Quantifying the Emerging Stimulant Threat for All Stakeholders

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2 National Emerging Threats Initiative Quantifying the Emerging Stimulant Threat for All Stakeholders National Cocaine, Meth and Stimulant Summit November 12, 218 Fort Lauderdale, FL

3 Supplies of Drugs Opioids Stimulants

4 Law Enforcement Seizure Data Data from High Intensity Drug Trafficking Areas (HIDTAs) Performance Management Process (PMP)

5 14% HIDTA 217 Seizures 1% 2% Cocaine/Crack Heroin Fentanyl Meth/Ice 83%

6 Heroin Seizures

7 Kilograms (Kg) HIDTA Heroin Seizures The above graph reflects the change in heroin seizures, in terms of amount seized (in kilograms) within all counties from 211 to 217. HIDTA

8 Seizures (kg) Number of Incidents HIDTA Seizures - Heroin Total seizures (kg) # of Incidents The above graph reflects the change in heroin seizures, in terms of amount seized (in kilograms) and the total number of incidents (reported in Kg, dosage units and liter forms) within all HIDTA counties from 211 to 217.

9 Seizures (kg) Number of incidents Southwest Border Seizures - Heroin CY17 Q1 CY17 Q2 CY17 Q3 CY17 Q4 HIDTA Seizures CBP Seizures HIDTA # of Incidents CBP # of Incidents *SWB HIDTAs includes Arizona, New Mexico, San Diego, South and West Texas The above graph compares HIDTA and Customs and Border Protection (CBP) cocaine seizures along the Southwest border of the United States in 217

10 HIDTA Heroin Seizures 217 The above map reflects the location of HIDTAs heroin seizures (reported in Kg and dosage units) in 217 as reported to PMP.

11 HIDTA Heroin Seizures 217 The above map reflects HIDTA heroin seizure percentages of change over the past seven years, by comparing 217 to 211

12 Opioid Prescriptions State Drug Monitoring Program (PDMP) Data

13 HIDTAs and Respective States HIDTA State HIDTA State Appalachia Appalachia Atlanta/Carolinas Central Valley California KY TN NC CA New England New York/ New Jersey Northwest Ohio MA NY WA OH Los Angeles Northern California Southwest Border-San Diego Gulf Coast CA CA CA AR Oregon Texoma Washington/ Baltimore OR OK MD Note: States were selected as representative among 15 HIDTAs, 1 of which had increases in cocaine and or methamphetamine seizures.

14 Opioid & Other Controlled Substances Prescription Rates for Representative States Rate of Rx per 1, Population

15 Cocaine Seizures

16 Seizures (kg) Number of Incidents Southwest Border Seizures - Cocaine CY17 Q1 CY17 Q2 CY17 Q3 CY17 Q HIDTA Seizures HIDTA # of Incidents CBP Seizures CBP # of Incidents *SWB HiDTAs include Arizona, New Mexico, San Diego, South and West Texas The above graph compares HIDTA and Customs and Border Protection (CBP) cocaine seizures along the Southwest border of the United States in 217

17 Kilograms (kg) HIDTA Cocaine Seizures The above graph reflects the change in cocaine/crack seizures, in terms of amount seized (in kilograms) within all HIDTA counties from 211 to 217.

18 The above graph reflects the change in cocaine/crack seizures, in terms of amount seized (in kilograms) and the total number of incidents (reported in Kg, dosage units and liter forms) within all HIDTA counties from 211 to 217.

19 Kilograms (Kg) HIDTA Cocaine Seizures Top 3 (PR/VI, S Florida, San Diego) Remaining HIDTAS Consistent Top Cocaine Seizure HIDTAs are S Florida, Puerto Rico/Virgin Islands (PR/VI), and San Diego. The graphic represents 217 cocaine seizures, to include crack, (in kilograms) by the three HIDTAs compared to the remaining HIDTAs.

20 Kilograms (Kg) Cocaine Comparison USCG (Removed) HIDTA (Seized) The above graph compares Cocaine Removed by the United States Coast Guard (USCG) (seizures combined with loss, e.g. drugs thrown into the ocean by crews of halted ships) with HIDTA cocaine seizures over a seven-year period.

21 HIDTA Cocaine/Crack Seizures 217 The above map reflects the location of HIDTAs cocaine seizures (reported in Kg and dosage units) in 217 as reported to PMP.

22 HIDTA Cocaine/Crack Seizures 217 The above map reflects HIDTA cocaine/crack seizure percentages of change over the past seven years, by comparing 217 to 211

23 Methamphetamine Seizures

24 **The total incident numbers reported above, include methamphetamine labs, reconstitution labs (meth extracted from meth in solution), ice conversion labs (small meth crystals/powder to large crystals), tablet extraction labs (removing the pseudoephedrine precursor from cold/allergy medicine), dumpsites (clan lab waste), and chemical or equipment only seizures.

25 Seizures (kg) # of Incidents Southwest Border Seizures - Methamphetamine/Ice CY17 Q1 CY17 Q2 CY17 Q3 CY17 Q4 HIDTA Seizures CBP Seizures HIDTA # of Incidents *SWB HIDTAs include Arizona, New Mexico, San Diego, South and West Texas CBP # of Incidents The graph above compares HIDTA and Customs and Border Protection (CBP) methamphetamine seizures along the Southwest border of the United States in 217.

26 The graph above highlights HIDTAs methamphetamine/ice seizures across all HIDTA from

27 Seizures (Kg) Number of Inicdents HIDTA Seizures - Methamphetamine/Ice Total seizures (kg) # of Incidents The above graph reflects the change in methamphetamine/ice seizures, in terms of amount seized (in kilograms) and the total number of incidents (reported in Kg, dosage units and liter forms) within all HIDTA counties from 211 to 217.

