MACOMB COUNTY STRATEGIC PREVENTION FRAMEWORK STATE INCENTIVE GRANT DATA PROFILE

MACOMB COUNTY STRATEGIC PREVENTION FRAMEWORK STATE INCENTIVE GRANT DATA PROFILE Assessing the Burden of Illicit Drugs and Alcohol Abuse: A Focus on Heroin and Prescription Drug Abuse September 2010

ACKNOWLEDGEMENTS Many thanks to the Macomb County Community Mental Health Office of Substance (MCOSA) for providing the opportunity to develop this data profile. Special thanks and appreciation are made to the following MCOSA staff whose input helped to make this profile a reality: Randy O Brien, Director, MCOSA Helen Klingert, Assistant Director, MCOSA Dawn Radzioch, Prevention and Training Coordinator, MCOSA Macomb County Strategic Planning Team RECOMMENDED CITATION Macomb County Community Mental Health, Office of Substance Abuse. (September 2010). Macomb County Illicit Drugs and Alcohol Abuse Profile. Macomb County, Michigan. This report was prepared by Harolyn Tarr, Epidemiologist Consultant Macomb County Office of Substance Abuse 2

TABLE OF CONTENTS Acknowledgements... 2 Recommended Citation... 2 Background... 6 Executive Summary... 7 Data Sources... 13 Consequences: Alcohol and Illicit Drug Mortality, Hospitalizations and Treatment... 13 Alcohol and Narcotic Law Arrests... 13 Alcohol Related Traffic Crashes... 13 Alcohol and Illicit Drug Consumption... 13 Population Estimates... 14 About Macomb County... 15 Combating Drug Abuse in Macomb County: A Policy Perspective... 17 State Legislation... 17 Resources... 18 Overview... 20 PART I... 22 Assessing the Burden of Illicit Drugs: A Focus on Heroin and Prescription Pain Relievers... 22 Drug related Mortality... 23 Heroin Poisoning Mortality... 23 Heroin Mortality by Gender... 24 Heroin Mortality by Age... 24 Heroin Mortality by Geographic Distribution... 25 Heroin Poisoning Hospitalizations... 27 Heroin Hospitalizations by Gender... 28 Macomb County Office of Substance Abuse 3

Heroin Hospitalizations by Age... 28 Heroin Hospitalizations by Geographic Distribution... 29 Prescription Drugs (Pain Relievers) Poisoning Mortality... 31 Prescription Drugs Mortality by Gender... 32 Prescription Drugs Mortality by Age... 32 Prescription Drugs Mortality by Geographic Distribution... 33 Prescription Drugs Hospitalizations... 35 Prescription Drugs Hospitalizations by Gender... 36 Prescription Drugs Hospitalizations by Age... 36 Prescription Drugs Hospitalizations by Geographic Distribution... 37 Drug Abuse Treatment Admissions... 39 Treatment Admissions by Gender... 41 Treatment Admissions by Age... 41 Narcotic Law Arrests... 43 Narcotic Law Arrests by Gender... 44 Narcotic Law Arrests by Age... 45 Narcotic Law Arrest by Race... 46 Narcotic Law Arrests by Police Department... 47 Illicit Drug Consumption... 49 A National Profile... 49 Michigan and Macomb County Illicit drug Consumption... 49 Heroin Use Among Youths... 50 Prescription Drug Use Among Youth... 51 PART II... 55 Assessing the Burden of Alcohol Abuse: A focus of Alcohol related Traffic Crashes and Underage Drinking... 55 Macomb County Office of Substance Abuse 4

Alcohol related traffic crashes, fatalities, and injuries... 56 Alcohol related Traffic Crash Fatalities... 56 Alcohol related Traffic Crashes... 58 Drinking and Driving by Age... 59 Alcohol related Traffic Crashes by Location... 60 Alcohol related Traffic Fatalities by Location... 60 Driving Under the Influence arrests... 62 Arrests by Age... 62 Arrests by Race... 64 Arrests by Location... 65 Underage Drinking... 68 Alcohol Use by Grade... 69 Binge Drinking... 70 Drinking and Driving and Riding Behaviors... 72 Other Works Cited... 74 Tables... 75 Glossary... 82 Macomb County Office of Substance Abuse 5

BACKGROUND In 2007, with support from the Michigan Department of Community Health, Mental Health & Bureau of Substance Abuse and Addiction Services (BSAAS), the Macomb County Community Mental Health, Office of Substance Abuse (MCOSA) led a countywide effort via the Strategic Prevention Framework, State Incentive Grant (SPFSIG) to profile substance abuse issues, specifically issues related to underage drinking and alcohol related traffic crashes, build and strengthen community and statewide capacity, and develop a strategic plan to address and sustain action around substance abuse issues around communities. As a result, a Needs Assessment Data Report which identified high risk groups and geographic areas hot spots to target prevention efforts and resources and a Community Strategic Plan which set forth four goals: 1) To decrease alcohol related traffic crash deaths in Macomb County; 2) To decrease over time the number of Driving Under the Influence (DUI) arrests in Macomb County (especially for teenagers and young adults); 3) To decrease alcohol use among middle school and high school students; 4) To decrease alcohol use among 18 20 year olds, were developed. This updated data report is an evaluative review of those substance abuse indicators related to alcohol related traffic crashes and underage drinking, identified in the 2007 needs assessment data report. Findings in the report should be used to measure the impact of the collaborative and sustained efforts to address substance abuse issues related to underage drinking and alcohol related traffic crashes as stated by strategic plan goals over time. In addition, as a result of ongoing monitoring and reporting of substance abuse problems throughout Macomb County, illicit drug issues related to increases in the use of opioids, specifically heroin and prescription pain relievers have been identified over the years. This report also explores this emerging trend from an epidemiologic prospective. Macomb County Office of Substance Abuse 6

EXECUTIVE SUMMARY This report marks the second data profile of alcohol and illicit drugs burden in Macomb County. The first report produced in 2007 detailed estimates related to alcohol related traffic crash deaths and underage drinking to allow for countywide strategic planning via the Strategic Prevention Framework State Incentive Grant (SPFSIG). There is an emerging national trend in the increased use, misuse, and prescribing of opioid based pain relievers. There is also a statewide trend in the increased treatment admissions of heroin and other opioid involved illicit drugs. This 2010 data profile presents estimates on indicators related heroin and prescription pain reliever mortality (deaths), morbidity (hospitalizations), arrests, and illicit drugs consumption patterns in Macomb County for the period of 2004 to 2008. This report also provides an assessment of the 2007 SPFSIG goals to reduce alcohol related traffic crashes and underage drinking in Macomb. Key findings in this report include: Opioids Heroin Opioid abuse poses the greatest drug related threat to Macomb County. Opioid poisonings accounted for 59 percent of drug related deaths in Macomb County in 2008. Between 2004 and 2008, there was a 102 percent increase in opioid poisoning deaths in the County. Heroin deaths, hospitalizations, and treatment admissions rates are on an increasing trend. The County wide heroin poisoning death rate was 6.26 per 100,000 population in 2008, a 200 percent increase from 2004 to 2008. In 2008, heroin accounted for 63 percent of the total opioid related poisoning deaths in the County. Heroin deaths and hospitalizations are higher among males (5.7 deaths per 100,000 population and 7.3 hospitalizations per 100,000 population) when compared to females (1.4 deaths per 100,000 population and 4.0 hospitalizations per 100,000 population). Persons aged 21 24 years had the highest heroin poisoning death rate at 8.97 per 100,000 population, followed by persons age 35 44 years at 6.01 per 100,000 population. Macomb County Office of Substance Abuse 7

Persons aged 15 24 years were hospitalized at a higher rate (14.5 hospitalizations per 100,000 population) compared to persons aged 25 44 years (9.1 hospitalizations per 100,000 population) and persons 45 65 years (4.6 hospitalizations per 100,000 population). The city of Warren had the highest number of heroin poisoning deaths (37 total deaths at 5.5 deaths per 100,000 population) during the period of 2004 2008. However, the city of Roseville had a higher death rate at 5.9 deaths per 100,000 population (14 total deaths) over the five year period. Warren and Roseville also experienced the highest hospitalization rates, 11.02 and 10.6, respectively. Prescription Pain Relievers Prescription pain relievers accounted for 32 percent of the total opioid involved poisoning deaths in 2008. Prescription pain reliever death rates are however on a declining since 2006 while hospitalization rates are currently on an increasing trend. The 2008 deaths rate due to prescription pain reliever poisonings was 1.6 deaths per 100,000 population while the 2008 hospitalization rate was 16.3 hospitalizations per 100,000 population, a rate two times higher than the heroin hospitalization rate. Prescription drug pain reliever poisoning deaths were higher among males (2.8 deaths per 100,000 population) when compared to females (1.8 deaths 100,000 per population) however, hospitalizations were higher among females (7.9 hospitalizations per 100,000 population) when compared to males (6.42 hospitalizations per 100,000 population) for the five year period of 2004 2008. Mortality was highest among persons aged 35 44 years (4.75 deaths per 100,000 population), followed by persons aged 45 64 years (3.83 per 100,000 population) for the period of 2004 to 2008. Hospitalizations were highest among persons aged 45 64 years (12.0 per 100,000 populations), followed by persons 65 years and older (11.2 per 100,000) for the period of 2004 to 2008. For the period of 2004 to 2008, the city of Warren had the highest number of prescription pain reliever poisoning deaths (26 deaths, a rate of 3.9). However, the cities of Eastpointe had Macomb County Office of Substance Abuse 8

