The Broward Report April 2011

Transcription

1 The Broward Report April 2011 Community Epidemiology Work Group James N. Hall South Florida Drug Observatory Nova Southeastern University 2

2 TODAY S TOPICS Underage Drinking Cocaine Continuing Signs of Decline Rx Opioids: Deaths Continue Unchecked Injecting Drug Use (IDU) Among Rx Opioid Users Marijuana: Increasing Use, Softening of Attitudes New Unregulated Synthetic Drugs On the Radar: Methamphetamine, GHB

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4 CURRENT (PAST 30-DAY) DRUG USE AMONG BROWARD COUNTY MIDDLE SCHOOL STUDENTS % Reporting Current Use Alcohol Cigarette Marijuana Inhalants Source: Florida Youth Substance Abuse Surveys

5 CURRENT (PAST 30-DAY) DRUG USE AMONG BROWARD COUNTY HIGH SCHOOL STUDENTS % Reporting Current Use Alcohol Cigarette Marijuana Inhalants Source: Florida Youth Substance Abuse Surveys

6 CURRENT (PAST 30-DAY) DRUG USE AMONG BROWARD COUNTY MIDDLE AND HIGH SCHOOL STUDENTS % Reporting Current Use Alcohol Cigarette Marijuana Inhalants Source: Florida Youth Substance Abuse Surveys

7 CURRENT (PAST 30-DAY) BINGE DRINKING AMONG BROWARD COUNTY MIDDLE & HIGH SCHOOL STUDENTS % Reporting Current Use High School Middle School Source: Florida Youth Substance Abuse Surveys

8 CURRENT ALCOHOL USE AMONG BROWARD MIDDLE AND HIGH SCHOOL STUDENTS BY GENDER % Reporting Use Past 30 Days Male Female Source: Florida Dept. of Children & Families Florida Youth Substance Abuse Surveys

9 ALCOHOL AND THE YOUNG BRAIN April Alcohol Awareness Month

10 FINDINGS OF THE NATIONAL EPIDEMIOLOGIC SURVEY ON ALCOHOL AND RELATED CONDITIONS As illustrated in the graph on the next slide, nearly half (or 47 percent) of the survey s 43,093 participants over the age of 18 who reported an alcohol dependency problem sometime in their lifetime had their first drink of alcohol before the age of 13 years. This survey was conducted for the National Institute on Alcohol Abuse and Alcoholism.

11 AGE OF ONSET AND ANY LIFETIME ALCOHOL DEPENDENCY 50% 47% 45% 38% AGED 18 AND OLDER % Alcohol Dependent 40% 30% 20% 10% 0% 32% 28% 15% 17% 11% 9% Age Began Drinking Source: National Epidemiologic Survey on Alcohol and Related Conditions Sample = 43,093

12 The Brain Continues to Develop into Adulthood The brain undergoes dramatic changes during adolescence. One of the areas still maturing from ages 5 to 20 years is the prefrontal cortex, the part of the brain that enables us to assess situations, make sound decisions, and keep emotions and desires under control. Introducing alcohol or other drugs while the brain is still developing may have profound and long-lasting consequences.

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14 Source: SAMHSA-National Survey on Drug Use and Health 2008

15 PERCENT OF BROWARD COUNTY HIGH SCHOOL STUDENTS REPORTING ALCOHOL USE BY AGE 13 OR YOUNGER % Reporting Use by Age More than a Sip or Two Drinking at least Once a Month Source: Florida Youth Substance Abuse Surveys

16 Percent Reporting Use BROWARD COUNTY STUDENT ALCOHOL USE BY GRADE LEVEL Past 30 days Lifetime th 7th 8th 9th 10th 11th 12th 45.7 Source: Florida Youth Substance Abuse Survey 2008 Broward County

17 PERCEIVED ATTITUDES ABOUT ALCOHOL AMONG BROWARD COUNTY MIDDLE AND HIGH SCHOOL STUDENTS % Reporting Current Use Wrong to Drink Regularly Daily Use Harmful Seen as Cool to Drink Source: Florida Youth Substance Abuse Surveys

18 USUAL SOURCE OF ALCOHOL IN PAST 30 DAYS AMONG BROWARD COUNTY AND STATE OF FLORIDA HIGH SCHOOL STUDENTS WHO DRINK: 2010 % of high school drinkers reporting Bought in store 9.2 Broward Florida Bought in restaurant, bar, club Bought at public event Someone bought it for me Source: Florida Youth Substance Abuse Surveys Someone gave it to me Took it from a Took it from a store family member Some other way

