community epidemiology report fall 2014 south florida drug abuse trends update

Community Epidemiology Report

Fall 2014

South Florida Drug Abuse Trends Update

James N. Hall, EpidemiologistCenter for Applied Research on Substance Use and Health DisparitiesNova Southeastern University

http://www.state.fl.us/cf_web/

MiamiMiami--

DadeDade

BrowardBroward

Palm Palm

BeachBeach

Flagler

Highlands

Hardee

Polk

Martin

St. Lucie

Okeechobee

Indian River

PutnamAlachua

Bradf

ordUnionColu

mbia

Gilchrist

Levy

Dixie

Suwannee

Hamilton

St.JohnsClay

Duval

Nas sau

Baker

Pinellas

Pasco

Manatee

Hillsborough

Bre va rd

Osceola

Orange

Seminole

Collier

HendryLee

Glades

De SotoSarasota

Palm Beach

LakeSumter

Hernando

Citrus

Marion

Taylor

Madison

Jeffe

rson

Wakulla

Leon

Franklin

Liberty

Gadsden

Jacks on

Calhoun

Gulf

BayW

ashing

ton

Escambia

Santa Rosa

Okaloosa

Walton

Broward

Dade

Holmes

Monroe

Volusia

Lafayette

Charlotte

1.8 Million

1.4 Million

2.6 Million

19.5Million

US Census Bureau2013 Population Estimates

South Florida Most Recent Indicator Changes

• Marijuana: Down – Grow House “Wax” • Cocaine: Stable, Mostly Modest Declines• Rx Opioids: Deaths Declining Hydromorphone • Benzodiazepines: Deaths Declining• Methylone as Mollys: Escalating

• Other Emerging Synthetic Drugs • Heroin: Increases related to Rx Opioids crackdown• Methamphetamine: Increasing among MSM et al

• MDMA: Disappearing• Muscle Relaxants: Declining

HIG

H

Mod

erat

eLo

wer

Levels of Indicator Intensity: HIGH Moderate Lower

Fall 2014

South Florida Key Findings 2014

• # 1 Key Change: There has been significant progress in reducing RX drug diversion along with moderate declines in consequences related to the nonmedical use of pharmaceuticals in most of Florida. However the availability of Hydromorphone (e.g. Dilaudid®) and deaths related to its misuse are rapidly rising.

Fall 2014

• # 2 Key Change: Methylone along with other hallucinogens are the fastest rising drugs analyzed by South Florida crime labs. There were 1,194 methylone crime lab items, mostly sold as “Mollys,” compared to only 54 MDMA reports in 2013.

Percent of Primary Addiction Treatment Admissions by Substance 2007-2012:

State of Florida

2007 2008 2009 2010 2011 201205

101520253035

28.4 28.8 28.2 24.1

27.8

31.6

22.3

18.4

14.5 11.2

8.5 8.2

28.830.6 31.3 29.9

25.1 23

8.3

10.8

16.1

23.927.5 25.1

2.7 2.5 2.2 2.2 2.23.2

9.5

8.9 7.7 8.7

8.9 8.9

Alcohol

Cocaine

Marijuana

Rx Opioids

Heroin

All Other

Perc

ent o

f All

Adm

issi

ons

Source: Substance Abuse and Mental Health Services Administration’s Center for Behavioral Health Statistics and Quality: Treatment Episode Data Set as provided by the Florida Department of Children and Families as of May 8, 2014.

Marijuana

AlcoholCocaine

Rx Opioids

All OtherHeroin

Exhibit 4 Top 10 Most Frequently Identified Drugs of Total Reports from South Florida Crime Labs Reports CY 20131

Drug 2013 % Δ vs. 2012Cocaine 10,147 Down 11 % Marijuana/Cannabis/THC 5,276 Down 2 %Methylone (N-Methyl-3,4-Methylenedioxycathinone) 1,194 Up 208 % Hallucinogen 984 Up 88 % Rx Opioids 933 Down 4 %Heroin 925 Up 33 % Rx Benzodiazepines 849 Down 4 %Methamphetamine 211 Up 24 %Phenylimidothiazole Isomer 154 Down 37 %Caffeine 131 Down 45 %All Other Analyzed Drugs 2,272 Down 18 % Total 23,069 Down 3 %

