Substance Use In Philadelphia People Places and Things. Perspectives on an Epidemic

Transcription

1 Substance Use In Philadelphia People Places and Things Perspectives on an Epidemic

2 Demographic and Socio-Economic Characteristics Philadelphia County, Pennsylvania ACS Five-Year Estimates

3 Year Substance Use Disorder and Major Depressive Episode for the Philadelphia-Camden- Wilmington Metropolitan Statistical Area (MSA), Pennsylvania, and the United States among Persons Aged 12 or Older (Except as Noted): Annual Averages, 2005 to 2010 Using 9.5% of the 1,315,154, est. Phila census pop 12 and older as well as DEA estimates to determine possible number of people needing D&A Tx ranges from 122,000 to 150, NOTE: For additional data, please see the tables available at Difference between Philadelphia-Camden-Wilmington MSA estimate and Pennsylvania estimate is statistically significant at the.05 level.b Difference between Philadelphia-Camden-Wilmington MSA estimate and United States estimate is statistically significant at the.05 level. Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2005 and 2006 to 2010 (Revised March 2012).

4

5

6 Drug Threat Rankings for the Philadelphia Division, July-December 2014 Rank Drug 1 Heroin 2 Pharmaceuticals 3 Cocaine 4 Crack Cocaine 5 Marijuana Source: DEA Philadelphia Division

7 Heroin Prices by Unit Showing Both Low and High Amounts in US Currency July-December 2014 reporting period Office Bag ( g) Gram Ounce Kilogram Philadelphia Division Office $10 $50-$85 -- $55,000-$63,000 Pittsburgh District Office $5-$15 $150 $2,000-$3,000 $50,000-$80,000 Allentown Resident Office $10-$15 $65 -- $65,000 Harrisburg Resident Office $10-$15 $100-$ $55,000-$65,000 Scranton Resident Office Wilmington (DE) Resident Office $5-$10 $60-$ $10 $75-$150 $2,100-$6, Source: DEA Philadelphia Division

8 2012 Heroin Counts, Purities, Prices, Origin, and City by Geographic Region National Heroin Threat Assessment, DEA Heroin Signature Program

9

10

11 Drug-Related Overdose Deaths in Pennsylvania Counties in 2014, as reported to DEA Philadelphia Field Division Source: Pennsylvania Coroner Data

12 National Drug Early Warning System (NDEWS) Philadelphia Sentinel Community Site Drug Use Patterns and Trends, 2016 Suet Lim, Ph.D. SCS Highlights: Mortality The outbreak of fentanyl-related intoxication deaths that began in 2014 continued unabated in Of the 688alcohol and/or drug intoxication deaths in 2015, 183 (27%) tested positive for fentanyl, which was an increase from 100 (16%) reported for Ten (10) of the 183 cases have no other positive detections for other substances and had fentanyl only on board. From mortality indicator data, heroin remained the most dangerous illicit drug in Philadelphia; it also remained the top-ranked drug detected among intoxication deaths with 381 cases testing positive for heroin. From morbidity indicator data, treatment admissions for heroin continued to increase steadily from 2013 to Cocaine remained a high-ranking drug; mortality indicator data showed that cocaine was the 3rd most detected drug among alcohol and/or drug intoxication deaths with 298 cases positive (2nd if alcohol-only intoxication deaths is excluded); primary treatment admissions showed a slight increase in primary treatment admissions in2015 from In 2015, cocaine reemerged as the top drug among National Forensic Laboratory Services(NFLIS)-positive reports for Philadelphia since Treatment admissions for benzodiazepines were low in 2015, but positive detections among intoxication deaths increased. As in the previous year, alprazolam remained the most frequently detected benzodiazepines among intoxication deaths, detected in 33% of cases in 2015 compared with 27% in Positive results for clonazepam and diazepam among intoxication deaths decreased, but they remained in the top 10 drugs detected. Of prescription opioids, the mortality indicator identified oxycodone as the top-ranked drug; however, the treatment indicator was low and showed a decrease in primary admissions for prescription opioids.

