Some drugs come and go like fashion trends. Others are steady and ever-present.
Editor's note: This is the second in a three-day series that looks at drug trends in the capital city.
Sunday: IV drugs
Monday: The new problem drugs - Meth and OxyContin
Tuesday: Kids and drugs
"A lot of things are cyclical, we see decreases in LSD for while, then an upswing. It's the same with heroin," said Dean Guaneli, the state's chief assistant attorney general. "Alcohol is consistent and marijuana is consistent, too."
In Juneau, changes in drug usage are reflected in the growing popularity of OxyContin, a powerful prescription narcotic, and methamphetamine, a powerful stimulant.
OxyContin was introduced about five years ago to treat people in chronic pain. Abusers generally clean off the time-release coating on the pills and crush them so they can snort - inhale - or inject the powder.
In the Lower 48, the growing use of methamphetamine, also known as meth, crystal or crank, seems to be cutting into the popularity of cocaine. That doesn't appear to be the case in Alaska and Juneau. Steve Hernandez, who supervises the Juneau Police Department's drug unit, says cocaine usage in Juneau is at a level comparable to the past few years.
"But we are seeing a drastic increase in methamphetamines in Southeast," he said. "We're seeing a lot of availability and use of meth on top of coke use."
Teenagers say marijuana and alcohol are the most popular drugs for their age group, but said they occasionally see cocaine and ecstasy, a stimulant. Police officer Paul Comolli, the Juneau-Douglas High School liaison officer, has not confiscated cocaine or crack, a smokeable form of cocaine, from any school-age kids in the two and a half years he's been on the job there. He said that although kids say there's an increase in ecstasy, he has not confiscated any.
"Far and away the thing that rips our town apart, same as every town across the country, is alcohol," said emergency room physician Ken Brown. "I can come in at night for a shift and be guaranteed to see three or four people totally incapacitated from alcohol."
Aside from alcohol, the problems Brown sees most often are narcotic-related overdoses and abuses, usually involving the prescription pain medications hydrocodone and oxycodone (often marketed under the brand name OxyContin) and the related but less-potent painkillers Percocet and Vicodan.
"Far and away most people taking pain medication have legitimate conditions, but there are definitely some people that get involved in the drugs, for maybe a legitimate initial reason and then persist in trying to get the drugs for not-so-legitimate a reason. We try to be very cautious about the number of narcotics we give out."
Brown said he knows of one drug overdose death caused by narcotic medicine this year in Juneau.
"Cocaine is probably the third most common drug of abuse," he said. "It's fairly prevalent, and definitely we see methamphetamine - it's not an uncommon drug to see."
Users come into the emergency room concerned about chest pains and heart attack symptoms. Brown said meth and coke have similar symptoms and side effects. They cause high blood pressure, which can lead to possible ruptures of blood vessels and strokes. Both drugs can induce psychosis, and concerned family members sometimes will bring in a user who is confused and disoriented.
He said the emergency room staff deals with people abusing drugs on a fairly constant basis.
"I don't think a day goes by that we don't have a drug-related problem in Juneau," he said.
Professionals at the Juneau Recovery Hospital treat a steady stream of alcoholics and drug addicts. The vast majority of patients - about 90 percent - are in for alcohol. The rest are in for drug treatment, either illegal drugs or abuse of prescription drugs. The percentage varies, and in some cases patients are combining drugs and alcohol.
"The biggest increase we've see is OxyContin. There's a real major increase," said Stephen Sundby, director of the recovery hospital. "Cocaine is pretty consistent for us. It's not falling off or dropping and it's not increasing."
The recovery hospital has inpatient and outpatient programs and also provides a short-term, one- to three-day detox program. Last year 433 people went through detox. This year's numbers are comparable. So far this year 501 people have used the recovery hospital's "sleep-off" room, a safe place where they are monitored but not admitted.
Last year 246 people went through the hospital's rehabilitation program. The program has been expanded this year to include people from throughout the state; 313 people had used the facility through September.
About one of every six felony cases prosecuted by the district attorney's office in Juneau in the past two years was a drug offense - growing, selling drugs or possessing even small amounts of drugs such as cocaine or heroin, said Dean Guaneli, chief assistant attorney general.
Possession of up to one pound of marijuana is a misdemeanor. A pound or more of marijuana, or any indication of intent to sell, raises the stakes to the felony level. There were 62 misdemeanor cases involving drugs in the past two years.
The district attorney's office focuses on cases involving violent crime. Rapes, homicides and assaults make up about a third of the 361 felony cases the office has prosecuted in the past two years. Another third of the felonies are property crimes such as burglaries. The remaining cases ranged from weapons offenses to felony drunken driving.
Guaneli said there were 76 cases where people were charged with a drug offense but it was overshadowed by a more serious charge, such as a burglar caught with pot in possession.
"If someone was pulled over for drunk driving and had a small amount of pot, that would be considered to be a drunk-driving case. If it was coke (and drunken driving), it would be a drug case," he said.
Guaneli said statewide, crimes committed under the influence of alcohol are more violent than crimes committed under influence of other drugs, particularly in rural Alaska. Virtually every violent crime in rural Alaska has a connection with alcohol, he said.
"Drug crimes have more a tendency to be property offenses," he said. "A good percentage of the property offenses are drug-related - burglaries, thefts, shoplifting and embezzlement. Not so much in rural, but in urban Alaska."
Guaneli said it's difficult to get an accurate picture of drugs. Drug cases require a big investment of police resources. He said murders always are reported and always investigated, but a drug crime such as a sale doesn't generate a victim who calls the police the way a theft does.
"We can say we have a handful of homicide cases, and not more. And that's all of them," he said. "Drugs are different. People don't report a drug sale.
"We find when troopers get a big task force together and go into a town and do a big undercover investigation, they can double the number of drug cases overnight. If they devote resources, they get tons more.
"My sense is this is not an overwhelming problem in Juneau. Police devote sufficient resources, but if they did a big undercover investigation, they could generate a lot more cases. That's what we find everywhere in the state."
Guaneli said Juneau does not have big, sophisticated drug organizations as do Fairbanks and Anchorage.
"You may get one or two organizers, with followers who sell for them," he said. "It's also cyclical, and we have had people come through and try to set up organizations."
Matt Felix has worked in drug programs for 30 years for the state and the city of Juneau. He now heads up the local chapter of the National Council on Alcoholism and Drug Dependence. He said users, recovering users and others in the drug community talk to him about trends in Juneau.
Felix said there tends to be a seasonal increase in drug and alcohol use in the fall and winter. He's seeing an increase in the use of OxyContin and prescription drugs this fall.
Felix said alcohol is the drug of choice in Southeast Alaska. Southeast is the region with the highest level of alcohol consumption in the state, according to tax revenues. Per capita, Southeast is one of the hardest-drinking areas of the nation.
"There are episodic outbreaks of drugs, but drinking is consistent, steady and heavy," he said.
Felix said alcohol-related domestic violence, property crimes, assaults and health issues far outweigh the problems created by drugs in Juneau.
"Alcohol is the 180,000-pound elephant in the closet and nobody wants to talk about it. It's an epidemic," he said. "The alcohol problem is so overwhelming in this region it makes the other problems look lightweight."
Riley Woodford can be reached at firstname.lastname@example.org.