1Data are for January–December 2013 and include primary, secondary, and tertiary reports. SOURCE: NFLIS, DEA, data retrieved May 9, 2014

Miami MSA includesPalm Beach, Broward,and Miami-Dade Counties

Number of Cocaine Reports Detected Among Decedents in Florida: 2000 - 2013

NUMBER of COCAINE

OCCURRENCESIncluding

“Present” &“Cause of

Death”

SOURCE: Florida Medical Examiners Commission Interim Report Jan-June 2013

0

1,000

2,000

1,105

1,3071,614 1,702 1,943 2,052 2,179

1,7911,462

1,402

1,444

1,318

1,336

State of Florida

2X0

50

100

150

200

250

300

94

121138 120 136 150 157

146 135 127

115

129

82

125

113

147 151

197 191168

143 126106

182

87

100Broward

Palm Beach

Number of Cocaine Reports Detected Among Decedents in Florida: 2000 - 2013

NUMBER of COCAINE

OCCURRENCESIncluding

“Present” &“Cause of

Death”

SOURCE: Florida Medical Examiners Commission Interim Report Jan-June 2013

20012002

20032004

20052006

20072008

20092010

20112012

2X1H...0

50

100

150

200

250

300

149 151

189

160 162 182

281

201

155

198184

198

238

94

121 138120

136150 157

146135 127

115

129

82

125

113

147151

197 191

168

143126

106

182

87

100

Miami-DadeBroward

Palm Beach

Cocaine TrendsRelated Deaths 2012 2 X 1h2013 Δ 2012 vs. x1h2013

State of Florida 1,318 1,336 Up 1 %

Palm Beach County 87 100 Up 15 %

Broward County 129 82 Down 36 %

So FL Crime Labs 2012 2013 Δ 2012 vs. 2013

3 SE FL Counties 11,411 10,147 Down 11 %

Primary Treatment 2011 2012 Δ 2011 vs. 2012

State of Florida 8.5 % 8.2 % Down 4 %

Rx Nonmedical Use in Florida2000 -2013

Responding to an Epidemic

Florida’s Response• July 2010 – Senate Bill 2272 Legal authority to

close “Pill Mills” and limited practitioner dispensing of CS Schedule II to 3-day supply

• August 2010 – Tamper-resistant OxyContin®.• March 2011 – Law Enforcement Strike Force• July 2011 - House Bill 7095 Comprehensive

law bans practitioner dispensing of CS II and new regulations. Permits PDMP to operate.

Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida Jan 2008 to Jun 2013

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2008 - Jun 2013 Reports

# “C

ause

of D

eath

” O

ccur

renc

es

1H'082H'08

1H'092H'09

1H'102H'10

1H'112H'11

1H'122H'12

2x1H'13

0

100

200

300

400

500

600

700

800

900

476 465533

652715

801

607

640

392343

279337 336

380340 336 358

341350

274

238 221153 147 160 142

110152

144201 176

239 268

141 129 136 129

139 176

136 171118 126 158

Oxycodone

Methadone

Morphine

Hydrocodone

House Bill 7095Takes effect

CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force

Exhibit 6 Number of Nonmedical Rx Opioids and Benzodiazepine Reports Detected among Decedents in Florida 2005 – 2x1h2013

# of

Dru

gs D

etec

ted

Amon

g D

eced

ents

20052006

20072008

20092010

20112012

2X1h20130

1,000

2,000

3,000

4,000

5,000

6,000

7,000

4,0354,416

5,059 5,4546,006

6,608 6,333

5,4895,290

2,608 2,973 3,3394,167

4,340

6,188 5,947

5,184 4,574

OpioidsBenzodiazepines

House Bill 7095Takes effect CS-II Dispensing Limits and

OxyContin Tamper Resistant

Strike Force

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2005 - Jun 2013 Reports

Number of Unique Patients Identified By Threshold Levels Number of Prescribers and Number of Pharmacies

by Quarter 2012-2013

Level 5

Level 6

Level 7

Level 8

Levels 9, 1015Source: 2012-2013 Annual Report

Florida’s Prescription Drug Monitoring Program (PDMP)

