SEW May Meeting Page 45 Drug Abuse Epidemiology Update Spring 2007 USA and Florida NIDA Community Epidemiology Work Group Seattle 61 st Semi-Annual Meeting Honolulu San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Austin Chicago Detroit St. Louis Atlanta D.C. Boston New York Newark Philadelphia New Orleans Miami/ Ft. Lauderdale (786) 242-8222 1
SEW May Meeting Page 46 Topics Cocaine Heroin Fentanyl Heroin Cheese Heroin Nonmedical Use of Rx Drugs Narcotic Analgesics Benzodiazepines Carisoprodol Methamphetamine Marijuana Ecstasy (786) 242-8222 2
SEW May Meeting Page 47 Cocaine Indicators NIDA Community Epidemiology Work Group Seattle Honolulu San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Austin Chicago Detroit St. Louis Atlanta Boston New York Newark Philadelphia D.C. New Orleans Miami/ Ft. Lauderdale Frequently Reported as a Secondary or Tertiary Drug by Clients Entering Treatment Programs Cocaine Indicators Increasing Only in Honolulu Stable in 19 Areas Increasing among former methamphetamine users (786) 242-8222 3
SEW May Meeting Page 48 Miami Cocaine Consequences % of all Drugs (Excluding Alcohol) Deaths 53 % ED Reports Crime Lab 61 % 71 % Heroin Indicators Increasing in Chicago Decreasing Atlanta Boston South Florida Honolulu Philadelphia Texas Remain at High Levels Baltimore Boston Detroit Los Angeles New York City Philadelphia St. Louis San Francisco NIDA Community Epidemiology Work Group Seattle San Francisco Los Angeles Phoenix San Diego Denver Minneapolis/St. Paul Austin Chicago Detroit St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale (786) 242-8222 4
SEW May Meeting Page 49 Heroin-Related Deaths in Florida 2000-2005 350 300 250 200 150 100 50 0 328 326 276 261 180 122 2000 2001 2002 2003 2004 2005 Source: FDLE Florida Medical Examiners Commission Reports 2000-2005 (786) 242-8222 5
SEW May Meeting Page 50 What is Cheese Heroin? Black tar heroin and crushed Tylenol PM tablets Highly addictive and very dangerous Tan-colored powder usually snorted through the nose with a tube, straw, or small ballpoint pen Packaged in a small paper bindle or zip lock baggie Can be bought for as little as $2 Popular among Latino juveniles Has been identified in more than a dozen Dallas schools and in surrounding suburbs (786) 242-8222 6
SEW May Meeting Page 51 Fentanyl-Contaminated Heroin: Chicago Some Users Seek Hot Bags Brand Names: Lethal Injection Drop Dead Incredible Hulk Fat Albert The Bomb Fentanyl-Contaminated Heroin Seattle Chicago San Francisco 291 Deaths in 2006 Los Angeles San Diego Honolulu Detroit 179 Deaths in Jan-Sept 2006 Philadelphia 103 Deaths Jan-Jun Jun 2006 Georgia and Maryland 36 Deaths each in 2006 New York and St. Louis 30 Deaths each in 2006 NIDA Community Epidemiology Work Group Phoenix Denver Minneapolis/St. Paul Austin Detroit Chicago St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale (786) 242-8222 7
SEW May Meeting Page 52 NonMedical Use of Rx & OTC Taking a higher-than prescribed dose, Taking someone else s s Rx medicine, Malicious poisoning by another, or Intentional abuse of Rx. Based on Report by Jane Carlislie Maxwell, PhD. Web site: www.utattc.net (786) 242-8222 8
SEW May Meeting Page 53 Current Use of Selected Illicit Drugs among Persons Aged 12 or Older: 2005 n= 19,700,000 People Percent Using in Past Month 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 8.1 Any Drug 6.0 2.6 Source: 2005 NSDUH 1.0 0.4 0.3 Marijuana Psychotherapeutics Cocaine Hallucinogens Inhalants Past 30 day Non-Medical Use of Pharmaceuticals 4,700,000 Pain Relievers 1,800,000 Tranquilizers 1,100,000 Stimulants 272,000 Sedatives Source: USDHHS: SAMHSA- OAS 2005 National Survey on Drug Use and Health (786) 242-8222 9
SEW May Meeting Page 54 Any Lifetime Non-Medical Use of Pain Relievers 2002 2005 29,600,000 32,700,000 Source: SAMHSA-OAS National Survey on Drug Use and Health Past Month Non-Medical Use of Rx Drugs by Young Adults Age 18-25 6.4% 6.2% 6.0% 5.8% 5.6% 5.4% 5.2% 5.0% 4.8% 6.1% 6.3% 6.0% 5.4% 2002 2003 2004 2005 Source: SAMHSA-OAS National Survey on Drug Use and Health (786) 242-8222 10