a higher death rate (5.49 deaths per 100,000 population), followed by Roseville (5.09 deaths per 100,000 population) and Sterling Heights (4.88 deaths per 100,000 population). Opioid Involved Treatment Macomb County ranked second among the regional agencies for the highest number of opioid involved treatment admissions. There was a 12.2 percent increase in opioid involved treatment admissions from 2008 (5,673 admissions) to 2009 (5,058 admissions). Of all admissions, heroin admissions were highest (36 percent), followed by alcohol abuse (31 percent); 11 percent of admissions were due to prescription pain relievers in 2009. A higher proportion of males (59.8 percent) were in treatment compared to females (42.2 percent) for opioid involved drug abuse in 2009. Persons aged 21 25 years accounted for the largest proportion (22.3 percent) of those in treatment for opioid involved drugs, followed by persons aged 26 29 years (16.4 percent). Illicit Drugs Consumption Five (5) percent of youth aged 12 17 years reported current illicit drug use other than marijuana during the period 2004 2006, an 8.5 percent increase from the period of 1999 2002 in Macomb County (NSDUH). Illicit drug use was highest among persons aged 18 25 years (9.6 percent) compared to persons aged 12 17 years (5.0 percent) and person aged 26 and older (2.8 percent) in Macomb County for the period 2004 2008. Macomb County residents aged 18 25 years also presented higher current illicit drug use rates when compared Michigan (9.3 percent) and the U.S. (8.5 percent) rates for current use (NSDUH). Persons aged 18 25 years also reported higher rates of past year non medical use of pain relievers (15.4 percent) when compared to persons aged 12 17 years (7.6 percent) and persons 26 and older (4.3 percent) for the period of 2004 2006 (NSDUH). The rate among Macomb County Office of Substance Abuse 9

this age group was higher in Macomb when compared to the U.S. (12.2 percent) and Michigan (13.9 percent). There was an increase in heroin use among Macomb high school students from 1.9 percent in 2007 to 3.4 percent in 2009 (YRBS). Macomb students also reported higher heroin use than the national rate (2.5 percent) but lower than Michigan s rate of five (5) percent. There was a decrease in current non medical use of prescription pain relievers among Macomb students from the period of 2008 to 2010 (MiPHY). Alcohol related Traffic Crash Fatalities Macomb County experienced a substantial reduction (71 percent) in alcohol related traffic crash fatalities and serious injuries when comparing the period of 2001 2005 (605 total fatalities or serious injuries, an average of 121 per year) to the period of 2006 2009 (139 total fatalities or serious injuries, an average of 35 fatalities or injuries per year). There was also a 12.5 percent reduction in the number of alcohol related traffic crashes between the two periods. Driving Under the Influence Arrests DUI arrest is on a steady decline in Macomb County. Macomb experienced a 12.5 percent decrease in the number of arrests from the year 2005 to 2009 (Michigan Drunk Driving Audit). Persons aged 21 24 year are still at highest risk for DUI arrests. Between the year 2005 and 2006, there was a 10.6 percent decrease in number of arrest made to this age group. However, DUI arrests among underage persons aged 13 20 years increased by 29 percent from 308 total arrests in 2005 to 397 total arrest in 2006. More recent arrests data is needed to assess this indicator to date. Alcohol Use Among Middle and High School Students According to the NSDUH Survey, current alcohol use among youth aged 12 17 years increased slightly when comparing the period of 1999 2001 (18.6 percent) to 2004 2006 (19.0 percent). Macomb County Office of Substance Abuse 10

More recent data from the YRBS and MiPHY surveys in 2010 showed that Macomb County students reported lower rates of current alcohol use (31.2 percent) when compared to the national rate of 41.8 percent and the Michigan rate of 37.0 percent. Alcohol Use Among Persons 18 20 Years More detailed consumption data is needed to assess use among persons aged 18 20 years. NSDUH provides data on alcohol consumption for persons aged 18 25 years. The data shows higher current alcohol use among persons aged 18 25 years (71.6 percent) when compared to other age groups and when compared to Michigan and the national rates, 67.5 and 61.0 percent, respectively (2004 2006). Past month binge drinking was also higher among persons aged 18 25 years (49.4 percent) when compared to persons aged 26 or older (25.5 percent) and persons aged 12 17 (11.5 percent) in Macomb County. Binge drinking rates for Macomb residents of this age group were also higher when compared to Michigan (46.9 percent) and the U.S. (41.6 percent). Data Gaps and Limitations There were data gaps that limited evaluation of certain SPFSIG goals, specifically alcohol and illicit drugs consumption among persons aged 18 20 years. These were the data limitations identified in this assessment: Alcohol and illicit drugs consumption data are not available specifically for persons aged 18 20 years. Currently, NSDUH is the only source for information on these young adults; however NSDUH uses the age category of persons aged 18 25 years. As 21 25 year olds may have higher consumption rates than 18 20 year olds, use of the NSDUH estimates for the 18 25 year olds may overestimate true prevalence in the younger adults aged 21 25 years. NSDUH data is also outdated (2004 2006) which limits real time assessment of the consumption patterns within adult populations. More recent data is needed to assess narcotic and alcohol related arrests by age, gender and race. The most recent data made available is for the year 2006. Lack of current data on narcotic arrests limits the ability to assess changes that may have occurred to date. Findings from the Michigan Profile on Healthy Youth Survey (MiPHY) may be only representative of participating schools and may not be generalizable to all public schools in the County. MiPHY does not randomly select schools for participation as the Youth Behavioral Risk Factor Survey (YRBS), but rather invite schools to voluntarily participate. Macomb County Office of Substance Abuse 11

Convenient (Non Probability) samples, such as MiPHY, are subject to self selection bias; and findings from this type of survey may not represent schools that opted out of participating. Caution should be taken when generalizing these findings to entire populations. Maps that indicate cause of death represent the zip code where the person resides. MDCH, Division of Vital Records and Statistics uses death certificates which captures underlying cause of death proximate cause of death for analysis. Poisoning death (ICD 10 codes, T40.0 T40.9) may not be captured as a drug death if it was listed as a poisoning. Macomb County Office of Substance Abuse 12

DATA SOURCES CONSEQUENCES: ALCOHOL AND ILLICIT DRUG MORTALITY, HOSPITALIZATIONS AND TREATMENT Michigan Department of Community Health, Division of Vital Statistics, County Death Files, 2004 2008 Michigan Department of Community Health, Michigan Resident Inpatient Files, 2004 2008 Michigan Department of Community Health, Bureau of Substance Abuse Services, Treatment Episode Admissions Data, 2008 2009 Substance Abuse and Mental Health Administration, Drug Abuse Warning Network Report, Area Profiles of Drug related Mortality, 2008 ALCOHOL AND NARCOTIC LAW ARRESTS Michigan State Police, Michigan Drunk Driving Audit, 2005 2009 Michigan State Police, Uniformed Crime Reporting Program, 2005 2006 ALCOHOL RELATED TRAFFIC CRASHES Office of Highway Safety Planning, Michigan Traffic Crash Facts, 2003 2009 Michigan State Police, Michigan Drunk Driving Audit, 2005 2009 ALCOHOL AND ILLICIT DRUG CONSUMPTION Office of Applied Studies. (2008). Sub State estimates from the 1999 2002 and 2004 2006 National Surveys on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration Michigan Department of Education, Michigan Profile on Healthy Youth, County Estimates, 2008 and 2010 Macomb County Office of Substance Abuse 13

Centers for Disease Control, Youth Risk Behavioral Factor Survey, 2009 Macomb Intermediary School Department, Youth Risk Behavioral Survey, 2003 POPULATION ESTIMATES The US Census Bureau, American Fact Finder Population Estimates, 2004 2009 Macomb County Office of Substance Abuse 14

ABOUT MACOMB COUNTY Macomb County is the third most populous County in Michigan with 829,436 residents; however geographically, it is the ninth smallest County in Michigan (570 sq mi). Over the past decade, Macomb County s population has grown exponentially, by 40,000 persons. Although unknown, it is believed that the new residents are moving from nearby cities such as Detroit and its surrounding metropolitan area. Macomb County s population is 50.8% female and 49.2% male. The median age of the residents is 38.6 years old. Figure 2 details the age distribution of Macomb County. When compared to Michigan and the U.S., Macomb County s high school graduation rate is equivalent to other regions with 87.2% of Macomb County residents being high school graduates compared to 87.6% of Michigan residents, and 84.5% of U.S. residents. A majority of Macomb County residents reside in owner occupied units, 79.3%, compared to 74.7% of Michigan residents, and 67.1% of U.S. residents, suggesting a higher level of neighborhood stability. Similar to other Michigan counties, Macomb County has a high unemployment rate due to the loss of jobs in the auto industry. However, the Macomb County Office of Substance Abuse 15

County s unemployment rate is comparable to the State and the U.S. unemployment rate at 9.3%, 9.5%, and 9.6% respectively. Macomb County s median household income is $56,377 compared to $49,694 in the State of Michigan and $52,175 at the U.S. level. When compared to Michigan and the U.S., fewer families live below the federal poverty level as seen in Figure 3. Socioeconomic status is a social determinant of health. Areas with high unemployment, low high school graduation rates, and low neighborhood stability are more likely to experience poor health, and risky or maladaptive behaviors, which can be demonstrated through increased rates of drug use and abuse. Macomb County Office of Substance Abuse 16

COMBATING DRUG ABUSE IN MACOMB COUNTY: A POLICY PERSPECTIVE Macomb County has an invested interest in preventing prescription drug abuse within its population. Prescription drug is the second most common drug of abuse among youth, behind marijuana use (NSDUH 2008). According to the American Census Bureau, 31.6% of Macomb County residents are under 24 years of age which places them at a high risk for prescription drug abuse (United States Census Bureau, 2008). STATE LEGISLATION State legislators that represent Macomb County, frequently introduce legislation that will impact drug abuse in youth. Given the knowledge that social pressures such as bullying could potentially cause behavioral problems with youth, Macomb County legislators have introduced legislation that directly impacts bullying. House Bill 4580 was passed by the House on May 13, 2010 which requires schools to implement policies to prevent bullying; currently the Senate is reviewing the bill in the Education Committee. In addition to legislation that impacts bullying and peer pressure, the State Senate received House Bills 4316 4318, which together would: Eliminate the current immunity against product liability lawsuits that specifically applies to drugs approved by the federal Food and Drug Administration (FDA). Create a three year window in which claims could be filed for injuries attributable to FDAapproved drugs during the time the immunity was in place. Allow civil suits to be filed under the Consumer Protection Act if a business misrepresented risks associated with a drug, herb, dietary supplement, or botanical supplement. If passed this legislation would establish protections for residents that consume prescription drugs that result in detrimental effects. Though this does not directly address drug abuse, some pharmaceuticals have addictive effects even when not misused. Falling along the same line of House Bill 4580 and House Bills 4316 4318, the State House passed House Bills 5198 5199 which would suspend the driver s license of a person that is caught buying alcohol for a minor (person under 21). The license suspension will serve in addition to the buyer facing fines and potential jail time. If passed by the State Senate and signed by the Governor, these Macomb County Office of Substance Abuse 17