3,000

500

5 Prescribers &5 Pharmacies 2,864

1,4151,097

427

514

178

51-% Decrease

Grams of Oxycodone Sales in Florida Per 100,000 Population

2009 2010 2011 2012 20130

10,000

20,000

30,000

40,000

50,000

60,000

70,000 63325

2880821614

Grams Sold Per 100,000 Population

National Rank Among States and Territories

# 1

# 19

# 22

Source: US Drug Enforcement Administration – ARCOSAutomation of Reports and Consolidated Orders System

Gra

ms

of O

xyco

done

Sol

d pe

r 100

,000

Hydromorphone (eg., Dilaudid®)

STATETOTAL

GRAMSGRAMS/

100K POP

1 FLORIDA 270,718.70 1,439.892 DELAWARE 10,501.64 1,169.53

3 VERMONT 6,099.61 974.78

4 CONNECTICUT 34,362.81 961.44

5 VIRGINIA 67,026.15 837.72

6 MONTANA 8,049.45 813.56

7NEW HAMPSHIRE 10,389.74 789.21

8 MARYLAND 43,353.71 750.9

9 WASHINGTON 48,346.19 718.95

10 OREGON 27,172.92 709.282008 2009 2010 2011 2012 2013

050

100150200250300350400450500

199212 213

253

414

440

Hydromorphone Related-Deaths in Flor-

ida

# of

Dea

ths

2013 ARCOS Grams Sold Per 100/Population

Source: US DEA ARCOS 3 Report 4 March 5, 2014Source: Florida Medical Examiners Commission

South Florida

Crime Lab Cases

Up 950-%

2011-2013

2 X1H

Exhibit 4 Top 10 Most Frequently Identified Drugs of Total Reports from South Florida Crime Labs Reports CY 20131


1Data are for January–December 2013 and include primary, secondary, and tertiary reports. SOURCE: NFLIS, DEA, data retrieved May 9, 2014

Number of Heroin Deaths in Florida: 2000 – 2x1h2013

20002001

20022003

20042005

20062007

20082009

20102011

2012

2x1h2013

0

50

100

150

200

250

300

350

276

328 326

261

180

12296

110132

111

58 62

117140

15

57

3627

26

17 8 10 6 6 4 126 20

61

39

4632

18

22 20 2638 30 26

1533 36

FloridaPalm BeachBrowardMiami-Dade

# H

eroi

n D

eath

s

SOURCE: Florida Medical Examiners Commission Reports 2000-2013

Number of Heroin Deaths in Florida: 2000 – 2x1h2013

20002001

20022003

20042005

20062007

20082009

20102011

2012

2x1h2013

0

10

20

30

40

50

60

70

15

57

36

2726

17

8

10

6 6 4

12

6

2017

5350 49

35

1713

4

17

85

3

9

4

61

39

46

32

18

2220

26

38

3026

15

3336

Series1

Palm Beach

Broward

Miami-Dade

# H

eroi

n D

eath

s

SOURCE: Florida Medical Examiners Commission Reports 2000-2013

Heroin TrendsRelated Deaths 2012 2 x 1H 2013 Δ 2012 vs. 2X1h 2013

State of Florida 117 140 Up 20 %

Palm Beach County 6 20 Up 233 %

Broward County 9 4 Down 56 %


3 SE FL Counties 696 925 Up 33 %


State of Florida 2.2 % 3.2 % Up 45 %

Top 10 Most Frequently Identified Drugs of Total Reports from South Florida Crime Labs Reports CY 20131


Source: US DEA – National Forensic Laboratory Information System as of May 9, 2014

Methylone isbeta-ketone MDMA

Molly

2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

5000

10000

15000

20000

25000

9495

14134

2179024330

22720 23332

23114

10337

53673752

10 24 11 1 15 28

4411 5147

107499985

“Ecstasy” and “Mollys” Items Identified in DEA’s NFLIS Toxicology Labs: 2004- 2013

MDMA

Methylone

Source: US Drug Enforcement Administration – National Forensic Laboratories Information System (NFLIS)

*The synthetic cathinones mephedrone and methylone act on the brain like MDMA

*

Nu

mb

er

of

Ite

ms

South Florida

Crime Labs Reports

SOURCE: US DEA: National Forensic Laboratory Information System DQS on May 9, 2014