13 Numbers of Overdose and Injury-related Deaths in Philadelphia, , Residents and Non-residents Drug overdose deaths have spiked in Philadelphia in recent years, with nearly 700 such deaths in In 2015, there were more than twice as many deaths from drug overdose in Philadelphia as there were from homicide. * Includes deaths with heroin or morphine (primary metabolite of heroin) detected ** Includes deaths with oxymorphone, hydromorphone, or buprenorphine detected *** Multiple drugs might be detected in an individual decedent (Source: Philadelphia Department of Public Health, Medical Examiner s Office) PHILADELPHIA DEPARTMENT OF PUBLIC HEALTH JUNE 2016

14 Numbers of Overdose Deaths in Philadelphia, by Drug, , Residents and Non-residents From 2003 to 2015, trends varied by the type of drugs detected: Heroin-related deaths increased sharply beginning in Heroin in Philadelphia has a high purity and low price.4 Deaths involving fentanyl spiked in 2006 and increased again beginning in For the same time periods, the use of fentanyl in combination with other drugs contributed to increases in deaths involving other drugs. For other pharmaceutical opioids like oxycodone and hydrocodone, trends have been more gradual with peak numbers of deaths occurring before Benzodiazepines and cocaine were detected in combination with opioids in approximately 90% and 70% of deaths, respectively.

15 Ranking Of The Frequency Of Drugs Present in Toxicology Test Results For Drug-Related Overdose Decedents, Philadelphia,

16 Location of Overdoses in Philadelphia, by Planning District, , Residents and Non-residents

17 Overdose Deaths by Place of Residence, 2015, Philadelphia Residents Only

18 Philadelphia has consistently exhibited higher rates of drug poisoning deaths than the United States and from the most up-to-date official vital statistics, experienced a much higher rate of increase than the United States Drug Poisoning Deaths, by Year, Philadelphia and United States, Number Crude Rate Age- Adjusted Rate Number Crude Rate Age- Adjusted Rate Number Crude Rate Age- Adjusted Rate Philadelphia, PA % with drug specified United States % with drug specified % 14.8% 19.0% 38, , , % 76.0% 80.7% SOURCE: Adapted by the NDEWS Coordinating Center from data taken from the Centers for Disease Control and Prevention, National Center for Health Statistics, Multiple cause of death , available on the CDC WONDER Online Database, released Data compiled in the Multiple cause of death were provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Retrieved between December May 2016, from National Drug Early Warning System (NDEWS) Philadelphia Sentinel Community Site Drug Use Patterns and Trends, 2015 (supported by PMEO Data) Suet Lim, Ph.D.

19 Medically Driven In 2012, 259 million prescriptions were written for opioids, which is more than enough to give every American adult their own bottle of pills. A recent study found further revealed that while almost 85 percent of doctors screen for signs of prior narcotic painkiller abuse, just one-third ask about a family history of addiction. o o Only 5 percent offer direct help to patients when signs of abuse are uncovered, and less than 40 percent refer such patients for treatment elsewhere, the survey found A recent report from December 2015 revealed that more than 47,000 Americans lost their lives to drug overdose in 2014, a 14% jump from 2013 In a national survey from 2014, 4.3 million Americans engaged in non-medical use of prescription painkillers each month info@marylandaddictionrecovery.com.

20 Prescription Opioid Users Have Switched to Heroin Some opioid abusers use prescription opioids or heroin, depending on availability and the price of each drug, and heroin availability is increasing in many regions in response to higher demand. Treatment providers in some areas of the United States reported in 2008 that prescription opioid abusers switch to heroin as they build tolerance to prescription opioids and seek a more euphoric high. Further, treatment providers are reporting that some prescription opioid abusers are switching to heroin in a few areas where heroin is less costly or more available than prescription opioids. It is also common for some heroin abusers to use prescription opioids when they cannot obtain heroin. Diverted CPDs are often more readily available than heroin in all drug markets; however, heroin use increased in many areas of the country in 2009, possibly because of increased demand among abusers of prescription opioids who could no longer afford CPDs. Prescription opioids are typically more expensive than heroin. For example, oxycodone abusers with a high tolerance may ingest 400 milligrams of the drug daily (five 80-mg tablets) for an average daily cost of $400. These abusers could maintain their addictions with 2 grams of heroin daily, at a cost of one- third to one-half that of prescription opioids, depending on the area of the country and the purity of the heroin.

21 Tableting heroin is a way for heroin distributors to attract customers who are CPD abusers. Source High Intensity Drug Trafficking Area (HIDTA)

22

23 Demographic Profiles of Alcohol and/or Drug Intoxication Deaths, Philadelphia, 2015 Gender Number Percentage Male Female Race/Ethnicity % 27.6% White, Non-Hispanic % African American, Non-Hispanic % Hispanic % Asian 4 0.6% Other 0 0.0% Age Under % % % % Philadelphia Department of Public Health, Medical Examiner's Office

24

25 Analysis The MEO 2015 data showed that heroin/morphine was the most frequently detected drug (n = 381) among intoxication deaths where a toxicology test was performed by the MEO (n = 688); it was present in 55.4% of these deaths. Consistent with morbidity indicator, intoxication deaths with heroin detected were overwhelmingly White males cases (76.6% males, 79.5% Whites). As Whites constituted 45.5% of the Philadelphia population, and in 2015, 66% of all intoxication deaths, the disproportionate distribution indicated heroin clearly as the primary drug of choice for White Philadelphians.

