State Epidemiology Outcomes Workgroup (SEOW) MARYLAND STRATEGIC PREVENTION FRAMEWORK Advisory Council Meeting 31 January 213 SEOW Director, Linda Simoni-Wastila lsimoniw@rx.umaryland.edu
Overview SEOW Who We Are and Mission Data NSDUH: National Survey on Drug Use and Health HSCRC: Health Services Cost Review Commission SMART: Substance Misuse and Abuse Reduction Team MPC: Maryland Poison Center FARS: Fatal Accident Reporting System Focus on 5 Areas: Opioid Analgesics Sedative-Hypnotics Marijuana Emerging Substances Alcohol 2
SEOW MARYLAND STATE EPIDEMIOLOGY OUTCOMES WORKGROUP 3
The Team Partnership with ADAA based at the University of Maryland Baltimore School of Pharmacy Pharmaceutical Health Services Research (PHSR) Department Pharmaceutical Research Computing Maryland Poison Center The Team Linda Simoni-Wastila, BSPharm, PhD (PHSR) Wendy Klein-Schwartz, PharmD (MPC) Corinne Woods, PharmD (PRC-Data Coordinator) Jeanne Yang (PRC-Programmer) Jenny Wei, PhD (PHSR-Post-Doctoral Fellow) Patience Moyo (PHSR-Doctoral Student) Jane Huang (PHSR-Doctoral Student) Pharmacy Students 4
SEOW: Mission The Maryland SEOW monitors the use of alcohol, tobacco, and other drugs and the consequences of such use in order to identify and prioritize the prevention and treatment needs of the state. To achieve this end, the Maryland SEOW oversees the collection, interpretation, and dissemination of statewide data that quantifies substance use and its consequences in the broader context of behavioral health for Maryland. The SEOW utilizes data to: Determine prevention and treatment priorities at the state, county, and local levels Identify, monitor, and interpret key indicators of use and consequences of tobacco, alcohol and substance use Support the state and jurisdictions as they assess need, develop interventions, and evaluate prevention and treatment efforts http://www.pharmacy.umaryland.edu/programs/seow/ 5
OPIOID ANALGESICS 6
6 5 NSDUH: Nonmedical Use of Pain Relievers in Past Year Age 12+ years, MD vs US 4.8 4.8 5. 5.1 4.9 4.8 4.9 4.6 % Reporting Use 4 3 2 3.5 3.6 4. 4.3 4. 3.8 4.2 3.9 US MD 1 4 5 6 7 8 9 1 11 Years 7
NSDUH: Maryland Sub-State Regions North Central Northeast South West Carroll Howard Caroline Cecil Harford Kent Queen Anne's Talbot Calvert Charles Dorchester St. Mary's Somerset Wicomico Worcester Allegany Frederick Garrett Washington 8
14 12 NSDUH: 28-21 Nonmedical Use of Pain Relievers in Past Year 12+ 12 to 17 18 to 25 26+ % Reported Use 1 8 6 4 2 9
Worcester Wicomico Washington Talbot Somerset St Marys Queen Annes Prince Georges Montgomery Kent Howard Harford Garrett Frederick Dorchester Charles Cecil Carroll Caroline Calvert Baltimore County Baltimore City Anne Arundel Allegany Maryland Overall HSCRC: Changes in Opioid-Related Inpatient and ED Visits from 28 to 211 Percentage Change in Inpatient Visits -.18 -.32.28.49.74.5.14.26.62.17.2.22.18.39.31.42.6.72.82.9.94.96.84 1.26 1.96 Worcester Wicomico Washington Talbot Somerset St Marys Queen Annes Prince Georges Montgomery Kent Howard Harford Garrett Frederick Dorchester Charles Cecil Carroll Caroline Calvert Baltimore County Baltimore City Anne Arundel Allegany Maryland Overall -.1 -.1 -.2 Percentage change in ED Visits -.2.7.17.1.1.15.6.4.3.5.14.5.1.26.12.12.32.6.7.2.14.98 1