19 USUAL DRINKING LOCATION IN PAST 30 DAYS AMONG BROWARD COUNTY AND STATE OF FLORIDA HIGH SCHOOL STUDENTS WHO DRINK: 2010 % of high school drinkers reporting My home Another person's home Car or Vechile Restaurant, bar, or club Public Place Broward Florida Public event School property Some other place Source: Florida Youth Substance Abuse Surveys 2010

20 Economic Costs of Underage Drinking in Broward County $ 258,700,000* *2007 Dollars Violent Crime 49% Motor Vechicle Crashes 17% Drownings 4% Burns.02% Fetal Al Synd 3% Risky Sex Behav 11% Poisoning 3% Suicide Property 1% Crime 11% Source: Popovici,I et al. University of Miami Study for Florida s State Epidemiology Work Group, June 2009

21 Number of Cocaine Reports Detected Among Decedents in South Florida: Jan June NUMBER of COCAINE OCCURRENCES Including Present & Cause of Death Miami-Dade Broward X 1h'10 SOURCE: Florida Medical Examiners Commission Interim Report 2010

22 Number of Cocaine Reports Detected Among Decedents in Florida: Jan June ,500 2,000 1,500 1, NUMBER of 0 COCAINE OCCURRENCES Including 300 Present & 250 Cause of 200 Death ,3071,614 1,034 1,105 1,702 1,943 2,052 2,179 1,791 1,462 All Florida 1, X 1h' Miami-Dade Broward X 1h'10 SOURCE: Florida Medical Examiners Commission Interim Report

23 Number of Cocaine Reports Among Deceased Persons by Polysubstance Use Status in Florida: # of Cocaine Detections Among Decedents Cocaine Plus Cocaine Only X 1h '10 Cocaine Plus ,367 1, CocaineOnly SOURCE: Florida Dept. of Law Enforcement, Florida Medical Examiners Commission Reports

24 Rates per 100,000 of Cocaine Emergency Dept. Reports Broward (2008), Miami-Dade, and USA: Rates per 100, Miami-Dade USA Broward SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.

25 Number of South Florida* Crime Lab Reports for Cocaine and All Other Drugs: 2007-Jun 10 *Miami-Dade, Broward, & Palm Beach Counties Combined Legend Cocaine All Other Drugs X1h ' Cocaine 67% 20,913 10, Cocaine 65% 19,156 10, Cocaine 62% 15,309 9, Cocaine 57% 13,196 10, ,000 20,000 30,000 40,000 Number of Crime Lab Samples Source: US DEA National Forensic Laboratory Information System

26 PRICE AND PURITY OF ALL USA LAW ENFORCEMENT COCAINE PURCHASES JANUARY JUNE 2009 Price/Pure Gram $200 $180 $160 $140 $120 $100 $80 $60 $ $ $ $ Price/Pure Gram Purity $ Percent Pure $20 10 $ H Source: Based on unpublished US DEA System to Retrieve Information from Drug Evidence (STRIDE) Data

27 NUMBER OF OPIATE-RELATED DEATHS BY HEROIN OR RX OPIOID IN FLORIDA: # of Opiates Detected Among Decedents Heroin 3 Rx Opioids 3 Rx Opioids Heroin 3,986 The 3 Rx Opioids are Methadone, Hydrocodone, and Oxycodone 60 SOURCE: Florida Medical Examiners Commission Reports

28 Prescription Opioid Nonmedical Use and Heroin Rx Opioid frequently misused by heroin users Not a significant number of Rx Opioid misusers also using heroin Increasing Injecting Drug Use among Rx Opioid nonmedical users in their 20s. Born 1981 to 1990; Entered Adolescence After major interventions for HIV Injecting Drug Users Priority Public Health Issue: Infected Syringes - Young Adults

29 Number of Oxycodone Reports Detected Among Decedents in Florida: Jan June 2010 NUMBER of Oxycodone OCCURRENCES Including Present & Cause of Death Florida 941 1,007 1,117 1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10 SOURCE: Florida Medical Examiners Commission Interim Report 2010

30 Number of Oxycodone Reports Detected Among Decedents in Florida: Jan June 2010 NUMBER of Oxycodone OCCURRENCES Including Present & Cause of Death ,007 1, Florida 1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H ' Palm Beach Broward Miami-Dade H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10 SOURCE: Florida Medical Examiners Commission Interim Report 2010