26 Analysis Analysis revealed that 12 percent of the decedents in the 2013 data set resided outside of the city of Philadelphia at the time of their death; in 2014, this rate was 11 percent. Four-fold increase in Fentanyl intoxication deaths from 2013 (NDEWS report, August 2015) Though other cities have been similarly challenged with rising mortality due to drug overdose, Philadelphia s overdose epidemic continues to grow and exceed that of other jurisdictions. Philadelphia, with a population of roughly 1.55 million, experienced 438 drug overdose deaths in 2012, 493 in 2013, and 655 in By comparison, New York City, with a population of 8.4 million, experienced 730 in 2013, and 788 in Cities with comparable rates of overdose have developed a range of strategies.

27 References Edward Bernstein. Overdose Prevention and Intranasal Naloxone Rescue Kits (NNRK) Distribution in the BMC Emergency Department: A City, State and Hospital Collaboration Traci C. Greena,b,c, Samuel K. McGowand, Michael A. Yokella,d,e, Enrique R. Pougetf, and Josiah D. Richa,b,d. HIV infection and risk of overdose: a systematic review and meta-analysis. AIDS February 20; 26(4): doi: /qad.0b013e32834f19b6. Strang J, Bird SM, Dietze P, Gerra G, McLellan AT. Take-home emergency naloxone to prevent deaths from heroin overdose. BMJ. 2014;349:g Accessed June 18, Binswanger IA, Blatchford PJ, Mueller SR, Stern MF. Mortality after prison release: opioid overdose and other causes of death, risk factors, and time trends from 1999 to Ann Intern Med. 2013;159(9): doi: /

28 Impact on Special Populations Adolescents (12 to 17 years old) In 2015, 276,000 adolescents were current nonmedical users of pain reliever, with 122,000 having an addiction to prescription pain relievers In 2015, an estimated 21,000 adolescents had used heroin in the past year, and an estimated 5,000 were current heroin users. Additionally, an estimated 6,000 adolescents had heroin a heroin use disorder in People often share their unused pain relievers, unaware of the dangers of nonmedical opioid use. Most adolescents who misuse prescription pain relievers are given them for free by a friend or relative. The prescribing rates for prescription opioids among adolescents and young adults nearly doubled from1994 to 2007.

29 Impact on Special Populations Women Women are more likely to have chronic pain, be prescribed prescription pain relievers, be given higher doses, and use them for longer time periods than men. Women may become dependent on prescription pain relievers more quickly than men. 48,000 women died of prescription pain reliever overdoses between 1999 and Prescription pain reliever overdose deaths among women increased more than 400% from 1999 to 2010, compared to 237% among men. Heroin overdose deaths among women have tripled in the last few years. From 2010 through 2013, female heroin overdoses increased from 0.4 to 1.2 per 100,000.

30

31 The vast majority of deaths have occurred in the Frankford, Richmond, Holmsburg and Nicetown sections of the city in Gurney St. has become the focal point of overdoses. SERVICES

32 Access To Care TREATMENT SERVICES

33 National Drug Early Warning System (NDEWS) Philadelphia Sentinel Community Site Drug Use Patterns and Trends, 2015 Suet Lim, Ph.D. SCS Highlights: Treatment Treatment admissions for benzodiazepines slightly increase from 2013 to 2014; mortality indicator data shows three benzodiazepines in the top ten drugs detected amongst intoxication deaths: alprazolam, clonazepam, and diazepam. Alcohol continues to be a top substance in primary treatment admissions and is the fourth most frequently detected drug among drug intoxication deaths with toxicology results. Marijuana continues to be in the top three primary treatment admissions; it is the most commonly identified substance in NFLIS. Philadelphia SCS Profile, 2015

34 PRESCRIPTION OPIOIDS The nonmedical use of prescription opioids was increasingly reported by individuals entering treatment. As primary drug of choice, Other Opiates represented 3.7% of primary treatment admissions in 2014 There has been an almost threefold increase from 2012 in the proportion of primary treatment admissions for other opioids. Of the 311 primary treatment admissions, 64.0% were male, 61.1% were White, 19.6% were African American, 3.2% were Asians and other races, and 16.1% were of Hispanic ethnicity. The largest age category for primary other opiates/opioids admissions was age (66.2%).

