community epidemiology report november 2014cdn.trustedpartner.com/docs/library...drug trends update...

Drug Trends Update Nov 2014

Jim Hall [email protected] 1

Community Epidemiology Report

November 2014

Drug Abuse Trends Update Broward County and

South Florida

James N. Hall, Epidemiologist

Center for Applied Research on

Substance Use and Health Disparities

Nova Southeastern University

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



a-pyrrolidinovalerophenone

“Flakka”

alpha-PVP

• Flaca – Skinny • Flakka – Beautiful, elegant woman who charms all • Wakka Flakka – Hip-Hop DJ • Elsewhere called

“Gravel”

Chemical structures of Synthetic Cathinones Pyrrolidinophenone compounds in comparison to MDPV



Toxic Effects: • Tachycardia, • Agitation, • Psychosis, • Violent behavior, • Excited Delirium • Hyperthermia • Kidney failure • Death

South Florida Crime a-PVP Lab Cases:

• 2012 - 2 • 2013 - 6 • 2014 - 120 +

Top 10 Most Frequently Identified Drugs of Total Reports

from South Florida Crime Labs Reports CY 20131

Drug 2013 % Δ vs. 2012

Cocaine 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 %

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



Methylone is beta-ketone MDMA

Molly

South Florida

Crime Labs Reports

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

Emerging Psychoactive Substances 2011–2013

19 190 145 43

428

1242

386 361

144 0

200

400

600

800

1000

1200

1400

2011 2012 2013

SyntheticCannabinoids

SyntheticCathinones

Other EmergingSynthetics

1

10

11

3 4

10 6

12 13

0

5

10

15

2011 2012 2013

SyntheticCannabinoids

SyntheticCathinones

Other EmergingSyntheticsNumber of Different Drugs



Emerging 169 Synthetic Drug Deaths in Florida - 2023

6

31

5

20

101

6 0

20

40

60

80

100

120

140

Cannabinoids Cathinones Other Synthetics

Present

Cause of Death

26

132

11

# o

f D

rug

Occ

urr

en

ces

Source: FDLE – Florida Medical Examiners Commission, November 2014

2C Phenethylamines 2C-B



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

Broward County - 2012

15.1 % 12.4 %

5.3 % 3.9%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

20%

FloridaLifetime

BrowardLifetime

Florida Past30 Days

Broward Past30 Days

Source: Florida Youth Substance Abuse Survey 2012



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

10% 17% 17%

38%

18%

0%

20%

40%

2010 2011 2012 2013 1st H2014

Percent By Year

1% 7%

28% 64%

Percent By Race/Gender

Black Female

White Female

Black Male

White Male0%

10%

20%

30%

40%

< 20 20's 30's 40's 50's 60's

2%

35%

26% 27%

9%

1%

Percent By Age



Methamphetamine Trends

So FL Crime Labs 2012 2013 Δ 2012 vs. 2013

3 SE FL Counties 170 211 Up 24 %

Related Deaths 2012 2013 Δ 2012 vs. 2013

State of Florida 146 169 Up 16 %

Primary Treatment 2011 2012 Δ 2011 vs. 2012

State of Florida 1.6 % 2 % Up 25 %

Rx Nonmedical Use in Florida 2000 -2013

Responding to an Epidemic



Ft. Lauderdale Pill Mill …….The doctor is in

9,201,731

Dose Units

49 in Florida 25 in Broward County



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 2008 to 2013

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

# “C

ause

of

De

ath

” O

ccu

rre

nce

s

476 465 533

652 715

801

607

640

392 343

279 255

337 336 380

340 336 358

341

350 274

238 221 168 153

147 160 142

110 152

144 201 176

239 268

300

141 129 136 129

139 176

136 171 118 126 158

133

0

100

200

300

400

500

600

700

800

900

Oxycodone

Methadone

Morphine

Hydrocodone

House Bill 7095 Takes effect

CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force



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, 10 15 Source: 2012-2013 Annual Report

Florida’s Prescription Drug Monitoring Program (PDMP)

3,000

500

5 Prescribers & 5 Pharmacies

2,864

1,415 1,097

427

514

178

51-% Decrease

Grams of Oxycodone Sales in Florida Per 100,000 Population

63,325

28,808 21,614

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

2009 2010 2011 2012 2013

Grams Sold Per 100,000 Population

National Rank Among States and Territories

# 1

# 19

# 22

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

Gra

ms

of

Oxy

cod

on

e S

old

pe

r 1

00

,00

0



Hydromorphone (e.g.., Dilaudid®)

STATE TOTAL

GRAMS GRAMS/

100K POP

1 FLORIDA 270,718.70 1,439.89

2 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

7 NEW HAMPSHIRE 10,389.74 789.21

8 MARYLAND 43,353.71 750.9

9 WASHINGTON 48,346.19 718.95

10 OREGON 27,172.92 709.28

199 212 213

253

414

432

0

100

200

300

400

500

2008 2009 2010 2011 2012 2013

Hydromorphone Related-Deaths in

Florida

# o

f D

eath

s

2013 ARCOS Grams Sold Per 100/Population

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

Exhibit 4 Top 10 Most Frequently Identified Drugs of Total

Reports from South Florida Crime Labs Reports CY 20131

Drug 2013 % Δ vs. 2012

Cocaine 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



Number of Heroin Deaths in Florida: 2000 –2013

276

328 326

261

180

122

96 110

132

111

58 62

117

199

15

57

36 27

26

17 8 10 6 6 4

12

6 20

61

39

46

32

18

22 20 26 38

30 26 15

33 40

0

50

100

150

200

250

300

350

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Florida

Palm Beach

Broward

Miami-Dade

# H

ero

in D

eath

s

SOURCE: Florida Medical Examiners Commission Reports 2000-2013

11



Number of Heroin Deaths in Florida: 2000 – 2013

15

57

36

27 26

17

8

10

6 6 4

12

6

20

17

53 50 49

35

17 13

4

17

8 5

3

9 11

61

39

46

32

18

22 20

26

38

30 26

15

33

40

0

10

20

30

40

50

60

70

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Palm Beach

Broward

Miami-Dade

# H

ero

in D

eath

s

SOURCE: Florida Medical Examiners Commission Reports 2000-2013

Heroin Trends Related Deaths 2012 2013 Δ 2012 vs. 2013

State of Florida 117 199 Up 70 %

Palm Beach County 6 20 Up 233 %

Broward County 9 11 Up 22 %

So FL Crime Labs 2012 2013 Δ 2012 vs. 2013

3 SE FL Counties 696 925 Up 33 %

Primary Treatment 2011 2012 Δ 2011 vs. 2012

State of Florida 2.2 % 3.2 % Up 45 %



Among Florida Youth “Most Don’t”

Drink, Smoke, or Take Drugs

Screening, Brief Intervention, Referral to Treatment

community epidemiology report november 2014cdn.trustedpartner.com/docs/library...drug trends update...

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