stiffer penalties would serve as a further deterrent against supplying alcohol to minors. Additional bills that would impact drug use, if passed, are House Bills 6226 and the tie barred House Bill 6038. Together these bills will consider more drugs to be Schedule I drugs in Michigan. The U.S. Department of Justice defines a Schedule I Drug as: The drug or other substance has a high potential for abuse. The drug or other substance has no currently accepted medical use in treatment in the United States. There is a lack of accepted safety for use of the drug or other substance under medical supervision. Examples of Schedule I substances include heroin, lysergic acid diethylamide (LSD), and marijuana (United States Drug Enforcement Administration, 2010). Some of the drugs that the bills would add to the list due to their mimicry to marijuana include K2 and BZP. Adding these drugs to the Schedule I list will serve as a formal update making the list more comprehensive and up to date with current trends of use. RESOURCES The State of Michigan also publishes and endorses resource guides for parents and youth. One such guide is Drug and Alcohol Abuse: A Parent/Child Guide to Michigan Law. This resource guide details why some youth will try drugs, what parents/guardians can do to prevent illicit drug use, what Michigan Law States regarding substance abuse, and what resources are available for youth that abuse drugs. Another guide that the State of Michigan endorses is the Parents Unite to Prevent Underage Drinking. This guide is geared towards parents and describes what they can do if they suspect alcohol abuse occurring in youth. Included in the manual are methods for talking to youth and those that influence them as well as resources for youth who abuse alcohol. In March 2009, The Michigan Department of Community Health, Mental Health & Substance Abuse Administration Bureau of Substance Abuse & Addiction Services (BSAAS) held a Prescription and Over the Counter Drug Abuse Summit, to raise awareness and provide the attendees with resources. The summit recognized the growing need for prescription drug abuse intervention and as a result the BSAAS is in the beginning stages of establishing a taskforce at the State level aimed at identifying and recommending evidence based prevention interventions and law enforcement strategies that will Macomb County Office of Substance Abuse 18

reduce the availability and illegal access to prescription and over the counter drugs. The taskforce will provide recommendations to BSAAS which will in turn support strategies that meet local and regional needs. The goal of this coordinated effort is a reduction of prescription and over thecounter drug abuse, by youth and adults. Currently, this taskforce is not operational, but full operation is expected for Fall 2010. Macomb County Office of Substance Abuse 19

OVERVIEW Drug abuse has deleterious effects on communities, families and individuals and is a major burden to society. Drug abuse is associated with numerous negative health and social consequences including increased mortality, injuries, overdose, sexually transmitted infections, spontaneous abortions, hepatitis, and liver and cardiovascular diseases and other life threatening conditions. The social consequences of substance abuse are also significant, which include loss of employment and productivity, failure in school, increased crime and imprisonment, decreased safety, family disintegration, domestic abuse, child abuse, and a host of mental and physical disabilities (Williams, 2007). In addition to severe health and social consequences, the National Institute on Drug and Addiction (NIDA) estimates the total overall cost of drug abuse in the United States to exceed half a trillion dollars. This includes approximately $181 billion for illicit drugs, $168 billion for tobacco, and $185 billion for alcohol (National Institute on Drug Abuse, 2008). Drug abuse is non discriminatory; it affects every culture, socio economic background, region, race, ethnicity, culture, and education level. Opioids, which include narcotics, are drugs that produce analgesic and sedative effects. Although opioids are often prescribed and manufactured as medications, they can also be manufactured and obtained illegally. As a substance of abuse, opioids are generally separated into two categories 1) heroin and 2) opioids other than heroin, which consist almost entirely of prescription pain relievers (Substance Abuse and Mental Health Administration, 2009). Heroin particularly is highly addictive and has a large potential for abuse. Heroin compared to morphine and other opioids is more fat soluble and crosses the blood brain barrier quickly. It therefore works more quickly but for a shorter time and results a proportion of the opioid related overdose, deaths, injuries, and treatment. Heroin is notably the greatest drug threat to communities and its abuse remains widespread, affecting both suburban and urban areas. Demand for heroin is high and easily accessible. The popularity of heroin is due, in part, to increased availability of low cost, high purity heroin that can be effectively snorted or smoked rather than injected. Heroin is sold on the street in small glassine bags with some type of marking or brand name on the package (Office of National Drug Control Policy Clearinghouse, 2008). Non medical use of prescription pain relievers is an emerging trend and has captured national and media attention. Studies have shown a significant increase in prescriptions for pain relievers such as Vicodin, Hydrocodone, OxyContin over the past five years. Data from the Michigan Automated Prescription Service (MAPS) reports that 15,989,795 prescriptions were written in 2006; this number Macomb County Office of Substance Abuse 20

increased to 17,254,281 in 2008 (State Epidemiology Workgroup, 2010). National studies also confirmed that giving away and loaning of prescription pain relievers are prevalent among youths and young adult populations. Macomb County Office of Substance Abuse 21

PART I ASSESSING THE BURDEN OF ILLICIT DRUGS: A FOCUS ON HEROIN AND PRESCRIPTION PAIN RELIEVERS Macomb County Office of Substance Abuse 22

DRUG RELATED MORTALITY The misuse and abuse of opioids, including non medical use of prescription drugs pain relievers, have become a growing problem for communities around the nation and have contributed significantly to the toll of the drug related deaths, hospitalizations, treatment, and arrests. Between 2004 and 2008, deaths from opioids poisoning increased by 102 percent in Macomb County. According to the 2008 Drug Abuse Warning Network (DAWN) report, there was an estimated 147 drug related deaths in Macomb County, a rate of 17.6 deaths per 100,000 population. This was an increase in number of deaths from 130 drug related deaths in 2007. Of the total deaths in 2008, 59 percent (87 deaths) were due to poisonings from opioid use. HEROIN POISONING MORTALITY Heroin excluding other opioids, was the leading cause of drug related deaths in Macomb County compared to cocaine in Wayne County in 2008 (Drug Abuse Warning Network, 2008). Figure 1 shows that drug related death rates due to heroin poisoning increased by more than 200 percent over the period of 2004 to 2008 (from 2.0 to 6.3 death deaths per 100,000 population) and increased by 136 percent between 2007 and 2008. In 2008, heroin accounted for 63 percent of the total opioid poisoning deaths and 35 percent (52 deaths) of the total drug related deaths in the County. Macomb County Office of Substance Abuse 23

HEROIN MORTALITY BY GENDER Mortality rates due to heroin poisoning among males are four times higher than females. Figure 2 shows that the five year mortality rate for the period of 2004 to 2008 was 5.74 deaths per 100,000 population among males (117 deaths), compared to a rate of 1.38 deaths per 100,000 population among females (29 deaths) during that same period. In 2008, there were 39 deaths among males and 13 deaths among females due to heroin poisonings. This was an increase from 19 deaths among males and three (3) deaths among females in 2007. HEROIN MORTALITY BY AGE Mortality rates are highest among person aged 21 24 years. Although persons 21 24 years consist of 4.5 percent of the total population in Macomb County, 11 percent of the heroin poisoning deaths occurred among this age group. Figure 2 illustrates a five year mortality rate (2004 2008) of 9.0 death per 100,000 population among person 21 24 years (17 deaths), followed by 6.0 deaths per 100,000 populations among persons aged 35 44 years (38 deaths), 5.8 deaths per population among person 25 35 years (32 deaths), and 4.4 deaths per 100,000 population among persons 45 64 years (48 deaths). There were a total of 11 total deaths among persons under the age 21 years and one death among persons 65 and older for the period of 2004 to 2008. Macomb County Office of Substance Abuse 24

HEROIN MORTALITY BY GEOGRAPHIC DISTRIBUTION Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Geographically, more heroin poisoning deaths occurred around the southern parts of the County. This area, which is home to the city of Warren, St. Clair Shores, Sterling Heights and Roseville is also the most populous part of the County. Figure 3 illustrates the city of Warren with highest total number of heroin poisoning deaths (37 deaths) over the period of 2004 to 2008, a rate of 5.5 deaths per 100,000 population. Neighborhoods within Warren with the highest contributing number of deaths were zip code 48091 (13 total deaths) and zip code 48089 (11 deaths) during those five years. Roseville experience 14 total deaths during the period of 2004 to 2008, a rate of 5.9 deaths per 100,000 population. Clinton Township and Sterling Heights both experienced 14 deaths during that same time period, with rates of 2.9 and 2.2 deaths per 100,000 population, respectively. The city of Utica experienced a total of 12 deaths due to heroin poisoning, a rate of 3.0 per 100,000 population. St. Clair Shores experienced 11 deaths due to the heroin poisoning, a rate of 4.6 deaths per 100,000 population; followed by Eastpointe with eight total death due to heroin poisoning, a rate of 4.9 deaths per 100,000. The remaining cities in Macomb County all experienced five (5) or less heroin poisoning deaths during the period of 2004 to 2008. Trends showing a sharp increase in heroin poisoning deaths within Macomb neighborhoods between 2007 and 2008 were also consistent with the countywide trend. The city of Warren experienced 11 heroin poisoning deaths compared to eight (8) deaths in 2007. Roseville experienced six (6) deaths in 2008, an increase from 2007. Clinton Township and Sterling Height both experienced five (5) deaths in 2008, an increase from 2007. Macomb County Office of Substance Abuse 25

Source: Michigan Department of Community Health, Division of Vital Records and Statistics, Michigan Residents Inpatient Files, 2004 2008 Macomb County Office of Substance Abuse 26

HEROIN POISONING HOSPITALIZATIONS Hospitalization data is used to determine disease morbidity and cost to healthcare systems. Individuals may make multiple hospital visits in which each instance will be counted toward the total number of hospitalizations within a specified community. Hospitalizations due to heroin poisoning are consistent with the County wide trend for heroin poisoning deaths. Figure 4 illustrates hospitalization rates due to heroin poisoning at the point of discharge. The figure shows a 164 percent increase in hospitalizations rates from 2004 to 2008. In 2007, there were 33 total hospitalizations due to heroin poisoning, a rate of 4 hospitalizations per 100,000 population. In 2008, this number doubled to 65 total hospitalizations, a rate of 7.8 hospitalizations per 100,000 population. Macomb County Office of Substance Abuse 27