35 HEROIN Data from Behavioral Health Special Initiative, Philadelphia Department of Behavioral Health and Intellectual disability Services shows that heroin use was responsible for 21.1% of primary treatment admissions in Philadelphia This represents 1.6 pp increase from 2013, and 3.2 pp increase from In 2014, males constituted 70.1% of primary heroin admissions. Whites accounted for 62.4% of primary heroin treatment admissions African Americans (20.1%) and Asians and others (3.2%) Hispanics constituted 14.3% of primary heroin treatment admissions. National Drug Early Warning System (NDEWS), Philadelphia Sentinel Community Site Drug Use Patterns and Trends, 2015, Suet Lim, Ph.D.

36

37 Drug and Alcohol Services funded through CBH and BHSI 2014 Drug and Alcohol Level of Care Unique Clients Paid by Level of Care Detoxification 3,706 Inpatient Detoxification 352 Non-Hospital Detoxification 3,408 OP Substance Abuse 24,514 D&A Case Management 2,225 D&A Outpatient 19,729 IOP 14,609 Methadone Maintenance 5,874 Residential Rehabilitation 7,375 Non-Hospital Rehabilitation 7,375 Grand Total 27,353

38

39 PHILADELPHIA DBHIDS PROVIDER NETWORK AND TREATMENT CAPACITY 188 active drug and alcohol facilitates in Philadelphia licensed by Pennsylvania Department of Drug and Alcohol Programs (DDAP). (As of 12/1/2016) DBHIDS contracts with 186 licensed Drug and Alcohol Providers in the DBHIDS Network operating over 350 sites. (As of 12/22/16) The Philadelphia DBHIDS treatment system for alcohol and other drugs includes: (2) Behavioral Assessment Centers (BAC) and (5) Crisis Response Centers (CRC) (12) Detoxification Facilities with a licensed capacity of 310 beds (35) Rehabilitation Facilities (Short and Long Term) with an average daily census (Jan Aug 16) of 507 and a total licensed capacity of 1,568 (11) Providers operating 14 OTPs (9) Providers offering MAT with Buprenorphine and/or Vivitrol across (19) facilities; As of 12/2016, there are approximately 600 Buprenorphine slots

40 PHILADELPHIA DBHIDS PROVIDER NETWORK AND TREATMENT CAPACITY (14) Methadone Maintenance Treatment (MMT) Programs with a total licensed capacity of 5,872 slots (60) Drug and Alcohol Outpatient Sites of which (42) are Intensive Outpatient Programs (IOP), which provide up to 10 hours/week of treatment services (8) Halfway Houses (14) School and Community Based Providers for Prevention (3) Student Assistant Program (SAP) Providers for Prevention (3) Drug and Alcohol Case Management Providers (6) Centers of Excellence; Some funded through DBHIDS and others funded through Health Choices Physical Health Network (HMOs). (1) Drug and Alcohol Partial Hospitalization Program Located in the Port Richmond section of Philadelphia, The Pathways to Recovery Program is operated by PHMC, recently increased its capacity to 50 slots, and provides up to 25 hours/week of treatment services, targets individuals with co-occurring diagnoses, embrace Vivitrol and buprenorphine and will collaborate with Methadone Maintenance Treatment (MMT) Programs for individuals preferring Methadone

41

42

43 3/23/2017 DBHIDS OFFICE of ADDICTION SERVICES 44

44 3/23/2017 DBHIDS OFFICE of ADDICTION SERVICES 45

45 Prevention Point Philadelphia Prevention Point Philadelphia (PPP) provides a mix of fixed office based and mobile sites through out the city. The goal of the service provision is to reduce the harm associated with drug use and provide services to the most vulnerable Philadelphians. Services provided are: Sterile Syringe Exchange Free Medical Clinics, both Mobile and Office Based Medical Case Management for Chronic Conditions Harm Reduction Services Center HIV Clinic Health and Harm Reduction Education Wound Care Services (Mobile and Office Based) Overdose Prevention Training and Naloxone Distribution HIV/HCV Testing Substance Use Counseling and Referral Point of Refuge (Shelter program (Winter Months) Soup Kitchen

46 Narcan, also called Naxolene, is a drug that can be used to reverse some or all of the symptoms of acute opiod overdose.2 Opiods include: heroin, codeine, fentanyl, and morphine.1 Narcan may be administered via a nasal spray (Figure 1) intravenously (Figure 2), intramuscularly, or subcutaneously