11
Total number of admissions 7 6 5 4 3 2 1 123 SMART: Maryland Admissions for Prescription Opioid-Related Treatment by County of Residence, FY 212* 64 61 389 379 9 9 426 198 67 151 76 288 63 53 211 63 12 252 68 36 142 244 128 193 * Data as of November 212 12
Total number of admissions 12, 1, 8, 6, 4, 2, SMART: Maryland Admissions for Opioid-Related Treatment, FY 28-212* 1,852 1,232 1,358 2,55 3,711 11,311 4,538 1,24 5,91 1,53 Rx Opioids Heroin 28 29 21 211 212 Fiscal Year * Data as of November 212 13
% of total admissions 35 3 25 2 15 1 5 SMART: Proportion of Total Admissions by Primary Substance Problem, FY 28-212* 28 29 21 211 212 Alcohol Crack Other Cocaine Marijuana/Hashish Heroin Non-Rx Methadone Oxycodone Other Rx Opioids * Data as of November 212 14
SEDATIVE-HYPNOTICS 15
HSCRC: Inpatient Admissions and ED Visits: Sedative-Hypnotics In 211, 562 inpatient admissions and 1591 ED visits related to sedativehypnotics Between 28 and 211 Inpatient sedative-hypnotic-related hospital admissions increased.2% Largest increases in Kent County (.5%) and Allegany County (.6%) ED visits increased <.1%
* Data as of November 212 17
1.4 1.2 SMART: Proportion of Total Admissions with Benzodiazepines as Primary Substance, FY 28-212* 1.16 % of total admissions 1..8.6.4.2.68.81.74.97. 28 29 21 211 212 * Data as of November 212 18
SMART: County of Residence Among Patient Admissions for Benzodiazepine Related Treatment in FY 212* 2 159 Total number of admissions 15 1 5 52 48 54 9 16 2 16 16 1 8 11 4 17 7 6 9 8 2 5 12 13 3 17 * Data as of November 212 19
MARIJUANA 2
% Reporting Use 8 7 6 5 4 3 NSDUH: Marijuana Use in Past Month Age 12+ years, MD vs US 6.2 6.1 6. 6. 5.9 6. 5.7 5.5 5.1 4.8 5.1 6.4 5.4 5.4 6.8 6.9 6.1 5.6 US MD 2 1 3 4 5 6 7 8 9 1 11 Years 21
% Reporting Use 45 4 35 3 25 2 15 1 5 NSDUH: Perceptions of Great Risk of Smoking Marijuana Once a Month Age 12+ years, MD vs US 39.1 39.7 39. 35.6 39.7 39. 39.2 39.6 38.9 38.9 37.9 36.3 36.1 35.1 33.6 32.3 33. 32.5 3 4 5 6 7 8 9 1 11 US MD Years 22
NSDUH: Age 12+ years, Use vs Perceptions of Great Risk of Smoking Marijuana Once a Month, MD 45 4 35 35.6 39.7 39. 39.2 39.6 36.3 35.1 33. 32.5 % Reporting Use 3 25 2 15 1 5 Perceptions of Great Risk of Smoking Marijuana Once a Month Marijuana Use in Past Month Marijuana Use in Past Year 1.5 1.4 1.2 9.2 9.7 1.4 1.2 1.1 1. 5.73 5.54 5.1 4.79 5.6 5.35 5.41 6.11 5.55 3 4 5 6 7 8 9 1 11 Years 23