HEROIN HOSPITALIZATIONS BY GENDER Higher rates of hospitalizations due to heroin poisoning occurred among males when compared to females. Figure 5 shows the five year hospitalizations rate among males was 7.3 hospitalizations per 100,000 population (148 total hospitalizations) compared to 4.0 hospitalizations per 100,000 population among females (84 total hospitalizations) during the period of 2004 to 2008. HEROIN HOSPITALIZATIONS BY AGE Persons aged 15 24 were hospitalized at a higher rate compared to all other age groups. For the period of 2004 to 2008, the five year hospitalization rate for persons age 15 24 was 14.5 hospitalizations per 100,000 population (74 hospitalizations). This rate was followed by persons aged 25 44 at 9.1 hospitalizations per 100,000 population (107 hospitalizations) and persons 45 64 years at 4.6 hospitalizations per 100,000 population. There were no hospitalizations due to heroin poisoning for persons under age 15 years and those over age 65 years. Macomb County Office of Substance Abuse 28

HEROIN HOSPITALIZATIONS BY GEOGRAPHIC DISTRIBUTION Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Between the period of 2004 to 2008, there were a total of 232 hospitalizations due to heroin poisoning in Macomb County. Figure 6 depicts the number of hospitalizations by Macomb County cities and zip codes. Of the total number of hospitalizations in the County, 32 percent (74 hospitalizations) occurred among residents of Warren, a rate of 11.0 hospitalizations per 100,000 population. Sterling Heights had the second highest at 30 hospitalizations due to heroin poisoning, a rate of 4.7 hospitalization per 100,000 population. There were 25 hospitalizations among Roseville residents, a rate of 10.6 hospitalizations per 100,000 population; 21 hospitalizatons among Utica residents, a rate of 5.3 hospitalizations per 100,000 population; 19 hospitalizations in Clinton Township and 17 hospitalizations in St. Clair Shores, rates of 4.0 and 5.6 hospitalizations per 100,000 population, respectively. Fraser accounted for 10 hospitalizations. The remaining cities all had less than 10 hospitalizations due to heroin poisoning. Macomb County Office of Substance Abuse 29

Source: Michigan Department of Community Health, Division of Vital Records and Statistics, Michigan Residents Inpatient Macomb County Office of Substance Abuse 30

PRESCRIPTION DRUGS (PAIN RELIEVERS) POISONING MORTALITY Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Prescription drugs, opioids (pain relievers), are widely used to treat pain and functional status despite the effects on hormones and the immune system and its propensity for addiction and abuse. Misuse and abuse of pain relievers have become a serious problem due to their widespread use leading to easy access from physicians and friends. The misuse of pain relievers such as Codeine, Morphine, Hydrocodone, Oxycodone, and Meperidine has added to the total drug related death toll in Macomb County. This problem has, however, been on a decreasing trend over the past two years. Figure 6 illustrates deaths from prescription drug poisoning peaked in 2006 at a rate of 3.1 deaths per 100,000 population (26 total deaths). At this point, deaths from prescription drugs accounted for 32 percent of the total drug related deaths due to opioid poisonings. In 2008, this proportion was reduced to 15 percent of the 81 total deaths due to opioid poisoning in the County. Macomb County Office of Substance Abuse 31

PRESCRIPTION DRUGS MORTALITY BY GENDER Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Males experienced a higher mortality rate from prescription drug poisoning compared to females. Figure 7 shows the five year death rate more than 1.5 times higher at 2.8 deaths per 100,000 population among males (57 deaths) compared to 1.6 deaths per 100,000 population among females (34 deaths). PRESCRIPTION DRUGS MORTALITY BY AGE Figure 7 also shows that persons between the ages 35 44 years had the highest death rate compared to all other age groups over the period of 2004 to 2008. Mortality rates among persons aged 35 44 years was 4.8 deaths per 100,000 population (17 deaths), followed by persons aged 45 64 years at a rate of 3.8 death per 100,000 population (30 deaths), and 3.1 death per 100,000 population (17 deaths) among persons aged 25 34 years. Macomb County Office of Substance Abuse 32

PRESCRIPTION DRUGS MORTALITY BY GEOGRAPHIC DISTRIBUTION Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Figure 9 illustrates neighborhoods by the number of prescription drug poisoning deaths. Between the period of 2004 and 2008, there were a total of 91 prescription drug poisoning deaths, a five year death rate of 2.2 deaths per 100,000 population for the County. Of this total, 29 percent (26 deaths) occurred in Warren, a rate of 3.87 deaths per 100,000 population. Other cities with a high number of prescription drug poisoning deaths, were the cities of Roseville and Sterling Heights, contributing 12 deaths each during this period, with rates of 5.09 and 1.9 deaths per 100,000 population, respectively. A total of 10 deaths occurred in St. Clair Shores, a rate of 3.3 deaths per 100,000 population, followed by nine (9) deaths in Eastpointe (5.49 deaths per 100,000 population) and eight (8) deaths in Clinton Township, a rate of 4.9 deaths per 100,000 population. The remaining cities had six (6) or fewer deaths occurring between 2004 and 2006. Macomb County Office of Substance Abuse 33

Source: Michigan Department of Community Health, Division of Vital Records and Statistics, Michigan Residents Inpatient Files, 2004 2008 Macomb County Office of Substance Abuse 34

PRESCRIPTION DRUGS HOSPITALIZATIONS Although deaths due to prescription drug poisonings have been on a decline since 2006, hospitalizations are on the rise. Figure 10 shows a 60 percent increase in the rate of hospitalizations between the year 2006 and 2008 due to prescription drug poisonings. In 2008, the hospitalizations rate was 16.3 hospitalizations per 100,000 population among Macomb residents (135 hospitalizations) an increase from the 2007 rate of 13.6 hospitalizations per 100,000 population (113 hospitalizations). The national public awareness efforts which begun in 2003 to address increased poisonings and fatalities with use of opioid based pain relievers, specifically Propoxyphene, may have partly contributed to the sharp decline in 2006. Poisonings by pain relievers that include Propoxyphene (generic name Darvon) are attributable to approximately 25 percent of prescription drug pain reliever hospitalizations each year. Figure 11 illustrates hospitalizations due to pain relievers containing Propoxyphene. Trend data shows that hospitalizations due to propoxyphene poisonings are consistent with the overall trend for poisoning by all opioid based pain relievers. Figure 11 also shows that hospitalizations rates due to pain relievers containing Propoxyphene are again on an increasing trend. Macomb County Office of Substance Abuse 35

PRESCRIPTION DRUGS HOSPITALIZATIONS BY GENDER Hospitalizations rates due to prescription pain relievers are higher among females compared to males. During the period of 2004 to 2008, the five year hospitalization rate was 7.9 hospitalizations among females (166 hospitalizations) compared to 6.4 per 100,000 hospitalizations among males (131 hospitalizations). PRESCRIPTION DRUGS HOSPITALIZATIONS BY AGE Persons aged 45 64 years were hospitalized at a higher rate when compared to other age groups. Figure 12 shows that the hospitalization rate for persons aged 45 64 years was 12.0 per 100,000 population (131 hospitalizations), a rate 1.7 times higher than the County wide rate of 7.2 hospitalizations per 100,000 population. Persons 65 years and over experienced the second highest rate at 11.2 hospitalizations per 100,000 populations (65 hospitalizations); followed by persons aged Macomb County Office of Substance Abuse 36

45 64 years at 8.7 hospitalization per 100,000 population (103 hospitalizations), and persons aged 15 26 years at a rate of 5.9 hospitalizations per 100,000 population (30 hospitalizations). There were a total of eight (8) hospitalizations among persons under the age of 15 during the five year period of 2004 to 2008. PRESCRIPTION DRUGS HOSPITALIZATIONS BY GEOGRAPHIC DISTRIBUTION Figure 13 illustrates the number of poisonings by prescription pain reliever by Macomb cities and zip codes. Data from the Michigan Inpatients Files for the five year period of 2004 to 2008 shows that the highest number of hospitalizations (119 hospitalizations) occurred in the city of Warren, a rate of 17.7 hospitalizations per 100,000 population. This rate is 2.5 times higher than the County wide fiveyear rate of 7.2 hospitalizations per 100,000 population. Sterling Heights had the second highest number of hospitalizations (77 hospitalizations), a rate of 12.1 per 100,000 population. There were 75 hospitalizations in Clinton Township, a rate of 15.6 per 100,000 population. Roseville had a total of 64 hospitalizations, a rate of 27.2 hospitalizations per 100,000 population and the highest rate in the County. St. Clair Shores had 43 hospitalizations, a rate of 14.1 hospitalizations per 100,000 population and Utica had a total 37 hospitalizations, a rate of 10.6 hospitalizations per 100,000 population. All cities had at least one (1) hospitalization due to poisoning by prescription pain relievers. Macomb County Office of Substance Abuse 37

Source: Michigan Department of Community Health, Division of Vital Records and Statistics, Michigan Residents Inpatient Files, 2004 2008 Macomb County Office of Substance Abuse 38

DRUG ABUSE TREATMENT ADMISSIONS Substance abuse treatment data is an indicator of treatment availability, access and available financial resources for addressing substance abuse and dependence issues within a community. In 2009, there were a total of 24,222 opioid involved treatment admissions in Michigan, a 17.6 percent increase in opioid involved treatment admissions from the previous year total of 20,585 admissions. Of those 2009 admissions, Macomb County contributed 12 percent of the total count. In addition, Macomb County ranked second in the State for number of opioid involved treatment admissions, preceded by the city of Detroit (Figure 14). In 2009, there were a total of 5,673 treatment admissions in the County, a 12.2 percent increase from the 2008 total of 5,058. In 2009, there were decreases in treatment admissions due to alcohol, Macomb County Office of Substance Abuse 39

cocaine, crack, and benzodiazepines. However, treatment admissions increased substantially for prescription pain relievers (a 35 percent increase) and heroin (a 20 percent increase). Opioid abuse contributed to more than 50 percent of the total number of treatment admissions in the County. Figure 15 illustrates percents of treatment admissions by substance type. The data shows that opioids, both heroin and prescription pain relievers, accounted for 47 percent of the total number of treatment admissions. Heroin, the most frequent primary substance of abuse among persons in treatment in Macomb County, accounted for 36 percent of admissions, followed by alcohol (31 percent), marijuana (12 percent), and prescription drugs pain relievers at 11 percent. Macomb County Office of Substance Abuse 40