28 Kilograms (kg) HIDTAs Methamphetamine/Ice Seizures SWB HIDTAs Remaining HIDTAs The graph depicts the change in methamphetamine seizures by Southwest Border (SWB) HIDTAs compared to the rest of the HIDTAs.

29 HIDTA Meth/Ice Seizures 217 The above map reflects the location of HIDTAs methamphetamine seizures (reported in Kg and dosage units) in 217 as reported to PMP.

30 HIDTA Meth/Ice Seizures 217 The above map reflects HIDTA methamphetamine seizure percentages of change over the past seven years, by comparing 217 to 211

31 The above map reflects the location of HIDTAs Stimulant seizures in 217 as reported to PMP.

32 The above map reflects stimulant (methamphetamine and cocaine) seizure percentage of change over the past seven years.

33 Stimulant Prescriptions State Drug Monitoring Program (PDMP) Data

34 KY TN NC CA AR MA NY WA OH OR MD Stimulant Prescription Rates for Representative States Rate of Rx per 1, Population

35 Demand for Drugs Opioids Stimulants

36 New Initiates in (s) Nonmedical/Illicit Use Opioids

37 Past Year Nonmedical/Illicit Users in (s) - Opioids

38 New Initiates Nonmedical/ Illicit Users in (s) Stimulants

39 Past Year Nonmedical/Illicit Users in (s) - Stimulants

40 Supplies and Demand Opioids Stimulants

41 Seizures (Kg) New Initiate (s) Heroin HIDTA New Inititate The graph to the above reflects heroin new Initiate data versus HIDTA Seizures from over a seven year period

42 Opioid & Other Rx per 1, pop Opioid Rx New Initiates (s) Opioid & Other Rx per 1, pop vs Opioid Rx New Initiates Opioid & Other Rx per 1, pop Opioid Rx New Initiates *For Opioid & Other Rx, states included are KY, TN, NC, CA, MA, NY, OH The graph to the above compares Opioid & Other Prescription Rates for Representative States per 1, population against Opioid prescription New Initiates over a six year period.

43 Seizures (Kg) New Initiate (s) Cocaine HIDTA New Inititate The above graph reflects cocaine new Initiate data versus HIDTA Seizures from over a seven year period

44 Seizures (Kg) New Inititae (s) Methamphetamine HIDTA New Inititate The-graph to the above reflects methamphetamine new Initiate data versus HIDTA Seizures from over a seven year period

45 Stimulant Rx per 1, Pop Stimulant Rx New Initiates (s) Stimulant Rx and New Initiates Stimulant Rx per 1, pop Stimulant Rx New Initiates *States included are KY, TN, NC, CA, MA, NY, OH The graph to the right reflects stimulant new Initiates data compared against stimulant prescriptions per 1, population

46 Seizures (Kg) New Initiate (s) Stimulants (Meth and Cocaine) HIDTA New Inititate The above graph reflects stimulant new Initiate data versus HIDTA Seizures from over a seven year period

47 Supplies and Deaths Opioids Stimulants

48 Seizures (Kg) Deaths (Drug-related overdoses) HIDTA - Heroin NETI - 8/8/18 *217 Overdose death data is provisional HIDTA DEATHS The above graph compares HIDTA Heroin seizures to heroin related drug overdose deaths over a seven-year period.

49 Opioid & Other Rx Per 1, Pop Deaths (Rx Opioid related overdoses) 155 Opioid & Other Rx per 1, Pop and Rx Opioid Deaths Opioid & Other Rx per 1, pop *States included are KY, TN, NC, CA, MA, NY, OH Opioid & other non-stimulant controlled substances Rx as reported by 7 state PDMPs for 211 through 216 compared to the number of overdose deaths involving opioid Rx, as reported from CDC WONDER in August 218.

50 Seizures (Kg) Deaths (Drug-related overdoses) Cocaine NETI 8/8/18 HIDTA *217 Overdose death data is provisional DEATHS The comparison of HIDTA seizures of Cocaine to deaths involving cocaine show rapid increases from 211 through 216, suggesting that the increased deaths are highly correlated with increasing supply.

51 Seizures (kg) Deaths (Drug-realded Overdoses) 3 25 Methamphetamine/Ice HIDTA NETI 8/8/18 *217 Overdose death data is provisional DEATHS Methamphetamine seizures and deaths, while smaller in numbers than cocaine, are both increasing at a faster rate from 211 to 217.

52 The Opioid Epidemic and Emergence of Major Stimulant Abuse are intertwined

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54 Drug Abuse Varies by HIDTAs, States, and Communities 1) States & HIDTAs, need to develop Emergency Threat Initiatives 2) Communities need to develop Emerging Threat Initiatives with HIDTAs and States.

55 Who should be Involved? Supplies of Drugs Law Enforcement HDTAs, state police, county & municipal Prescription Drug Monitoring Programs Demand for Drugs Public Health Agencies Substance Abuse Prevention Substance Abuse Prevention Epidemiology Workgroups

56 Who should be Involved? Adverse Outcomes from drug misuse & abuse OD Maps Hospital Emergency Departments Medical Examiners Emergency Medical Services Community Organizations

57 John L Eadie Contact Information Presentation by: Public Health and Prescription Drug Monitoring Projects Coordinator National Emerging Threats Initiative jeadie@pdmpneti.org

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61 This is a SmartArt Graphic Text 1

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