NSDUH: Age 12-17 years, Use vs Perceptions of Great Risk of Smoking Marijuana Once a Month, MD % Reporting Use 4 35 3 25 2 15 1 5 35.6 35.2 33. 33.5 33.7 3.9 31.9 26.5 26.1 Perceptions of Great Risk of Smoking Marijuana Once a Month Marijuana Use in Past Month Marijuana Use in Past Year 14.8 15.1 14.5 12.3 12.4 12.8 13.4 13.7 13.2 7.87 7.42 6.88 5.63 5.78 6.26 6.86 7.7 6.12 3 4 5 6 7 8 9 1 11 Years 24
NSDUH: Age 18-25 years, Use vs Perceptions of Great Risk of Smoking Marijuana Once a Month, MD 35 3 3.3 29.9 28.4 28.1 3.4 28.6 28.9 3.9 31.4 % Reporting Use 25 2 15 1 5 25.9 25.4 24.6 24.1 22.5 19.43 19.1 17.77 21.4 2.6 18.5 16.8 16.9 15.86 16.42 16.28 13.86 13.36 Perceptions of Great Risk of Smoking Marijuana Once a Month Marijuana Use in Past Month Marijuana Use in Past Year 3 4 5 6 7 8 9 1 11 Years 25
% Reported Use 45 4 35 3 25 2 15 1 5 28-21 Perceptions of Great Risk of Smoking Marijuana Once a Month 12 to 17 18+ 26
Total number of admissions 1, 8, 6, 4, 2, SMART: Maryland Admissions for Marijuana/Hashish Treatment, FY 28-212* 7,63 8,184 8,516 9,521 8,855 28 29 21 211 212 * Data as of November 212 27
SMART: Maryland Admissions for Marijuana/Hashish Treatment by County of Residence, FY 212* 2,5 2,257 2, Total number of admissions 1,5 1, 5 169 724 1,1 37 98 89 168 272 196 225 48 36 221 75 483 766 117 231 11 1 286 431 175 13 * Data as of November 212 28
EMERGING SUBSTANCES 29
What is Spice? Synthetic marijuana (cannabinoids) Typically contains several different ingredients Ingredients vary in potency, but are much more potent than THC Smoked like marijuana Adverse effects have been reported, including dysrhythmias, suicidal ideation, psychosis, and convulsions 3
Calls to MPC for Spice (Oct 21 through 212) 3 25 2 15 1 5 DEA emergency scheduling of synthetic marijuana Federal Drug Policy Amendment Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 21 211 212 31
What are Bath Salts? Stimulants Effects similar to amphetamine and cocaine Substituted Cathinones Including methylenedioxypyrovalerone (MDPV) Mephedrone and methylone Commonly swallowed or snorted, but can also be smoked or injected Case reports suggest it may cause nausea, palpitations, violent behavior, paranoia, kidney and liver failure, suicide, and more 32
14 Calls to MPC for Bath Salts (211 through 212) 12 1 8 6 4 2 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 211 212 DEA emergency scheduling of bath salts Federal Drug Policy Amendment 33
ALCOHOL 34
6 5 NSDUH: Past-Month Alcohol Use Age 12+ Years, MD vs US 54.7 51.7 53.1 53.1 54. 55.1 54. 51.9 54.9 5.5 5.2 51.1 51.4 51. 51.4 51.8 51.8 51.8 % Reporting Use 4 3 2 US MD 1 3 4 5 6 7 8 9 1 11 Years 35
35 NSDUH: Past-Month Alcohol Use Among Underage (Age 12-2) Drinkers, MD vs US % Reporting Use 3 25 2 15 1 28.9 28.5 28.3 27.1 26.5 26.3 28.4 28.1 28.1 27.2 26.8 26.7 25.6 26. 25.1 25.1 US MD 5 3 4 5 6 7 8 9 1 11 Years 36
28-21 Past-Month Alcohol Use 7 12 to 2 18+ 6 % Reported Use 5 4 3 2 1 37
NSDUH: Past-Month Binge Drinking Age 12+ Years, MD vs US 25 22.8 22.7 22.7 22.8 23.2 23.3 23.5 23.4 22.9 % Reporting Use 2 15 1 21.7 19.7 2. 2.2 21.1 22.1 2.9 2.2 2.9 US MD 5 3 4 5 6 7 8 9 1 11 Years 38
