Mayors Opioid Summit PATTERNS AND TRENDS OF THE OPIOID EPIDEMIC IN BROWARD COUNTY TYPES OF OPIOIDS DEFINITION OF OPIOID. Pill Press from China

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1 The Opioid Epidemic In Broward County 8/24/217 Mayors Opioid Summit PATTERNS AND TRENDS OF THE OPIOID EPIDEMIC IN BROWARD COUNTY Jim Hall Senior Epidemiologist Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University DEFINITION OF OPIOID Similar to opium Morphine and similar drugs derived from opium All substances, both natural and synthetic, that bind to opioid receptors in the brain and body TYPES OF OPIOIDS Illegal Heroin Legal Prescription Opioid Pain Relivers (e.g., Oxycodone, Hydrocodone, Methadone, Morphine, Rx, et al) Illicitly manufactured Opioid Analogues (e.g.,, U-47, et al sold as Heroin or adulterants to Heroin, Cocaine or other drugs, and counterfeit prescription medications) Real Fake Pinellas County Florida Pill Press from China Counterfeit Xanax with Source: Royal Canadian Mounted Police Jim Hall 1

2 The Opioid Epidemic In Broward County 8/24/217 MME Rate Per 1, Population AN EPIDEMIC OF DEATHS Plus,18 Rx Opioid Occurrences In 21 AN EPIDEMIC OF DEATHS USA 91 deaths a day in 215 Florida 14 + deaths a day in 21 plus 27 non-fatal Overdoses Broward County 1 deaths a week plus 17 non-fatal Overdoses Jan Aug 217 Death Rate still increasing Top 5 Ft. Lauderdale Pill Mill.The doctor is in October28 March 29 ARCOS 49 in Florida 25 in Broward County 9,21,731 Dose Units Rx Morphine Milligram Equivalent Rates per 1, in Southeast Florida Counties and USA: 21 vs USA Up From 12. MME_PerCap_21 18 MME in MME_PerCap_ BROWARD, FL MIAMI-DADE, FL PALM BEACH, FL USA Source: Centers for Disease Control and Prevention July 217 Jim Hall upfrontin@aol.com 2

3 The Opioid Epidemic In Broward County 8/24/217 # of Opioids Detected Among Decedents Number of Occurrences Number of Heroin Occurrences Number of Occurrences 9, 8, 7,, Number of Nonmedical Rx Opioids Occurrences Detected among Decedents in Florida 25 21* Opioids 5,454,,8,333 5,489 5, 4,35 4,415,59 4, CS-II Dispensing Limits and 3, OxyContin Tamper Resistant 2, 1, *21 projection based on 2 x 1H21 5,85 Strike Force,514 5,24 House Bill 795 Takes effect 8,12* X1H 21 Source: FDLE Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 25 - June 21 Reports Number of Heroin Related-Deaths in Broward County Florida: st H of 21 Heroin Cases 9 % Cause of Death 92 % w/other Drugs x1stH 21 Source: 21 FL Medical Examiner Interim Report Occurrences Among Deceased Persons in Broward County FL: Jan 214-Jun st H of 21 Heroin Cases 8 97 % Cause of Death 8 % w/other Drugs H 214 2H 214 1H 215 2H 215 1H 21 Heroin, Morphine,, and 3 Other Rx Opioid Occurrences Among Deceased Persons in Broward County FL: Jan 215-Jun Heroin 73 Morphine st H 215 2nd H 215 1st H Occurrences of 3 Selected Rx Opioids among Deceased Persons in Broward County: Jan 215 -June Hydrocodone 1 Oxycodone 9 Methadone st H 215 2nd H 215 1st H 21 Number of Selected Opioid Occurrences among Deceased Persons in Broward County: Jan 215 June 21 Opioid 1st H 215 2nd H 215 1st H Morphine Heroin Oxycodone Hydrocodone 11 1 Methadone 9 Jim Hall upfrontin@aol.com 3