Emerging Psychoactive Substances 2011–2013

2011 2012 20130

200

400

600

800

1000

1200

1400

19 19014543

428

1242

386 361

144

Synthetic CannabinoidsSynthetic CathinonesOther Emerging Synthetics

2011 2012 201302468

101214

1

1011

3 4

106

12 13 Synthetic Cannabinoids

Synthetic Cathinones

Other Emerging Synthetics

Number of Different Drugs

Current (past 30-day) Marijuana Use Among Broward County Middle and High School Students

2000-2012

Source: Florida Youth Substance Abuse Surveys 2000-2012

2000 2002 2004 2006 2008 2010 201202468

101214161820

17.2

13.9 14.5

11.414 15.3

19

4.5 5.2 5

2.5 3.5 4.3

3.7

High School Middle School

% R

ep

ort

ing

Cu

rre

nt

Us

e

Percent of Broward County High School Students Reporting Marijuana Use by Age 13 or Younger

2000-2012

2000 2002 2004 2006 2008 2010 20120

2

4

6

8

10

12

14

16

18 16.7%

11% 10.5%9.4%

8.1% 8%9.7%


% R

epo

rtin

g U

se

by

Ag

e 1

3

Current (past 30-day) Marijuana Use Among Palm Beach County Middle and High School Students

2000-2012


2000 2002 2004 2006 2008 2010 20120

5

10

15

20

25 22.720.7

17.8 17.3 17.4

22.7

20.6

65.5

3.35.2

3.86

2.7

High School Middle School

% R

ep

ort

ing

Cu

rre

nt

Us

e

Percent of Palm Beach County High School Students Reporting Marijuana Use by Age 13 or

Younger 2000-2012

2000 2002 2004 2006 2008 2010 20120

2

4

6

8

10

12

14

11%

13.6% 13.2%12.1%

8.9%

11%12.4%


% R

epo

rtin

g U

se

by

Ag

e 1

3

Addiction is a Developmental Disease: It Starts Early

1

10

100

Child Teen Young Adult Adult

57%

1.5%

5.5%

<12 12-17 18-25 >25

36%

Fi r

st M

ari j

uan

a U

se,

(Pe r

c en

t o

f I n

i tia

tes)

Source: US Dept HHS: SAMHSA National Survey on Drug Use & Health 2011

Percent of First TimeMarijuana UsersBy Age

A major concern about marijuana use among youth is the link between its early first use and life-long drug dependency and addiction problems. Nearly 13 percent of adults who met the criteria for drug abuse or dependency in the past year first used marijuana by age 14 or younger as compared to 2 percent of those who did not use marijuana for the first time until age 18 or older.

(Source: US Department of HHS: SAMHSA 2011 National Survey on Drug Use and Health, Released August 2012.)

Percent of Past Year Drug Dependence or Abuse Among Adults Aged 18 or Older

By Age of First Marijuana Use: 2011

12.7%

2.2%

0%

2%

4%

6%

8%

10%

12%

14%

Age of First Marijuana Use

% P

as

t Y

ea

r D

ep

de

nc

e/A

bu

se

14 Years orYounger

18 or Older

Source: SAMHSA-National Surveys on Drug Use and Health 2011

14 yrs. Or Younger 18 or Older

Percent of Past Year Serious Mental Illness Among Lifetime Marijuana Users Aged 18 or Older

By Age of First Marijuana Use: 2002 and 2003

21.0%

17.4%

12.2% 10.5%

0%

5%

10%

15%

20%

25%

Age of First Marijuana Use

% P

as

t Y

ea

r S

MI

Before 12 Yrs

12-14 Yrs

15-17 Yrs

18 or Older

Source: SAMHSA-National Surveys on Drug Use and Health 2002-2003

< 12 yrs. 12-14 yrs. 15-17 yrs. 18 or Older

Percent of high school students having ridden or driven in the past 30 days with or as driver

having used marijuana or alcoholRODE with Driver who had used

marijuana or alcohol

Florida Plam Beach Broward0

5

10

15

20

25

30

25.4 25.727.0

21.4 20.618.4

Marijuana Alcohol

DROVE after using marijuana or drinking alcohol

Florida Palm Beach Broward0

5

10

15

20

25

30

11.2 12.3 10.98.1

107%

Rep

ortin

g

% R

epor

ting

Source: FL-DCF - 2012 Florida Youth Substance Abuse Survey

Percent of High School Males Reporting Having Used Synthetic Marijuana Florida and