SEW May Meeting Page 55 First Time Drug Users: 2005 #1 Rx Pain Relievers* 2,200,000 * Includes 526,000 OxyContin @ #2 Marijuana 2,100,000 #3 Rx Tranquilizers 1,286,000 #4 Cocaine 872,000 Source: SAMHSA-OAS National Survey on Drug Use and Health Drug-Related Deaths 1999-2003 Rx Opiates more likely than cocaine or heroin to be cause of death Rx Opiate Deaths increased 91 % Cocaine Deaths increased 23 % Heroin Deaths increased 12 % Methadone Deaths increased 213 % Source: National Center for Health Studies (786) 242-8222 11
SEW May Meeting Page 56 Emergency Department Rx Drug Reports 2004 1,300,000 Drug Misuse & Abuse Reports 495,732 Non-Medical Pharmaceuticals 32 % Rx Opiates 29 % Benzodiazepines 6 % Muscle Relaxants 33 % Other Pharmaceuticals Source: SAMHSA, OAS DAWN ED 2005 (786) 242-8222 12
SEW May Meeting Page 57 DxM DAWN Review 2004 5,581 Non-Medical DxM Emergency Dept. Reports 44 % of all DxM ED Reports 32 % of Non-Medical Reports Aged 12-17years 17years 16 % of Non-Medical Reports Aged 18-20 years Source: SAMHSA Drug Abuse Warning Network DAWN USA Treatment Admissions By Primary Drug 1992-2004 Percent of all Admits 13 % Heroin 14.2 % 0.8 % Rx Opiates N= 60,017 3.2 % 1992 2004 Source: SAMHSA, OAS Treatment Episode Data Sets (TEDS) 2004 (786) 242-8222 13
SEW May Meeting Page 58 Dependence or Abuse of Specific Illicit Drugs among Persons Aged 12 or Older: 2005 Rx Drug Cocaine Stimulants Hallucinogens Heroin Inhalants 409 371 227 221 2,062 1,549 Rx = 2,062,000 Source: NSDUH 0 500 1,000 1,500 2,000 2,500 Numbers (in Thousands) of Users with Dependence or Abuse Prescription Drug Sales 1997-2004 35 mill Oxycodone 20 mill Hydrocodone 5 mill Methadone 1997 2004 Source: DEA Automation of Reports and Consolidated Orders System (ARCOS) (786) 242-8222 14
SEW May Meeting Page 59 WHY? Rx Why are our Rx med Controlled Substances Out-of of-control? WHY? Theft and fraud from legitimate health care, Changes in illicit drug trafficking since 911, Declining purity of street heroin Prescription drug advertising, Counterfeit medication from third-world world, Fraudulent, unregulated internet sales, and Lack of a State Rx monitoring systems (786) 242-8222 15
SEW May Meeting Page 60 Increasing Rx Opiates Atlanta Baltimore Denver Detroit Ft. Lauderdale Minneapolis/St. Paul Philadelphia San Diego Seattle Stable or Mixed in 11 Areas NIDA Community Epidemiology Work Group Honolulu Seattle San Francisco Los Angeles Phoenix San Diego Denver Minneapolis/St. Paul Austin Detroit Chicago St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale Rx Opiates Broward County, Florida has Second Highest Percent of RX Opiate Treatment Admissions at 15.2 % (excluding alcohol) Next Highest: Baltimore 6.9 % Texas 6.4 % Denver 6.1 % Seattle 5.2 % Boston 4.3 % (786) 242-8222 16
SEW May Meeting Page 61 2500 2000 Opiate-Related Deaths in Florida 2000-2005 1500 1000 Heroin 3 Rx Opiates 500 0 2000 2001 2002 2003 2004 2005 Source: FDLE Florida Medical Examiners Commission Reports 2000-2005 Rx Opiate-Related Deaths January June 2006 ME District St. Petersburg Jacksonville Tampa Palm Beach Orlando Melbourne Broward Miami-Dade Rx Opiate Deaths 213 168 138 133 107 94 72 29 Source: FDLE Florida Medical Examiners Commission Interim Report 2006 (786) 242-8222 17
SEW May Meeting Page 62 Benzodiazepine Indicators Among CEWG Communities Philadelphia and Broward County, FL have highest numbers of Benzodiazepine Deaths, ED Reports, Treatment Admissions, and Crime Lab Cases NIDA Community Epidemiology Work Group Honolulu Xanax Alprazolam Seattle San Francisco Denver Los Angeles Phoenix San Diego Minneapolis/St. Paul Austin Detroit Chicago St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale Benzodiazepine-Related Deaths January June 2006 ME District St. Petersburg Jacksonville Palm Beach Broward Tampa Orlando Miami-Dade Benzodiazepine Related Deaths 105 79 77 58 49 39 31 Source: FDLE Florida Medical Examiners Commission Interim Report 2006 (786) 242-8222 18
SEW May Meeting Page 63 37 WALLACE 2001 Ds, Soma: Carisoprodol Substances for Surveillance Dance, Las Vegas Cocktail, (with Vicodin) Soma Coma (with codeine) Carisoprodol In Florida 148 related-deaths deaths Jan-Jun Jun 2006 36 were considered cause of death In Broward County 84 DAWN Live! ED Reports Jan-Jun Jun 2006 51 Crime Lab Cases (786) 242-8222 19