31 PERCENT OF OTHER DRUGS DETECTED IN THE 1,185 LETHAL OXYCODONE DEATHS IN FLORIDA: % 70% 60% 50% 40% 30% 20% 10% 0% 72% 42% 12% 9% 7% Source: Analysis of 2009 Florida Medical Examiner Commission Complete Electronic Database by Nova Southeastern University Center for Study & Prevention of Substance Abuse

32 Drug Overdose Death Risk Profile* Demographic Indicators: White Male Approximately 39 years old High School Diploma or GED Employed Static Indicators: History of substance abuse History of drug related arrests History of addiction treatment History of mental health treatment History of non fatal drug overdose Circumstantial Indicators: Died at home Discovered by family member Last act = sleeping Found unconscious Others present at death scene Others aware of fatal drug use Others recognized distress Died from accidental multiple drug toxicity Most likely combinations = (alprazolam, oxycodone, cocaine, methadone) Under a physician s care * The above profile is derived from variables present in at least one third (33.3%) of the 207 closed, overdose death cases in Palm Beach County. SOURCE: Palm Beach County Sheriff s Office and Lynn University 2008

33 Percent of Primary Treatment Admissions by Substance for the State of Florida: 1999 (n= 84,524) Compared to 2009 (n= 77,604) 5% 0.50% 1% 3% % 28% Alcohol Only Alcohol w/drug Crack Cocaine Other Cocaine Marijuana 2% 1% 5% 16% % 20% 5% 18% 13% Heroin Opioids Amphetamines Tranquilizers Other/Unknown 31% 11% 10% SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010 2% 4%

34 Percent of Primary Addiction Treatment Admissions for Rx Opioids among all substances (including alcohol) in Florida: 1998 to % 18% 16% 14% 12% 10% 8% 6% 4% 2% 0% 19.1% 15.8% 10.7% 7.3% 8.3% 4.8%4.8% 5.4%5.4% 4.2% 2.1% 2.6%3.4% Source: SAMHSA - Treatment Episode Data Sets Submitted by the Florida Dept. of Children and Families as of January 6, 2011

35 Number of Primary Addiction Treatment Admissions Number of Primary Addiction Treatment Admissions for Prescription Opioids for Prescription Opioids in Florida by Age: 1999 vs n= 2, n= 12, yrs 1820 yrs 2125 yrs 2630 yrs 3135 yrs 3640 yrs 4145 yrs 4650 yrs 5155 yrs 5660 yrs 6166 & 65 over yrs 1999 n= 2, n= 12, SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010

36 Percent of Primary Rx Opioid Addiction Treatment Admissions By Age Groups in Florida: 1998 TO % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% * Unknown Age 66 and older 61 to 65 yrs 56 to 60 yrs 51 to 55 yrs 46 to 50 yrs 41 to 45 yrs 36 to 40 yrs 31 to 35 yrs 26 to 30 yrs 21 to 25 yrs 18 to 20 yrs 12 to 17 yrs Source: SAMHSA - Treatment Episode Data Sets Submitted by the Florida Dept of Children and Families as of January 6, 2011

37 Sources of Oxycodone Dose Units Dispensed Annually in Florida 83,000,000 Pills 440,000,000 Pills Dispensed by Practitioner Dispensed by Pharmacist or Hospital Source: Analysis of US Department of Justice 2009 and 2010 data by NSU Center for Study And Prevention of Substance Abuse

38 Oxycodone Dispensed in Florida In 2009, Florida with 5.9 percent of the nation s population dispensed 12.2 percent of all the Oxycodone dose units (or pills) in the nation and 16.9 percent of the total grams of Oxycodone dispensed nationwide. The average dose unit dispensed in Florida was 18 mg as compared to 13 mg nationally. Florida dispensed more pills and total grams of Oxycodone that any other state or territory.

39 Rates per 100,000 of Nonmedical Use Oxycodone Emergency Dept. Reports Miami-Dade, Broward, and USA: Rates per 100, SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.. Broward USA Miami-Dade 14

40 Rates per 100,000 of Oxycodone Nonmedical Use Emergency Department Reports by Age Groups DAWN Ft. Lauderdale Division vs. USA: 2009 Rate per 100, USA Broward & Palm Beach yrs yrs yrs yrs yrs yrs yrs. SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.

41 Number of Oxycodone Reports Detected Among Decedents by Age Groups in Florida: Jan-Jun # of Oxycodone Reports State of Florida 1, <18 yrs yrs yrs yrs. >50 yrs. Source: FDLE Florida Medical Examiners Commission Interim Report 2010

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44 Percent of Persons Aged 12 and Above Reporting Nonmedical Use of Rx Pain Relievers in the Past Year: Percent Reporting Past Year Use Florida Palm Beach Broward Miam i-dade SOURCE: SAMHSA (2010): Substate Estimates from the National Surveys on Drug Use and Health (Office of Applied Studies).