TREATMENT ADMISSIONS BY GENDER Males accounted for the larger proportion of opioid involved treatment admissions compared to females. Figure 16 shows that 59.8 percent of those admitted to treatment for opioid abuse in 2008 were males compared to 40.2 percent among females. There was a slight closing of the gender gap in 2009, with 57.8 percent of opioid involved admissions were by males and 42.2 percent by females, however this proportion difference between years was not substantial. TREATMENT ADMISSIONS BY AGE Persons aged 21 25 years accounted for the largest proportion, 22.3 percent, receiving opioid involved treatment in 2009. Figure 17 shows there were 665 opioid involved admissions, a rate 15.5 admissions per 1,000 population. Persons aged 26 29 years had the second largest proportion (16.4 percent) of opioid involved admissions. Figure 17 shows there were 489 admissions by persons aged 26 29 years in 2009, a rate of 5.7 admissions per 1,000 population. There were 296 admissions by persons aged 18 20 years, a rate of 19.2 per 1,000 population in 2009. Macomb County Office of Substance Abuse 41

Macomb County Office of Substance Abuse 42

NARCOTIC LAW ARRESTS Arrest data represented in this report are from the Uniform Crime Reporting Program. The program counts one arrest for each separate instance in which a person is arrested, citied, or summoned for an offense. A person may be arrested multiple times during a year, the arrest data does not capture the number of individuals who have been arrested rather; data show the number of arrests made by Law Enforcement Officers (Uniformed Crime Reports, 2007). Arrest data are useful in the assessment of illicit drug abuse because they indicate level of drug activity related to purchases and sales within communities. Arrest data also indicate the burden on the justice and law enforcement systems within a given locality and assess the level of law enforcement investment in addressing the problem. According to the Uniform Crime Reporting Program, drug law violations relate to the unlawful possession, sales, use, growing and manufacturing of illegal drugs including opium or cocaine and their derivatives (morphine, heroin, codeine); marijuana; synthetic narcotics manufactured, narcotics that causes addiction (demerol, methadone); and dangerous non narcotic drugs: amphetamines, barbiturates, Benzedrine (Uniformed Crime Report, 2007). Non indexed arrests are those arrests that are due to crimes against property or behavioral crimes. The most recent data available for Macomb County shows that in 2006, there were 43,496 arrests made for non indexed crimes. Of those, approximately 20 percent were due to arrests made for violation of narcotic laws (3,980 total arrests), violation of liquor laws (915 arrests) or driving under the influence of alcohol or narcotics (3,530 arrests). Figure 18 shows that narcotic law violation was the sixth highest reason for arrests in the County in 2006. Macomb County Office of Substance Abuse 43

NARCOTIC LAW ARRESTS BY GENDER Consistent with the trend for the State of Michigan and the U.S., males are arrested at a higher rate compared to females for narcotic law violations in Macomb County. Figure 19 illustrates that in 2006, 80 percent of the narcotic law arrests made were among males (2,670 arrests) compared to 20 percent for females (666 arrests). There were more females (713) and males (2,854) arrested in 2005 when compared to the year 2006. Macomb County Office of Substance Abuse 44

NARCOTIC LAW ARRESTS BY AGE Persons aged 25 44 years were arrested at a higher rate than persons of other age groups. In 2006, 47 percent (1,497) of the arrests made for narcotic law violations were among persons aged 25 44 years. Persons aged 18 24 consist of only 4.1 percent of the total population in 2006. However, 35 percent of the total narcotic law arrests (1,100) made were among this age group. There were 142 narcotic law arrests made to persons less than 18 years of age. Figure 19. Macomb County Percentage of Narcotic Law Arrests by Gender, 2006 20% (666) 80% (2,670) MALE FEMALE Macomb County Office of Substance Abuse 45

NARCOTIC LAW ARREST BY RACE In 2006, 76 percent (2,523 arrests) of narcotic law arrests were made to Whites, while 23 percent (779 arrests) were made to Blacks. Blacks consist of 6.6 percent of Macomb County s population compared to 87.6 percent for Whites. Macomb County Office of Substance Abuse 46

NARCOTIC LAW ARRESTS BY POLICE DEPARTMENT In 2006, there were more narcotic law arrests made by the city of Warren Police Department, 25 percent (1,008 arrests), compared to all other departments in the County. Eastpointe had the second highest number of arrests made (327 arrests); followed by St. Clair Shores with 245 total arrests. There were no arrests reported in the city of Armada, Memphis, or Mount Clemens. In addition, the Macomb Sheriff made 504 narcotic law arrests Countywide. Macomb County Office of Substance Abuse 47

Macomb County Office of Substance Abuse 48

ILLICIT DRUG CONSUMPTION A NATIONAL PROFILE Illicit drug consumption, specifically non medical use of prescription pain relievers, has made the national attention since a noted increased use and abuse among youth and young adult populations in 2002. According to the 2008, National Survey on Drug Use and Health (NSDUH), 8.0 percent (20 million people) of persons 12 or older were current illicit drug users. Of youth aged 12 17 years, 9.3 percent reported current illicit drugs user within the past month. Nationally, marijuana continues to be the most frequently used illicit drug among persons 12 years or older at 6.7 percent, followed by psychotherapeutics at 2.9 percent; inhalants (1.1 percent) and hallucinogens (1.0 percent). In 2008, 1.9 percent of persons aged 12 or older reported non medical use of pain relievers, nationally. According to the 2008 NSDUH Survey, rates of current use of illicit drugs were higher for young adults aged 18 to 25 (19.6 percent) than for youths aged 12 to 17 years (9.3 percent) and adults aged 26 years and older (5.9 percent). Among young adults, 16.5 percent used marijuana in the past month, 5.9 percent used prescription drugs, non medically, 1.7 percent used hallucinogens, and 1.5 percent used cocaine. MICHIGAN AND MACOMB COUNTY ILLICIT DRUG CONSUMPTION NSDUH data for the period of 2004 2006 is the latest data available at the sub State level on adult illicit drug consumption. The national data presented in the previous section described the prevalence of illicit drug use by illicit drug types including marijuana. Figure 23 illustrates illicit drug use for cocaine, heroin, non medical use of prescription drugs, hallucinogens, and MDMA (methylenedioxymethamphetamine or ecstasy) excluding the use of marijuana by age group for Macomb County, Michigan, and U.S. for the period of 2004 2006. The data show that during the period of 2004 2006, 5.0 percent of youth, more than 36,000 youths, reported illicit drug use other than marijuana in Macomb County, an 8.5 percent increase from the 1999 2002 rate of 4.61 percent by this age group. Illicit drug use among persons aged 18 25 years was higher among Macomb residents (9.6 percent) compared to Michigan (9.3 percent) and the U.S. (8.5 percent). Use among this population also Macomb County Office of Substance Abuse 49

increased from the 1999 2002 rate of 6.24 percent. Persons aged 26 years or older reported illicit drug use at a rate of 2.8 percent, a rate higher than the national rate of 2.7 percent but the same as Michigan. For the period of 1999 2002, 1.5 percent of persons aged 26 or older reported past month use of illicit drug other than marijuana in Macomb County. HEROIN USE AMONG YOUTHS Heroin consumption among Macomb County youth population is consistent with the County wide trend showing increased deaths and hospitalizations due to opioid poisonings. According to the 2009 Youth Risk Behavioral Survey (YRBS), an estimated 3.4 percent (approximately 950 persons) of high school students reported heroin use within the past month, a rate higher than the national rate of 2.5 percent and lower than the State wide rate of 5.0 percent. Figure 24 shows an increase in heroin use among high school students by 79 percent from the 2007 rate of 1.9 percent. Macomb County Office of Substance Abuse 50

PRESCRIPTION DRUG USE AMONG YOUTH According to the 2004 2006 NSDUH survey, persons aged 18 25 years reported higher non medical use of pain relievers compared to the other age groups. Figure 25 shows that Macomb County residents within this age group reported higher use (15.4 percent) when compared to Michigan (13.9 percent) and the U.S. (12.2 percent). Data also shows that 7.6 percent of persons age 12 17 reported past year non medical use of prescription pain relievers. This rate was higher than the statewide rate of 7.1 percent but lower than the national rate of 8.3 percent. Macomb County Office of Substance Abuse 51

More recent illicit drug consumption data was made available for youth populations through the 2008 and 2010 Michigan Profile for Healthy Youth Survey (MiPHY). Figure 26 shows that nonmedical use of pain relievers was the third reported substance by high school students behind alcohol (31.3 percent) and marijuana (19.0 percent). In 2010, 9.6 percent of high school students reported that they used prescription pain relievers, non medically. This is a decrease from the 2008 prevalence of 11 percent. A higher percentage of students in the 7 th grade (12.7 percent) reported prescription pain reliever use compared to 9 th (8.6 percent) and 11 th graders (10.7 percent). This trend is consistent with 2007 prevalence rates by grade. Macomb County Office of Substance Abuse 52

A study conducted by Boyd et al. on prescription drug abuse and diversion among adolescents found that 36 percent of the students who participated in the study had a prescription for sleeping medication (Ambien, Halcion, Restoril), sedative or anxiety medication (Ativan, Xanax, Valium, Klonopin), stimulant medication for attention deficit/hyperactivity disorder (Ritalin, Adderall) and pain medication (Vicodin, OxyContin, Tylenol 3). Opioid pain medications were more widely prescribed (46 percent lifetime and 33 percent past year prescription). Girls were significantly more likely to a have a prescription for pain medication and more likely to use them non medically than boys. The study also showed that current medical users were 2.9 times more likely to get approached to divert their medications and there was evidence of trading medications. Students were also more likely to give away or loan their medications rather than trade or sell: 25 percent of those with pain Macomb County Office of Substance Abuse 53

medication prescription reported giving away or loaning; 21 percent with stimulants; 20 percent of those with sleep medications; and 15 percent with prescription for sedatives. Overall 24 percent of those with prescription medications gave away or loaned their medications with higher percentage of giving away reported among girls compared to boys (Boyd, 2007). Macomb County Office of Substance Abuse 54

