incomplete and can be problematic. Use of Internet to obtain information from pro & anti-drug sites (BUT information can be erroneous, untested, outdated, or extreme). Problems testing & identifying various drugs. Lack of detox & treatment protocols. Misperception that all club drugs are alike.

90 Substances Identified by Labs Participating in the National Forensic Laboratory Identification System: 1997-2005

91 Club Drugs in Texas  Club drugs can be a ticket to treatment—often with poor outcomes.  Ecstasy treatment numbers are up and it is moving out of the club scene.  GHB centered in DFW metroplex.  Rohypnol—blue punch to get around dye.  Ketamine numbers low.  PCP indicators rising—”Buck Naked”.  Coricidin HPB (“Skittles”) used by kids.  Lack of evidence-based treatment for the dependent.

92 Admissions to Texas Treatment Programs by Primary, Secondary or Tertiary Problem with a Club Drug: 1988-2005

93 % of All Drugs Identified by Texas DPS Labs: 1998-2005

94 Admissions to DSHS-Funded Treatment Programs With a 1 st, 2 nd, or 3 rd Problem With a Club Drug: 2005

95 Primary Problem of Club Drug Admissions to Texas Programs: 2005

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97 Ecstasy “Ecstasy” can be MDMA, MDA, MDE, PMA, etc. MDMA can result in dependence or abuse but evidence- based treatment protocols do not presently exist. MDMA can damage serotonin neurons. MDMA use can result in depression, sleep, mood & anxiety disturbances, & memory deficits. Heavy users displayed deficits on many measures of neuropsychological tests, particularly those associated with mental processing speed & impulsivity. Selective impairments of neuropsychological performance associated with regular use not reversed by prolonged abstinence. Higher scores on SCL-90 for phobic anxiety, obsessive- compulsive behavior, psychosis, somatization & loss of sex and pleasure. Research on effects of ecstasy continuing to emerge.

98 Race/Ethnicity of Texas Clients Admitted with a Problem with Ecstasy: 1990-2005

99 Ecstasy Indicators in Texas

100 NDARC Study of Ecstasy Users* N=329; young, well educated, employed or students; oversample of heavy users. Polydrug users with high IDU rates. Young female polydrug users & those who binged on ecstasy for 48 hours reported physical, psychological, & other problems which they attributed to ecstasy use. Users may benefit from credible information to modify use and reduce problems. Need treatment options to meet demand indicated. Topp, Hando, Dillon et al., Ecstasy Use in Australia, Drug and Alcohol Dependence 55 (1999) 105-115.

101 GHB, GBL, 1-4 BD, Fantasy

102 GHB Use associated with little precision in doses, with effects varying from euphoria to somnolence to coma. GHB and alcohol together reported to be synergistic. Withdrawal is complicated and requires detoxification in a medical setting. Abuse potential is known but little information on treatment.

103 GHB Adverse Effects Central Nervous System depressant-- intoxication, then deep sedation. GBL and 1-4BD turn into GHB when swallowed. Role of web re: inaccurate information and availability. Threat of drink spiking. Tolerance & dependence build rapidly. Intervention & treatment may be delayed because providers lack knowledge about GHB dependence. Little information on treatment.

104 NDARC Study of GHB Users* N=76; recent users of GHB Used GHB in combination with other drugs: 30% drank 5+ drinks, 20% used Ketamine. 4% dependent on GHB. Frequent reports of adverse effects. Half had overdosed on GHB GHB used with other drugs may place users at significant risk of range of negative consequences. *Degenhardt, Darke, Dillon, “GHB use among Australians,” Drug & Alcohol Dependence 67 (2002), 89-94

105 LSD Slang terms--Acid, Blotter, or name of picture on tab. Is a small paper square with picture or jello-like square tab. Desired Effects--distortion of senses, introspection. Adverse Effects--anxiety, panic reaction, or “Bad Trip.” LSA?—extracted from morning glory or wood rose seeds—less potent? More prevalent than we think?

106 SPECIAL ANNOUNCEMENTS FROM MARK/JLF SPECIAL ANNOUNCEMENTS FROM MARK/JLF (updated 12-11-01) SHOP OUR CATALOG DISCLAIMER AND INFORMATION "JLF sells poisonous-non-consumable items, consisting of various raw materials and related merchandise used for art, hobby, science, industry, and/or religion. Products include Amanita muscaria ("Fly Agaric") mushrooms, Claviceps purpurea ("Ergot Fungus") sclerotia, Trichocereus pachanoi ("San Pedro") cactus, Psilocybin mushroom spores and kits, Papaver somniferum ("Opium Poppy") pods, Argyreia nervosa ("Hawaiian Baby Woodrose") seeds, Anadenanthera colubrina ("Cohoba") seeds, and many other ethnobotanicals. Also pure compounds such as yohimbine, L-tryptophan, etc." JLF Poisonous Non-Consumables P.O. Box 184 Elizabethtown, IN 47232

107 DISSOCIATIVE DRUGS: PCP, Ketamine, DXM Distort perceptions of sight and sound and produce feelings of detachment, but not hallucinations (Zombie effect)

108 Phencyclidine PCP, Angel Dust, Killer Weed Dissolved in embalming fluid (“Fry,” “Amp,” “Water, Water”). Swallowed, sniffed, smoked on joints dipped in “Fry”. NYC—menthol cigarettes are dipped into liquid PCP or blunts are laced with powdered PCP. Washington, DC—”dippers”—cigarettes dipped into PCP.

109 PCP Indicators in Texas

110 KETAMINE

111 Anesthesia doses 2-10 mg/km; recreational doses 50-100 mg. Unsafe sexual behavior associated with frequent use of Ketamine. Use at gay circuit parties of concern. Taken in cyclical binges similar to cocaine or methamphetamine. Available as powder to snort or as liquid to inject; used with “puffers” to get exact dosing. Users can become psychologically dependent but no evidence of physiologic withdrawal syndrome. SPECIAL K (Ketamine)

112 NDARC Study of Ketamine Users* N=100; well-educated; older group of party drug users. Some had access because in medical field. Used with MDMA, MDA & amphetamines. Many had regular negative side effects such as inability to speak, blurred vision, lack of coordination. Issue for warnings: Usually unpleasant side effects seen by some as “positive” and encouraged experimentation. *Dillon, Copeland, Jansen, Patterns of Use and Harms Associated with Non-Medical Ketamine Use, Drug and Alcohol Dependence 69 2003) 23-28.

113 What is DxM ? Dextromethorphan is a psychoactive drug found in common over the counter cough medicines. Source: www.http:third-plateau.lycaeum.org/beginner/index.html

114 “Robotrip” – high dosages can produce hallucinogenic effects“Robotrip” – high dosages can produce hallucinogenic effects Part of family of psychoactive compounds called “dissociative anesthetics.”Part of family of psychoactive compounds called “dissociative anesthetics.” Some effects have been described as similar to those of ketamine (Special K) and PCP.Some effects have been described as similar to those of ketamine (Special K) and PCP. The DxM experience is described as occurring on levels, or plateaus depending on the amount of the dose taken. Each plateau is different from another. There are 4 major plateaus + a fifth one that is generally unpleasant and involves a possible trip to the hospital Source: www.http:third-plateau.lycaeum.org/beginner/index.html

115 DXM Calculator

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117 HIV Cases in Texas: 1987-2005

118 AIDS Cases in Texas: 1987-2005

119 Texas HIV Cases by Gender & Race/Ethnicity: 1987-2005

120 Texas AIDS Cases by Gender & Race/Ethnicity: 1987-2005

121 www.gcattc.net www.samhsa.gov


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