25 NSDUH: Past-Month Binge Drinking Among Underage (12-2) Drinkers, MD vs US % Reporting Use 2 15 1 19.4 19.2 18.9 18.8 18. 17.7 17.5 17.3 17.9 16.2 16. 16.7 15.7 15.6 16.3 14.6 US 5 MD 3 4 5 6 7 8 9 1 11 Years 39
5 NSDUH: Past-Month Binge Drinking Age 18-25 Years, MD vs US 41.3 41.4 41.5 42. 42. 41.4 41.4 41.2 4.2 % Reporting Use 4 3 2 39.8 37.6 37.3 37.5 4.2 4.6 36.7 36.1 39.6 US MD 1 3 4 5 6 7 8 9 1 11 Years 4
3 28-21 Past-Month Binge Drinking 12 to 2 18+ 26+ % Reported Use 25 2 15 1 5 41
HSCRC: Inpatient Admissions and ED Visits: Alcohol In 211, 42,215 inpatient admissions and 26,659 ED visits related to alcohol Between 28 and 211 Inpatient alcohol-related hospital admissions increased.58% Largest increases in Kent (2.2%), Carroll (1.5%), and Frederick (1.2%) counties ED visits increased.18% Largest increases in St. Mary s (.7%), Carroll (.52%), and Worcester (.51%) counties
6 SMART: Age Distribution of Patients Admitted for Alcohol Treatment*, FY 28-212 % of Total Admissions 5 4 3 2 48.8 22.1 14.9 45.3 44.4 43. 43.3 24.7 26.1 26.8 23.4 16.7 16.2 16.5 15.4 12 to 2 21 to 25 26 to 45 46 to 65 Over 65 1 13.5 13.9 13.9 13.7 13.7.6.8.8.7.9 28 29 21 211 212 Fiscal Year * One of three substance-abuse problems reported at admission. 43
3, SMART: Maryland Admissions for Alcohol Related Treatment by County of Residence, FY 212* 2,5 2,461 Total number of admissions 2, 1,5 1, 5 272 1,438 1,3 67 173 347 441 441 232 427 25 48 47 113 84 61 283 468 17 169 467 429 358 49 * Data as of November 212 44
Number of crashes 16 14 12 1 8 6 4 2 FARS: Maryland Alcohol-Related Fatal Crashes 28-211 123 19 14 139 25 114 123 29 94 131 31 1 No drivers died 1 driver died 28 29 21 211 45
Proximity of Alcohol-Related Fatal Crashes to Alcohol Outlets 46
Summary Opioid Analgesics Opioid analgesic use declining in US and MD Opioid-related hospital inpatient admissions up.2%; ED visits up <.1% 211 Hotspots: Prince Georges, Montgomery, Baltimore City, Worcester, Garrett Heroin treatment admissions stable Rx opioid/all opioid treatment admissions up from 15% 28 to 33% 212 Sedative-Hypnotics Hospital admissions up.2% 211 Hotspots: Cecil and Alleghany % Benzodiazepine treatment admissions/all treatment admissions inc from.68 28 to 1.16 212 47
Summary Marijuana Use declining in US and Maryland overall BUT Among 12-17 year olds: Perception of great risk declined from 33% - 26% Among 18-25 year olds: Perception of great risk declined from 26% to 17% AND both past year and past month use increased Treatment admissions increasing Bath Salts and Spice Keep on eye on trends 48
Summary Alcohol Past-month use stable or declining (including underage drinkers) Binge-drinking among underage drinkers down 3.3% since 28 Binge drinking remains problem for 18-25 year olds (up 3.5% from 21) Alcohol-related hospital admissions increased.58%; ED visits increased.18% Alcohol treatment admissions down or stable for all age groups 49