Broward County - 2012

Florid

a Life

time

Broward

Lifetime

Florid

a Pas

t 30 Day

s

Broward

Past 3

0 Days

0%

4%

8%

12%

16%

20%15.1 %

12.4 %

5.3 % 3.9%

Source: Florida Youth Substance Abuse Survey 2012

Percent of High School Males Reporting Having Used Synthetic Marijuana Florida and

Palm Beach County - 2012

Florida Life-time

Palm Beach Lifetime

Florida Past 30 Days

Palm Beach Past 30 Days

0%2%4%6%8%

10%12%14%16%18%20%

15.1 % 14.6 %

5.3 % 4.7%

Source: Florida Youth Substance Abuse Survey 2012

Number of Synthetic Cannabinoids Poison Control Exposure Calls

2012 2013 Jan-Apr 2014

Source: Florida Poison Information Center – Miami 1-800-222-1222

Synthetic Cannabinoids

Poison Exposure Calls

# of Poison Exposure

Calls Jan-Dec 2012


Calls Jan-Dec 2013


Calls Jan-Apr 2014

State of Florida 537* 194** 34

Broward County 37 7 0

Miami-Dade County 45 9 3

Palm Beach County 24 6 0

* The total of 537 includes 271 calls in January-April 2012 ** The total of 194 includes 78 calls in January-April 2013

Marijuana Trends


3 SE FL Counties 5,388 5,276 Down 2 %

Detected in ME Decedents

2012 2 x 1H 2013 Δ 2012 vs. 2X1h 2013



State of Florida 25.1 % 23 % Down 8 %

“Budder” Beware: Dangers of Marijuana Wax

• Marijuana Wax • “Budder,” or • Butane hash oil, or even • “ear wax hash”

Produced by soaking marijuana plant material in a solvent such as butane which extracts various cannabinoids of the plant.

• Thirty-four percent or 1/3 of High School Seniors who say that they have used marijuana in the past year who live in the states that have passed medical marijuana laws report that one of their sources of marijuana is another person's medical marijuana prescription. And 6 percent say they get it from their own prescription.

• It thus appears that state medical marijuana laws provide an additional avenue of accessibility to the drug for teens.

(Source: US Department of HHS: NIH-NIDA 2013 Monitoring the Future Survey Released December 2013)

The Question for Doctors……..

How a Bill becomes Law

How a Pill becomes MedicineUS Food and Drug Administration• Clinical Trials• FDA Medical Review• FDA Medical Panel Approval

Denver Area Colorado USA0

2

4

6

8

10

12

14

16

7.887.29

6.05

9.628.56

6.01

12.2

11.18

6.58

13.45

11.66

7.01

2004-062006-082008-102010-12

Percent

Source:

National Survey on DrugUse and HealthSubstate Data

Marijuana Use in the Past Month Age 12 and Above: Comparison of 2004-06, 2006-08, 2008-10 & 2010-12 NSDUH: Metro Denver vs. Colorado vs. USA

Denver Area Colorado USA0

5

10

15

20

25

30

35

40

45

30.6132.03

39.15

26.8228.84

38.18

21.9924.2

34.7

19.6322.1

31.82

2004-062006-082008-102010-12

Percent

Perception of Great Risk of Smoking Marijuana Once a Month: Comparison of 2004-2006, 2006-2008, 2008-2010, & 2010-2012

NSDUH: Denver Metro vs. Colorado vs. USA

Source: National Survey on DrugUse and HealthSubstate Data

Do you know anyone with a Medical Marijuana License/Card?

Denver Public Schools 2011-12 school year

Yes, 36%

No, 64%

No Marijuana Use in Past 30 Days

The range of all students answered yes, rose from

19% among 6th graders to 51% among 12th graders.