4 The Opioid Epidemic In Broward County 8/24/217 Number of Occurrences Number of Patients or Admissions Opioid Occurrences and Number and Percent as Cause of Death Among Deceased Persons in Broward County FL : Jan 21-Jun % 94 9% Total Occurrences 9 91 # Cause 8 73% 72 % Cause % % % 2 4 1% 9% 8% 7% % 5% 4% 3% 2% 1% % % as Cause of Death Broward County Florida Opiate Overdose Deaths Includes Heroin, Prescription Opioids, and Clandestine Opiate Analogues Opiate Overdose Deaths Opiate Overdose Deaths Jan-Jun Drug Deaths Source: 21 Source: FL Medical FDLE - Florida Examiners Medical Commission Examiners Interim Commission Report Source: Broward County Medical Examiner s Office Overdose Poisoning Cases for Heroin and Opioids, in Broward County Hospitals: Jan-Jun ED 221 Inpatient 2 Heroin Patients Opioid Patients Inpatient 8 12 ED Source: Florida Agency for Health Care Administration 21 Opioid Crime Lab Reports for Broward County Number and Percent of all Exhibits Heroin 53 (8.3%) Oxycodone 238 (3.7%) 11 (1.7%) Hydromorphone 9 (1.4%) Buprenorphine 49 (.8%) Hydrocodone 48 (.8%) Morphine 4 (.7%) Carfentanil 35 (.%) Methadone 22 (.4%) Furanyl 2 (.3%) Total 1,188 (18.7%) Source: US DEA NFLIS Data Queried 5/22/217 Symptoms of Opium Withdrawal Heroin from Mexico shown in Green nausea sweating cramps vomiting diarrhea insomnia loss of appetite agitation irritability mood swings depression anxiety muscle soreness aching bones fever runny nose twitching Jim Hall upfrontin@aol.com 4

5 The Opioid Epidemic In Broward County 8/24/217 # of Cocaine Deaths # of Cocaine Deaths Dope Sick Addiction is the Affliction IMPACT ON CHILDREN 78 % of Children in Florida s Child Care System for Parent s SUD Photo Source: The Daily Beast, Data Source: Florida Behavioral Health Association Number of Neonatal Abstinence Syndrome Cases State of Florida: Broward ,33 1,19 1,3 1,53 1,772 1,93 2,487 Source: Florida Agency for Health Care Administration % 9% 8% 7% % 5% 4% 3% 2% 1% % Percent of Treatment Admissions by Primary Drug Broward County: % 14% 22% 8% 3% 2% 1% 27% n=5,79 n=5,9 n=5,998 n=5,811 n=5,439 n=,382 n=,171 n=7,737 Other/Unknown Marijuana Rx Opioids Heroin Cocaine/Crack Alcohol Source: Florida Department of Children and Families and Broward Behavioral Health Coalition Number of Cocaine Deaths in Florida and Broward County 2-21* ,228* , x 1st H * * Projected Increase based on 2 X 1 st Half of 21 Source: Florida Medical Examiners Commission 21 Interim Report Top 1 Co-Occurring Substances Among Florida Cocaine-Caused Deaths in 215 Morphine Ethanol Heroin Alprazolam Codeine Cannabinoids Oxycodone Hydromorphone Nordiazepam 5.% 7.8% 1.4% 13.2% 12.% 21.8% 25.1% 28.% Sources: Florida Medical Examiners Commission 215 Report and Florida drug-related Outcomes Surveillance and Tracking (FROST) System 32.3% 31.1%.% 5.% 1.% 15.% 2.% 25.% 3.% 35.% Jim Hall upfrontin@aol.com 5

6 The Opioid Epidemic In Broward County 8/24/217 Epidemic of Opioid Use Disorder and Deaths The Perfect Storm For Pain Rx Tolerance Need More OUD Dope Sick Mexican Heroin Pill Mills Street Analogues el al IM Opiates Polysubstance Abuse Xanax Cocaine Marijuana Alcohol Whatever Counterfeit Pills Abstinence Relapse Overdose Emergency Exit This Presentation and Annual Broward Drug Trends Report Jim Hall Emergency Exit Or For Pleasure Naloxone Distribution Appropriate Prescribing By: Doctor, Dentist, Physician Assistant, Nurse Practitioner Intervention Training for Families Increased Treatment Availability Medically Assisted Treatment Intensive Outpatient Services Recovery Support Systems Mayors Opioid Summit