SEW May Meeting Page 64 Marijuana Indicators NIDA Community Epidemiology Work Group Remain stable at High Levels in 15 CEWG Areas and Increased in Atlanta, Baltimore, Chicago, Detroit, St. Louis Honolulu Seattle San Francisco Los Angeles Phoenix San Diego Denver Minneapolis/St. Paul Austin Chicago Detroit St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale 290 USA Emergency Departments Marijuana Reports Jan-June June 2006 N = 18,277 > 34 33% 25-34 yrs 25% < 18 yrs 14% 18-24 yrs 27% Hispanic 15% Black 40% White 45% SOURCE: DAWN Live!, OAS, SAMHSA, updated 09/18/2006 (786) 242-8222 20
SEW May Meeting Page 65 Potency of Seized Marijuana Has Doubled since 1995 9 8 7 6 5 4 3 2 1 0 3.48 2.8 3.2 3.7 3.78 3.82 Percent of THC 3.26 3.65 3.75 3.96 3.16 4.5 5 4.89 5.34 6.11 4.59 7.19 8.14 8.5 7.79 7.16 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 Source: US DOJ National Drug Intelligence Center The University of Mississippi Potency Monitoring Project (786) 242-8222 21
SEW May Meeting Page 66 Methamphetamine Indicators Decreased in Atlanta but remained at High Levels Stable at low levels in 10 CEWG cities east of the Mississippi River NIDA Community Epidemiology Work Group Seattle Minneapolis/St. Paul Honolulu San Francisco Los Angeles Phoenix San Diego Denver Austin Chicago Detroit St. Louis Atlanta Boston New York Newark Philadelphia D.C. New Orleans Miami/ Ft. Lauderdale Methamphetamine Indicators Decreasing Denver Honolulu Minneapolis/ St. Paul St. Louis Increasing Seattle Texas Stable Los Angeles San Francisco NIDA Community Epidemiology Work Group Honolulu Seattle San Francisco Los Angeles Phoenix San Diego Denver Minneapolis/St. Paul Austin Detroit Chicago St. Louis New Orleans Atlanta Boston New York Newark Philadelphia D.C. Miami/ Ft. Lauderdale (786) 242-8222 22
SEW May Meeting Page 67 Methamphetamine Indicators Decline of Small Clandestine Labs. Now 80 % of Meth Used in USA from Super Labs in Mexico and Southern California Source: DEA Summer 2006 Polydrug Labs (786) 242-8222 23
SEW May Meeting Page 68 MDMA Indicators NIDA Community Epidemiology Work Group Honolulu Seattle San Francisco Los Angeles Phoenix San Diego Denver Minneapolis/St. Paul Austin Chicago Detroit St. Louis Atlanta Boston New York Newark Philadelphia D.C. New Orleans Miami/ Ft. Lauderdale Increases Reported in Atlanta, Chicago, Miami/Ft. Lauderdale, San Francisco, Seattle, and Texas Source: SAMHSA-OAS- National Survey on Drug Use and Health 2003 (786) 242-8222 24
SEW May Meeting Page 69 ecstasy Rising Reversing decline since 2001 State Deaths Up 56 % from 16 in 2 Half 05 to 25 in 1 st Half 06 Dade Student current use up 40% 04 to 06 from 1% to 1.4% and Up 20% Statewide 05 06 29 28 27 26 25 Percent Reporting First Use of Alcohol Before the Age of 13 Years Among High School Students USA, Florida, & Miami-Dade County 25.6 25.4 28.9 27.9 26.1 25.9 25.4 USA Florida Miami-Dade Broward Hillsborough Orange Palm Beach % Reporting Use 24 23 Before 13 Yrs Source: US Dept. of HHS Centers for Disease Control & Prevention 2005 Youth Risk Behavior Surveillance Survey (786) 242-8222 25
SEW May Meeting Page 70 Percent of Any Lifetime Alcohol Dependency by Age of First Alcohol Use Among Those Aged 18 and Older USA % Alcohol Dependent 50% 40% 30% 20% 10% 0% 47% 45% 38% 32% 28% 15% 17% 11% 9% 13 14 15 16 17 18 19 20 21 Age Began Drinking Source: National Epidemiologic Survey on Alcohol and Related Conditions Sample = 43,093 776 1,157 Source: Florida Medical Examiners Commission Drugs Identified in Deceased Persons 2005 (786) 242-8222 26
SEW May Meeting Page 71 DENs in Florida Community Drug Epidemiology Networks Established DENs Miami 1987 Ft. Lauderdale 1996 Tampa 2006 Jacksonville 2006 Read Me First NIDA Manual CEWG Reports DEN Desktop Disk Local Sample Reports Data Resources Consumption Consequences Criminal Justice PowerPoint Programs Assessing Drug Abuse Resources for Florida Community Drug Epidemiology Networks (786) 242-8222 27
SEW May Meeting Page 72 (786) 242-8222 28