47 Sterile Syringe Program Distributed over 2.4 million Syringes Over 7,000 Participants in ,200 New Registrants in 2016 Over 800 referrals to treatment Low Threshold Services

48 Prevention Point Philadelphia Program Sterile Syringe Exchange Program Free Medical Clinics Medical Case Management for Infectious Diseases Wound Care Harm Reeducation Services Center Suboxone Treatment Health Education Overdose Prevention Training/Naloxone Number of Persons Served ,257 1, , ,500 2,200 Distribution HIV/HCV Testing Substance Use Counseling/Referral Point of Refuge (Winter Shelter) Soup Kitchen 1, ,800 meals

49 COORDINATED RESPONSE TO ADDICTION by FACILITATING TREATMENT (CRAFT) PROJECT YRLY Prev. Pnt. Over 2,000,000 SYRINGES EXCHANGED Targeting chronic substance abusers who utilize Prevention Point Philadelphia s Syringe Exchange Program (SEP) through a Coordinated Response to Addiction by Facilitating Treatment (CRAFT). The goal of the CRAFT Pilot Project was to increase the number of clients linked to Z treatment for behavioral health care from the designated SEP site and identify and remove typical barriers that prohibit clients from entering behavioral health care from the SEP.

50 CRAFT Data Review Since the restart of CRAFT on 12/8/15 through 9/30/16, the Project held 369 individual counseling sessions with 324 unique individuals at PPP. The data below reveals that: 75.3% (278/369) of the visits involved CBH members. 9.8% (39/369) of the visits were BHSI eligible participants. 14.9% (52/369) of the participants were out-of-county or privately insured 75.9% of the participants were male, while 24.1% were female. Participants ranged from 19 to 65 years of age, with a median of 39 years old. 42% of the participants admitted to an episode of heroin/opioid overdose within the past year. However, due to data collection form modifications this question was not posed to all participants, thus underrepresents true value. 81.3% of the participants were referred to behavioral health care. 18.7% of the remaining participants were directed to other resources and services such as identification acquisition, case management, homeless shelters, recovery housing, out-of-county insurance providers and private carriers. Of the participants referred to treatment, 62.5% were for inpatient and 37.5% were for outpatient care. The rate of linkage to care after referral was approximately 60%. The most significant factors that contributed to the linkage to care rate were: 1) lack of identification; 2) shortage of beds at the detoxification and inpatient levels of care, and medication assisted treatment rehabilitation beds; 4) chronic and acute homelessness; 5) participants not ready to completely engage in treatment process; and 6) problems with transportation.

51 The Journey of Hope Project Seven treatment programs have been transformed to provide comprehensive, recovery-oriented, substance abuse and co-occurring treatment services to individuals experiencing prolonged homelessness These seven programs are: Horizon House Susquehanna Park Horizon House Susquehanna Park II North Philadelphia Health Systems (NPHS) Miracles in Progress II Sanctuary North Philadelphia Health Systems (NPHS) Miracles in Progress I RHD Womanspace Philadelphia RHD New Start II RHD New Start I (Halfway House)

52 Housing Stability

53

54 Sources Analysis of Philadelphia Overdose Deaths : July 2015 (supported by PMEO Data) The Drug Enforcement Administration (DEA) Philadelphia Field Division (PFD) Intelligence Program Analysis of Pennsylvania Overdose Deaths 2014 (supported by PMEO Data) The Drug Enforcement Administration (DEA) Philadelphia Field Division (PFD) Intelligence Program National Drug Early Warning System (NDEWS) Philadelphia Sentinel Community Site Drug Use Patterns and Trends, 2015 (supported by PMEO Data) Suet Lim, Ph.D. Philadelphia Medical Examiners Office (PMEO), Department of Public Health National Forensic Laboratory Information System (NFLIS); 2013 and 2014 reports Delaware Valley Intelligence Center, Philadelphia Narcan Administration by Zip Code 1/1/ /31/2015 Reducing Drug Overdose in Philadelphia: Background on the Problem and Recommended Actions Jose Benetiz, Silvana Mazzella, Janna Ataiantsz, Jeanette Bowles, Stephen Lankenau Prevention Point Philadelphia, Drexel University, School of Public Health, July 2,2014

55 Access Behavioral Health Special Initiative (BHSI) Community Behavioral Health (CBH) Member Services

56 Questions? More Information? Department of Behavioral Health Intellectual disability Services 1101 Market Street 8thFl Department of Behavioral Health Intellectual disability Services (DBHIDS) 3/23/