PART II ASSESSING THE BURDEN OF ALCOHOL ABUSE: A FOCUS OF ALCOHOL RELATED TRAFFIC CRASHES AND UNDERAGE DRINKING Macomb County Office of Substance Abuse 55

ALCOHOL RELATED TRAFFIC CRASHES, FATALITIES, AND INJURIES Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 In 2007, Macomb County developed a strategic plan via the Strategic Prevention Framework, State Incentive Grant (SPFSIG) which set forth four goals to assess the impact made over time towards reducing the burden of alcohol related consequence, and specifically alcohol related traffic crash deaths and underage drinking. These goals are 1) To decrease alcohol related traffic crash deaths in Macomb County; 2) To decrease over time the number of Driving Under the Influence arrests in Macomb County (especially for teenagers and young adults); 3) To decrease alcohol use among middle school and high school students; 4) To decrease alcohol use among 18 20 year olds. This section of the report reviews key indicators that would measure the impact of concerted efforts to address these problems over time. ALCOHOL RELATED TRAFFIC CRASH FATALITIES The Michigan Traffic Crash Facts conducts surveillance on factors related to traffic crashes Statewide and for Michigan counties and cities. Overall, alcohol related traffic crash fatalities and injuries have been on a steady decline, Statewide. In 2009, there were 613 persons killed or seriously injured in Michigan, a 17.4 percent decrease in fatalities, Statewide. Macomb County data shows similar trends in alcohol related fatalities. For the period of 2001 2005, Macomb County ranked third behind Wayne and Oakland counties for the highest number of fatalities or serious injuries (605 total fatalities or an average of 121 fatalities or serious injuries per year) for that time period in Michigan. Figure 1 illustrates the number of person killed or seriously injured by county for the period of 2006 2009. The data shows that for this period, Macomb County ranked fifth during the four year period, a total of 139 fatalities (an average of 35 fatalities or serious injuries per year) and succeeded by Wayne (523 fatalities or injuries), Genesee (192 fatalities or injuries), Kent (185 fatalities or injuries) and Oakland (176 fatalities or injuries) counties. However in 2009, Macomb County however ranked third again for number of alcohol related traffic crash fatalities with 19 total fatalities. Macomb County Office of Substance Abuse 56

Macomb County Office of Substance Abuse 57

ALCOHOL RELATED TRAFFIC CRASHES Although Macomb County has experienced a significant reduction in the number of alcohol related fatalities and serious injuries per year since 2005, decline in the number of alcohol related traffic crashes have been unstable over the past 10 years. Figure 3 illustrates the number of alcohol related traffic crashes by year since the year 2000. The data shows the number of alcohol related crashes has been on an unstable decline with 945 reported crashes in 2005, a 12.5 percent decrease from the previous year; 1,002 reported crashes in 2007, an 8.2 percent increase from the previous year; and 795 reported crashes in 2009, a 13.7 decrease from 2008. Overall the data shows that there is significant difference in the number of fatalities and serious injuries between the periods of 2002 2005 and 2006 2009, a 71 percent decrease in fatalities and injuries; and although a reduction, there was less notable differences in the number of alcohol related traffic crashes between the two periods; a 12.5 percent decrease in alcohol related traffic crashes. Figure 3 also shows that approximately four (4) percent of all crashes each year were alcohol related. Macomb County Office of Substance Abuse 58

DRINKING AND DRIVING BY AGE According to the 2009 Michigan Traffic Crash Facts, persons aged 21 24 years reported being the drinking driver in alcohol related crashes at a higher rate than other age groups. Figure 4 illustrates that in 2009, 133 persons aged 21 24 years, a rate of 35.1 crashes per 10,000 population were reported as the drinking driver in alcohol involved crashes in the County. Persons aged 25 34 years reported the second highest rate at 18.2 crashes per 10,000 population (200 total drivers). There were 73 persons under the age of 21 who were reported as the drinking driver in alcohol related traffic crashes. The 2009 data identifies similar high risk age groups for drinking drivers when compared to 2005. In 2005, persons aged 21 24 years were also reported at a higher rate as being the drinking driver in alcohol related traffic crashes, a rate of 51.7 crashes per 100,000 population (234 crashes). There were 167 persons under the age of 21 who were reported as being the drinking driver in alcohol related traffic crashes. Overall, there were decreases in drinking and driving by all age groups when compared to the 2005 data. Macomb County Office of Substance Abuse 59

ALCOHOL RELATED TRAFFIC CRASHES BY LOCATION Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 According to the 2009 Office of Highway Safety, Michigan Traffic Crash Report, a large proportion of alcohol related traffic crashes occurred around the southwest part of the County. The city of Warren, the most populous city, ranked highest for the number of alcohol related traffic crashes with 125 reported crashes (Table 1). There were 147 alcohol related traffic crashes reported in Warren during 2005, a 15 percent decrease. Consistent with the 2005 trend, Clinton Township ranked second with 119 reported crashes in 2009, however, there were no decreases from the 2005 number of 118 report alcohol related traffic crashes. There were 95 reported crashes in Sterling Heights, a decrease from 108 in 2005; 57 crashes in Roseville, a decrease from 73 crashes in 2005; and 53 reported crashes in Shelby Township, an increase from 47 reported alcohol related traffic crashes in 2005. Overall, there were decreases in alcohol related traffic crashes by most cities when the year 2005 was compared to 2009. Table 1. Macomb County Alcohol related Traffic Crashes by City, 2009 795 Total Crashes Rank City/ Township # of Crashes Rank City/Township # of Crashes 1 Warren 125 14 Bruce Twp 8 2 Clinton Twp 119 14 Centerline 8 3 Sterling Heights 95 14 Ray Twp 8 4 Roseville 57 15 Richmond Twp 7 5 Shelby Twp 53 16 Armada Twp 6 6 St. Clair Shores 51 16 New Baltimore 6 7 Chesterfield Twp 50 17 New Haven 4 8 Harrison Twp 44 18 Lenox Twp 2 8 Macomb Twp 44 18 Romeo 2 9 Mt. Clemens 38 19 Grosse Pointe Shores 1 10 Eastpointe 28 19 Richmond 1 11 Utica 15 20 Armada 0 12 Washington Twp 12 20 Lake Twp 0 13 Frazer 11 20 Memphis 0 Source: Office of Highway Safety, Michigan Facts Traffic Crash Facts, 2009 ALCOHOL RELATED TRAFFIC FATALITIES BY LOCATION There were a total of 19 alcohol related traffic crash fatalities in Macomb County in 2009 (Office of Highway Safety Planning, 2005 2009). By cities, Clinton Township ranked number one with five (5) total fatalities, followed by Roseville and Warren, both reporting four (4) alcohol related traffic crash Macomb County Office of Substance Abuse 60

fatalities. There were two (2) alcohol related fatalities reported in Washington Township and one (1) reported in Centerline, Macomb Township, Shelby Township, and Sterling Heights. Table 2: Macomb County Alcohol related Traffic Fatalities by City, 2009 19 Total Fatalities Rank City # Fatalities 1 Clinton Twp 5 2 Roseville 4 2 Warren 4 3 Washington Twp 2 4 Centerline 1 4 Macomb Twp 1 4 Shelby Twp 1 4 Sterling Heights 1 Source: Office of Highway Safety Planning, Michigan Traffic Crash Facts, 2009 Note: Data are presented for alcohol related deaths only. Data does not include persons who experienced serious injuries Macomb County Office of Substance Abuse 61

DRIVING UNDER THE INFLUENCE ARRESTS Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Trend data shows substantial progress towards reducing the number DUI arrests in Macomb County (Michigan Drunk Driving Audit, 2005 2009). Figure 5 shows a steady decline in DUI arrests since 2005, a 16.5 percent decrease in the number of arrests. Macomb County, however, remains third in the State for counties with the highest number of DUI arrests behind Wayne and Oakland counties. ARRESTS BY AGE The Michigan Uniformed Reporting System (UCR) provides data by age, gender, jurisdictions and selected causes of arrests. The most recent available data (2006) shows that persons aged 21 24 years had the highest number of DUI arrests when compared to other age groups. Figure 6 shows that there were 587 DUI arrests among this age group, a decrease from 657 arrests in 2005. Persons aged 25 29 years presented the second highest number of DUI arrests with a total 510 arrest, a decrease from 587 arrests in 2005. Trends showing high risk age groups for DUI arrests were consistent between 2005 and 2006. Macomb County Office of Substance Abuse 62

Figure 7 shows that of persons 18 24 year olds, 23 year olds were reported with the highest number of arrests (166 total) in 2006. This was an increase from the 2005 total of 141 total arrests. There was also an increase in the number of DUI arrests among persons 18 years of age, 86 arrests in 2005 and 99 arrests in 2006; a decrease among persons 19 years of age, 123 arrests in 2005 and 112 arrests in 2006; and no difference among persons 20 years of age, 108 in 2005 and 109 in 2006. Overall, the number of arrests for persons aged 13 20 years (underage drinkers) increased by 29 percent from a total of 308 arrests in 2005 to 397 in 2006. More recent data is needed for this indicator to effectively evaluate changes to date. Macomb County Office of Substance Abuse 63

ARRESTS BY RACE Figure 8 illustrates the percentage of DUI arrest by race and gender. The data shows that in 2006, 66 percent of the DUI arrests were among white males, a lesser proportion when compared to 2005 (76 percent). The percentage of DUI arrests by white females increased by two (2) percent from 21 percent in 2005 to 23 percent in 2006. Seven (7) percent of the arrests were among black males and two (2) percent were among black females in 2006. Macomb County Office of Substance Abuse 64