Yes, 80%

No, 20%

Used Marijuana in Past 30 Days

Current (past 30-day) Alcohol Use Among Palm Beach County Middle and High School Students

2000-2012


2000 2002 2004 2006 2008 2010 20120

10

20

30

40

50

60

40 38.8

48.3 46.342.2

41.8

3825.6

21.818.4 19.8

16.5 19.1

11.9High School Middle School

% R

ep

ort

ing

Cu

rre

nt

Us

e

Current (past 30-day) Binge Drinking Among Palm Beach County Middle & High School Students

2000-20012


2000 2002 2004 2006 2008 2010 20120

5

10

15

20

25

30

22.1 22.3 22.325.1

21.8 2118.1

10.5 9.47.2

9.2

5.96.6

4.2

High School

Middle School

% R

ep

ort

ing

Cu

rre

nt

Us

e

Current Alcohol Use Among Palm Beach High County School Students by Gender 2006-2012

2000 2006 2008 2010 201220

22

24

26

28

30

32

34

36

38

32.7 33.832.4

31.6

26.8

31.2

36.8

29.9

33.1

27.8

Male Female

% R

ep

ort

ing

Use P

ast

30

D

ays

Source: Florida Dept. of Children & Families Florida Youth Substance Abuse Surveys 2006-2012

Note: Rates by Gender not available for 2002 to 2004

Percent of Palm Beach County High School Students Reporting Alcohol Use by

Age 13 or Younger 2000-2012

2000 2002 2004 2006 2008 2010 20120

5

10

15

20

25

30

35

40

45 41.838.4

43.3

36.333.2

27.325.4

11.9

7.2 6 4.3 5.2 5.9 5.4

More than a Sip or Two

Drinking at least Once a Month


% R

epo

rtin

g U

se

by

Ag

e 1

3

Age of Alcohol Onset and Any L ifetime Alcohol Dependency

among Adults Aged 18 and Older

47% 45%

38%32%

28%

15% 17%11% 9%

0%

10%

20%

30%

40%

50%

13 14 15 16 17 18 19 20 21

Age Began Drinking

Source: National Epidemiologic Survey on Alcohol and Related Conditions Sample = 43,093

% A

lcoh

ol D

epen

den

t

Methamphetamine Arrests Broward County, FL: Jan 2010–July 2014 n=168

2010 2011 2012 2013 1st H 20114

0%10%20%30%40%

10%17% 17%

38%

18%

Percent By Year

1% 7%

28%64%

Percent By Race/Gender

Black FemaleWhite FemaleBlack MaleWhite Male< 20 20's 30's 40's 50's 60's

0%5%

10%15%20%25%30%35%

2%

35%

26% 27%

9%

1%

Percent By Age

Methamphetamine Trends


3 SE FL Counties 170 211 Up 24 %

Related Deaths 2012 2 x 1H 2013 Δ 2012 vs. 2X1h 2013



State of Florida 1.6 % 2 % Up 25 %

Percent of Addiction Treatment Clients Reporting Injecting Drug Use by Primary Drug at Admission:

State of Florida 2012

Sources: US SAMHSA Treatment Episode Data Sets (TEDS) for Statewide 2012

Treatment Primary Drug

State of Florida

%

Heroin 82 %Prescription Opioid 36 %Methamphetamine 27 %Cocaine 5 %

SBIRT• Screening

• Brief Intervention

• Referral to Treatment

What is SBIRT?

SBIRT is a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services• For persons with substance use disorders and • Those who are at risk of developing these

disorders

Primary care centers, trauma centers, and other community settings provide opportunities for early intervention with at-risk substance users.

SBIRT: Review of Key Terms

Screening: Very brief set of questions that identifies risk of substance use related problems.

Brief Intervention: Brief counseling that raises awareness of risks and motivates client toward acknowledgement of problem.

Referral: Procedures to help patients access specialized care.

SBIRT Goals Increase access to care for persons with substance use disorders and those at risk of substance use disorders. Foster a continuum of care by integrating

prevention, intervention, and treatment services. Improve linkages between health care services and alcohol/drug treatment services.

http://beta.samhsa.gov/sbirt

community epidemiology report fall 2014 south florida drug abuse trends update

Documents

heroin slide

number of cocaine reports

south florida key findings

rx benzodiazepines

number of cocaine occurrences

state of florida percent

florida department of

miamidade counties slide