45 Number of Alprazolam Reports Detected Among Decedents in Florida: Jan June 2010 NUMBER of Alprazolam OCCURRENCES Including Present & Cause of Death , , Florida 1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10 Palm Beach Broward Miami-Dade H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H ' SOURCE: Florida Medical Examiners Commission Interim Report 2010

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48 Percent of High School Students Reporting Any Past 30-Day Marijuana Use Broward County, FL: Percent Reporting Current Use Broward Source: Centers for Disease Control and Prevention: Youth Risk Behavior Surveillance

49 CURRENT (PAST 30-DAY) DRUG USE AMONG BROWARD COUNTY MIDDLE AND HIGH SCHOOL STUDENTS % Reporting Current Use Alcohol Cigarette Marijuana Inhalants Source: Florida Youth Substance Abuse Surveys

50 PERCEIVED ATTITUDES ABOUT MARIJUANA AMONG BROWARD COUNTY MIDDLE AND HIGH SCHOOL STUDENTS % Reporting Current Use Wrong to Smoke Marijuana Regular Use Harmful Seen as Cool to Use Trying Marijuana Harmful Source: Florida Youth Substance Abuse Surveys

51 Percent of Broward Middle School Students Reporting Delinquent Behaviors by 60% 50% 40% 30% 20% 10% 0% 28% 19% 2% 2% 3% Carried Handgun Not Current Marijuana Users Past Month Marijuana Users Attempted Steal Vehicle 28% Be en Arrested 1% 7% Handgun to School 13% 48% Bee n Suspended 11% 40% Attacked to Hurt 3% Drunk or High at School 57% 1% 35% Sold Illegal Drugs Source: FL DCF 2008 Florida Youth Substance Abuse Survey Broward County % Reporting Delinquent Behavior in Past Year Current (past 30-day) & Non-Current Marijuana Use

52 Percent of Broward High School Students Reporting Delinquent Behaviors by 60% 50% 40% 30% 20% 10% 0% 3% 10% Carried Handgun Not Current Marijuana Users Past Month Marijuana Users 6% 1% Attempted Steal Vehicle 3% 17% Be en Arrested 3% 1% Handgun to School 22% 9% 8% Bee n Suspended 27% Attacked to Hurt 5% Drunk or High at School 51% 2% 30% Sold Illegal Drugs Source: FL DCF 2008 Florida Youth Substance Abuse Survey Broward County Sample= 4,993 Broward High School Students % Reporting Delinquent Behavior in Past Year Current (past 30-day) & Non-Current Marijuana Use

53 5% 20% Percent of Primary Treatment Admissions by Substance for the State of Florida: 1999 (n= 84,524) Compared to 2009 (n= 77,604) 0.50% % 6.50% 3% 5% 18% 28% 13% Alcohol Only Alcohol w/drug Crack Cocaine Other Cocaine Marijuana Heroin Opioids Amphetamines Tranquilizers Other/Unknown 18% 11% 10% SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010 2% 16% 31% 2% 1% 5% %

54 Widely Available Synthetic Cannabinoids Need for Laboratory Standards - Crime Labs - Urine Drug Tests

55 WHOLE NEW PHARMACOPOEIA? Synthetic Stimulants, Hallucinogens, and Marijuana Substitutes Not New Science 40 years of Pharmaceutical Research Rejected for Medical/Human Use Not profitable for drug traffickers

56 21 ST CENTURY: THE PERFECT STORM Cheap to make in China and elsewhere Easy to Market Worldwide via Internet Particularly to Drug Users Subculture International Delivery Services Legal Retailers Not for Humans The Mimic Drugs Fake Pot, Ecstasy Beat the Drug Test Highly Profitable Incense. Bath Salts Role of Organized Crime or Terrorism? Global Phenomena

57 65 PERCENT OF BROWARD CRIME LAB ALLEGED ECSTASY IS BZP IN 2010 BZP TFMPP?

58 Be On ALERT MEPHEDRONE Meow Meow MDPV I-10 from New Orleans 2C-E Europa Chlorophenylpiperazine - mcpp

59 MDPV (3,4-Methylenedioxypyrovalerone)

60 ON THE RADAR Return of GHB Drug-Facilitated Rape New Sources of Methamphetamine

61 The Broward Report April 2011 James N. Hall South Florida Drug Observatory Nova Southeastern University Phone: (786)