ARRESTS BY LOCATION Figure 9 shows the number of DUI arrests by Macomb County Police Department. According the Michigan Uniform Crime Report (2006), the Macomb County Sheriff s Department reported the most number of DUI arrests at 562 arrests, a decrease from 749 in 2005. Among Macomb cities, Clinton Township Police Department made the highest number of DUI arrests (368 total arrests), a decrease from 400 arrests in 2005. Sterling Heights Police Department made the second highest number of DUI arrests (307), a decrease from 333 arrests in 2005. The city of Warren made fewer arrests in 2006 (282 arrests) when compared to 2005 (475 arrests). Figure 10 shows the number of underage drinking arrests by Macomb County Police Department. The data shows that 68 arrests were made by the Macomb Sheriff Department in 2006, a decrease from 2005 (73 total arrests). Clinton Township Police Department made the highest number of DUI arrests among minors (43 arrests) in 2006, an increase from 34 arrests in 2005. Sterling Heights also had an increase in the number of DUI arrests among minors from 26 arrests in 2005 to 40 arrests in Macomb County Office of Substance Abuse 65

2006. The city of Utica Police Department made 24 DUI arrests among minors in 2005 and 35 arrests in 2006. There was a decrease in number of DUI arrests to minors in Warren, 36 arrests in 2005 and 25 arrests in 2006. The increases in number of arrests made to minors by Police Department may be due to efforts to crack down on underage drinking and driving activities in the County. More recent data is needed to effectively evaluate the results of these efforts to date. Macomb County Office of Substance Abuse 66

Macomb County Office of Substance Abuse 67

UNDERAGE DRINKING The National Survey on Drug Use and Health (NSDUH) provides sub State estimates for alcohol and illicit drug use for adult and youth populations. The most recent sub State level data available is for the 2004 2006 timeframe. More current data illustrating alcohol consumption patterns are available for youth populations via the Michigan Profile on Healthy Youth (MiPHY) and the Youth Risk Behavioral Surveys (YRBS), these estimates will be used to describe consumption patterns for high school and middle school populations. Current use of alcohol is having one or more drinks within the past 30 days. The NSDUH survey reported increases in current alcohol use among by all age groups in Macomb County when compared to the period of 1999 2001. Macomb County residents also reported higher alcohol use when compared to the State and National rates. Figure 11 shows that for the period of 2004 2006, 19 percent of youth aged 12 17 years reported current use of alcohol, an increase from the 1999 2001 rate of 18.6 percent; 71 percent of persons aged 18 25 years also reported higher current alcohol use during 2004 2006 compared to 1999 2001 (63.8 percent), an 11.3 percent increase in current use; and 61.9 percent of persons 26 years or older reported current use of alcohol, a rate higher than the 1999 2001 rate of 54.9 percent. Macomb County Office of Substance Abuse 68

ALCOHOL USE BY GRADE Findings from the 2010 MiPHY survey for Macomb County shows that 31.2 percent of high school students in Macomb reported current use of alcohol, this is a decrease from 2008 rates of 42.8 percent. Figure 12 compares current use rates of Macomb students to the Statewide and national rates in 2009. The data shows that current use rates for both Michigan (37 percent) and the U.S. (41.8 percent) were higher than Macomb County. In 2010, 5.9 percent of 7 th graders, 24.3 percent of 9 th graders and 39.4 percent of 11 th graders reported current use of alcohol in Macomb County. Lifetime use of alcohol is defined as ever having drank alcohol in your lifetime. Figure 13 shows the percentage of students who reported ever drinking alcohol in their lifetime. In 2010, 54.3 percent of Macomb students reported lifetime use of alcohol; this rate is lower than the Statewide (68.8 percent) and national (72.5 percent) rates from the 2009 YRBS survey. In 2008, 59.1 percent of students reported lifetime use of alcohol in Macomb County. Macomb County Office of Substance Abuse 69

BINGE DRINKING Binge drinking is defined as having 5 or more drinks in one setting. It has been correlated with many adverse health and social consequences including death and injury as a result of alcohol related traffic crashes and arrests. According to the 2004 2006 NSDUH, binge drinking has increased among persons aged 18 25 years, from 41.7 percent during 1999 2001 to 49.4 percent during 2004 2006. Rates also increased for persons aged 26 or older, from 19.5 percent during 1999 2001 to 25.5 percent during 2002 2004. Figure 14 shows a higher percentage of binge drinking reported among persons aged 18 25 years, followed by persons age 26 or older. The data also shows that reported binge drinking rates was higher among Macomb County residents when compared to the Statewide and national rates for all age groups. Figure 15 illustrates binge drinking behavior by grade. The data shows that 19.7 percent of students in Macomb County reported current binge drinking behaviors, a decrease from the 2008 rates of 23 percent. Students in the 11 th grade reported higher binge drinking behaviors at 27.2 percent, followed by 9 th graders (13.4 percent), and 7 th graders (4.9 percent). Macomb youth reported lower percentage of binge drinking when compared to the State (23.2 percent) and national (24.2 percent) rates. Macomb County Office of Substance Abuse 70

Macomb County Office of Substance Abuse 71

DRINKING AND DRIVING AND RIDING BEHAVIORS Assessing the Burden of Illicit Drugs and Alcohol Abuse 2010 Figure 16 shows that 24 percent of Macomb County students reported riding with someone who had been drinking, a decrease from 27.3 percent in 2008. Statewide, 28.3 percent of students reported riding with someone who had been drinking; 27.5 percent of students reported this behavior nationally. By grade, 11 th graders reported higher percentage of riding with someone who had been drinking (26.6 percent); followed by 7 th graders (25 percent) and 9 th graders (21.7 percent) in Macomb County. Figure 17 shows that 7.1 percent of students in Macomb County reported drinking and driving behaviors in 2010, a decrease from the 2008 rate of 9.4 percent; this rate was also lower than both the State (8.4 percent) and the national (9.7 percent) rates. Students in the 11 th grade reported higher rates of drinking and driving behaviors (11 percent) when compared to those in the 9 th grade (3.7 percent). Macomb County Office of Substance Abuse 72

Macomb County Office of Substance Abuse 73

OTHER WORKS CITED Boyd, C., Esteban, S., Cranford, J., & Young, A. (2007). Prescription Drug Abuse and Diversion Among Adolescents in a Southeast Michigan School Department. Arch Pediatric and Adolescent Medicine, 276 324. National Institute on Drug Abuse. (June 2008). Understanding Drug Abuse and Addiction. Office of National Drug Control Policy, Drug Policy Information Clearinghouse. (January 2008). State of Connecticut Profile of Drug Indicators. Connecticut. Substance Abuse and Mental Health Administration, Treatment Episodes Data Set Report. (2009). State Epidemiology Workgroup. (May 2010). Michigan Burden Document Update: Focusing on Abuse of Alcohol, Prescription Drugs, and Tobacco. Williams, C., & Latkin, C. (2007). Neighborhood Socioeconomic Status, Personal Network Attributes, and Use of Heroin and Cocaine. American Journal of Preventive Medicine, 203 210. Macomb County Office of Substance Abuse 74

TABLES Table 1. Macomb County Number of Drug related Deaths by Selected Drug Category, 2004 2008 Drug Type 2004 2005 2006 2007 2008 Alcohol induced deaths 5 14 26 22 Cocaine 12 19 12 18 12 Heroin 16 20 34 22 52 Prescription Drug 10 23 26 22 13 Methadone 9 6 8 Stimulants (Amphetamines and Methamphetamines 9 6 8 Michigan Department of Community Health, Division of Vital Statistics, 2004 2008 Note: Populations with less than five deaths are represented with Table 2: Number and Rates of Heroin Poisoning Deaths by Gender, Age, and Year (Rate per 100,000 population) Population 2004 2005 2006 2007 2008 # of deaths Death rates 2004 2008 2004 2008 Males 407,903 13 19 27 19 39 117 5.74 Females 421,533 7 13 29 1.38 Under 21 yrs 223,589 5 11 1.00 21 24 yrs 37,923 6 5 5 17 8.97 25 34 yrs 109,696 6 6 14 32 5.83 35 44 yrs 126,334 5 11 6 14 38 6.01 45 64 yrs 219,313 6 15 12 14 48 4.37 Michigan Department of Community Health, Division of Vital Statistics, 2004 2008 Note: Populations with less than five deaths are represented with Table 3: Heroin Poisoning Hospitalizations by Gender, Age, and Year, (Rate per 100,000 Population) 2004 2005 2006 2007 2008 # of hospitalizations 2004 2008 Hospitalization rates 2004 2008 Males 16 27 41 20 44 105 25.7 Females 8 21 21 13 21 55 13.0 15 24 yrs 5 12 22 11 24 57 55.9 25 44 yrs 16 25 25 14 27 66 28.0 45 64 yrs 11 14 8 14 36 16.4 Michigan Department of Community Health, Michigan Inpatient Files, 2004 2008 Note: Populations with less than five deaths are represented with Macomb County Office of Substance Abuse 75

Table 4: Number and Rate of Prescription Pain Reliever Poisoning Deaths by Gender, Age, and Year, (Rate per 100,000 Population) Population 2004 2005 2006 2007 2008 # of deaths Death rates 2004 2008 2004 2008 Males 407,903 6 15 19 10 7 57 2.8 Females 421,533 8 7 9 6 34 1.6 25 34 yrs 109,696 9 17 3.1 35 44 yrs 126,334 13 6 30 4.8 45 64 yrs 219,313 16 9 11 6 42 3.8 Michigan Department of Community Health, Division of Vital Statistics, 2004 2008 Note: Populations with less than five deaths are represented with ; populations with zero deaths are represented with the number zero Table 5: Prescription Pain Reliever Hospitalizations by Gender, Age, and Year, (Rate per 100,000 population) 2004 2005 2006 2007 2008 # of hospitalizations 2004 2008 Hospitalizations rates 2004 2008 Male 42 27 35 42 54 200 6.4 Female 68 73 46 46 74 307 7.9 under 15 8 1 15 24 yrs 17 11 12 7 11 58 5.9 25 44 yrs 40 43 27 38 38 186 8.7 45 64 yrs 39 34 33 41 57 204 12 65 yrs and over 13 11 11 26 26 87 11.2 Michigan Department of Community Health, Michigan Inpatient Files, 2004 2008 Note: Populations with less than five deaths are represented with Macomb County Office of Substance Abuse 76

Table 6: Number and Rate of Heroin Poisoning Deaths by Macomb Zip Codes and Cities, 2004 2008 Combined Years (Rate per 100,000 population) ZIP Code City 2007 Population # of deaths 2004 2008 Death rates 2004 2008 48021 Eastpointe 33403 8 4.8 48035 Clinton Township 35216 7 4.0 48038 Clinton Township 42309 6 2.8 48043 Mount Clemens 17289 8 9.3 48066 Roseville 49123 14 5.7 48080 Saint Clair Shores 23543 5 4.2 48089 Warren 34760 11 6.3 48091 Warren 32238 13 8.1 48093 Warren 22929 6 5.2 48310 Sterling Heights 43051 5 2.3 48313 Sterling Heights 35421 5 2.8 48316 Utica 24820 5 4.0 Table includes communities with five or more deaths occurring during the period of 2004 2008 Macomb County Office of Substance Abuse 77

Table 7: Number and Rate of Heroin Poisoning Hospitalizations by Macomb Zip Codes and Cities, 2004 2008 Combined Years (Rate per 100,000 population) ZIP CODE City 2007 Population # of hospitalizations 2004 2008 Hospitalization rates 2004 2008 48015 Center Line 8526 6 14.1 48021 Eastpointe 33403 21 12.6 48026 Fraser 15552 10 12.9 48035 Clinton Township 35216 9 5.1 48038 Clinton Township 42309 6 2.8 48043 Mount Clemens 17289 6 6.9 48045 Harrison Township 26131 7 5.4 48047 New Baltimore 38522 7 3.6 48065 Romeo 10807 5 9.3 48066 Roseville 49123 25 10.2 48080 Saint Clair Shores 23543 5 4.2 48081 Saint Clair Shores 22220 7 6.3 48082 Saint Clair Shores 17495 5 5.7 48088 Warren 22583 11 9.7 48089 Warren 34760 25 14.4 48091 Warren 32238 18 11.2 48092 Warren 25802 13 10.1 48093 Warren 22929 7 6.1 48310 Sterling Heights 43051 9 4.2 48312 Sterling Heights 33721 8 4.7 48313 Sterling Heights 35421 7 4.0 48314 Sterling Heights 21485 6 5.6 48316 Utica 24820 5 4.0 48317 Utica 28234 12 8.5 Table includes communities with five or more hospitalizations occurring during the period of 2004 2008 Macomb County Office of Substance Abuse 78

Table 8: Number and Rates of Prescription Pain Reliever Poisoning Deaths by Macomb Zip Codes and Cities, 2004 2008 Combined Years (Rate per 100,000 population) Zip Code City 2007 Population # of deaths 2004 2008 Death rates 2004 2008 48021 Eastpointe 33403 9 5.4 48036 Clinton Township 22358 8 7.2 48042 Macomb 24170 6 5.0 48066 Roseville 49123 12 4.9 48088 Warren 22583 6 5.3 48089 Warren 34760 8 4.6 48310 Sterling Heights 43051 6 2.8 Table includes communities with five or more deaths occurring during the period of 2004 2008 Macomb County Office of Substance Abuse 79

Table 9: Number and Rate of Prescription Pain Reliever Poisoning Hospitalizations by Macomb Zip Codes and Cities, 2004 2008 Combined Years (Rate per 100,000 population) ZIP CODE City 2007 Population # of Hospitalizations 2004 2008 Hospitalizations rates 2004 2008 48015 Center Line 8526 10 23.5 48021 Eastpointe 33403 44 26.3 48026 Fraser 15552 11 14.1 48035 Clinton Township 35216 28 15.9 48036 Clinton Township 22358 15 13.4 48038 Clinton Township 42309 32 15.1 48042 Macomb 24170 10 8.3 48043 Mount Clemens 17289 22 25.4 48044 Macomb 47457 16 6.7 48045 Harrison Township 26131 16 12.2 48047 New Baltimore 38522 14 7.3 48048 New Haven 7908 5 12.6 48051 New Baltimore 16573 12 14.5 48062 Richmond 9375 5 10.7 48065 Romeo 10807 5 9.3 48066 Roseville 49123 64 26.1 48080 Saint Clair Shores 23543 22 18.7 48081 Saint Clair Shores 22220 13 11.7 48082 Saint Clair Shores 17495 8 9.1 48088 Warren 22583 14 12.4 48089 Warren 34760 46 26.5 48091 Warren 32238 32 19.9 48092 Warren 25802 14 10.9 48093 Warren 22929 13 11.3 48094 Washington 16801 6 7.1 48310 Sterling Heights 43051 22 10.2 48312 Sterling Heights 33721 16 9.5 48313 Sterling Heights 35421 24 13.6 48314 Sterling Heights 21485 15 14.0 48315 Utica 26013 11 8.5 48316 Utica 24820 9 7.3 48317 Utica 28234 17 12.0 Table includes communities with five or more hospitalizations occurring during the period of 2004 2008 Macomb County Office of Substance Abuse 80

DEATHS AND HOSPITALIZATION CODES ICD 10 Codes for poisoning by narcotics and psychodysleptics [hallucinogens] T40.0 Opium T40.1 Heroin T40.2 Other opioids Codeine, Morphine T40.3 Methadone T40.4 Other synthetic narcotics Pethidine T40.5 Cocaine T40.6 Other and unspecified narcotics T40.7 Cannabis (derivatives) T40.8 Lysergide [LSD] T40.9 Other and unspecified psychodysleptics [hallucinogens] Mescaline, Psilocin, Psilocybine Codes used in the analysis of narcotic poisoning deaths. Deaths include overdose of these substances, wrong substance given, or taken in error. IC9 CM Code for poisoning by narcotics and psychodysleptics [hallucinogens] Heroin 965.02 Methadone 965.09 Codeine, Morphine, Hydrocodone, Oxycodone 965.8 Propoxyphene Codes used in the analysis of narcotic poisoning hospitalizations. Macomb County Office of Substance Abuse 81

GLOSSARY BINGE DRINKING: Drinking five or more drinks on the same occasion on at least 1 day in the 30 days prior to the survey. BLACK: A person having origins of the black racial groups of Africa. CONVENIENT (NON PROBABILITY) SAMPLE: Study samples that are often made up of people who meet the study criteria and are easily accessible to the investigator. DEATH RATE: A death rate is calculated by dividing the number of deaths in a population in a year by the midyear resident population. Death rates in this report are expressed as the number of deaths per 100,000 resident population. DRUG LAWS: Violations of State and local laws, specifically those relating to the unlawful possession, sales, use, growing and manufacturing of illegal drugs. (The following drug categories are specified: opium or cocaine and their derivatives (morphine, heroin, codeine); marijuana; synthetic narcotics manufactured narcotics that can cause true addiction (demerol, methadone); and dangerous nonnarcotic drugs (amphetamines, barbiturates, benzedrine). DRUG RELATED DEATHS: any deaths related to recent drug use and is the basis for the death reported as underlying. D.U.I.: Driving or operating any vehicle or common carrier while under the influence of liquor or drugs. ILLICIT DRUGS OTHER THAN MARIJUANA: Includes cocaine, heroin, hallucinogens, inhalants, and the non medical use of prescription type pain relievers, tranquilizers, stimulants, and sedatives. ICD 9 CM CODES: International Classification of Diseases, Ninth Edition, Clinical Modification. A listing of diagnoses and identifying codes used to report diagnoses on claims. The Centers for Disease Control and Prevention (CDC) maintains several code sets included in HIPAA standards, including ICD 9 CM codes. ICD 10 CODES: International Classification of Diseases, Tenth Edition. A classification of diseases that permit the systematic recording, analysis, interpretation and comparison of mortality and morbidity data collected in different countries or areas and at different times. The ICD is used to Macomb County Office of Substance Abuse 82

translate diagnoses of diseases and other health problems from words into an alphanumeric code, which permits easy storage, retrieval and analysis of the data HEROIN: An opioid drug that is synthesized from morphine, a naturally occurring substance extracted from the seed pod of the Asian opium poppy plant. Heroin usually appears as a white or brown powder or as a black sticky substance, known as black tar heroin. MICHIGAN SUBSTANCE ABUSE COORDINATING AGENCY: A regional entity or agency under agreement with the Michigan Department of Community Health, Mental Health and Substance Abuse Administration, to provide substance abuse prevention and treatment services throughout the State of Michigan. MORBIDITY: Any departure, subjective or objective, from a State of physiological or psychological well being. MORTALITY: A measure of the frequency of occurrence of death in a defined population during a specified interval of time. OPIOIDS/OPIOIDS: Category of drug which include opioids (narcotic substances derived from opium) and opioids (semisynthetic and synthetic substances with similar narcotic properties). This category is subdivided into 1) heroin (specified) 2) methadone and 3) all other opioids/opioids such as codeine morphine, fentanyl, hydrocodone, oxycodone, and others. POPULATION: The U.S. Bureau of the Census collects and publishes data on populations in the United States according to several different definitions. Various statistical systems then use the appropriate population for calculating rates. Total population is the population of the United States, including all members of the Armed Forces living in foreign countries, Puerto Rico, Guam, and the U.S. Virgin Islands. Other Americans abroad (for example, civilian Federal employees and dependents of members of the Armed Forces or other Federal employees) are not included. Resident population includes persons whose usual place of residence (that is, the place where one usually lives and sleeps) is in one of the 50 States or the Department of Columbia. It includes members of the Armed Forces stationed in the United States and their families. It excludes international military, naval, and diplomatic personnel and their families located here and residing in embassies or similar quarters. Also excluded are international workers and international students in this country and Americans living abroad. The resident population is usually the denominator when calculating death rates and incidence of disease. Macomb County Office of Substance Abuse 83

PREVALENCE: is the number of cases of a disease, condition, or patterns with some other attribute present during a particular interval of time. Prevalence is usually used to measure current State of disease patterns among living population within a specified period of time. RATE: A rate is a measure of some event, disease, or condition in relation to a unit of population, along with some specification of time. UNDERLYING CAUSE OF DEATH: The underlying cause of death is (a) the disease or injury which initiated the train of events leading directly to death, or (b) the circumstances of the accident, violence, or substance use which produced the fatal injury. SELF SELECTION BIAS: Refers to when a group of people being studied has any form of control over whether to participate. Participants' decision to participate may be correlated with traits that affect the study, making the participants a non representative sample. STIMULANTS: category of drug which includes amphetamines and methamphetamines. SYSTEMATIC BIAS: Refers to a constant difference between the results from the sample and the theoretical results from the entire population. Macomb County Office of Substance Abuse 84