Jim Hall upfrontin@aol.com 1

South Florida Drug Trends Summer 13 Lower HIGH Moderate Rate per 1, Escambia Santa Rosa Okaloosa Holmes Bay Jacks on Calhoun Gulf Liberty Gadsden Leon Franklin Wakulla Madison Taylor Suwannee Dixie Hamilton Union Gilchrist Alachua Pinellas Levy Baker Pasco Hillsborough Manatee Nas sau Clay Putnam Citrus Lake Sumter Hernando Marion Polk Hardee Lee Duval Sarasota De Soto Charlotte St. Johns Flagler Seminole Orange Osceola Highlands Glades Collier Monroe Volusia Hendry Indian River St. Lucie Martin Dade The South Florida Report June 13 National Institute on Drug Abuse Walton Washington 19.3 Million Jefferson Lafayette Columbia Bradford Brevard Okeechobee 1.4 Million 1.8 Million Community Epidemiology Work Group James N. Hall Report # 57 South Florida Drug Observatory Nova Southeastern University US Census Bureau 1 Population Estimates.6 Million Data Sources June 13 June 13 Florida Medical Examiners Commission 1 interim Report on Drugs Identified In Deceased Persons by Florida Medical Examiners from Florida Department of Law Enforcement SAMHSA Drug Abuse Warning Network (DAWN) Emergency Department substance specific drug reports 4-11 Florida Department of Children and Families treatment data from all publicly-funded adult and youth treatment programs for Miami- Dade and Counties primary admissions for all treatment modalities January - December 1. (NFLIS), Drug Enforcement Administration (DEA), for January December 1 SAMHSA National Survey on Drug Use and Health Substate Estimates 8-1 of Substance Abuse and Mental Disorders Florida Poison Information Center Miami Poison for Emerging Drugs January 11 to April 13 South Florida Most Recent Indicator Changes Marijuana: High and Increasing Cocaine: 5-Year Decline Reversing Rx Opioids: Deaths Declining 17-% Benzodiazepines: Deaths Declining 17-% June 13 Ecstasy: Mostly Mollys tests as bk-methylone Heroin: Increases related to Rx Opioids crackdown Cannabinmimetics: Types & Problems + Pot Pens Methamphetamine: Low but Returning Key Issue for Gay Males and Heavy Club Druggers Levels of Indicator Intensity: HIGH Moderate Lower NUMBER of COCAINE OCCURRENCES Including Present & Cause of Death Cocaine Reports Detected Among Decedents in Florida: - 1,5, 1,5 1, 5 3 5 15 1 5 1,15 1,37 1,614 1,7 1,943,5,179 1,791 1,46 State of Florida 1,4 1,444 SOURCE: Florida Medical Examiners Commission Interim Report Jan-Jun 1 1,336 1 3 4 5 6 7 8 9 1 11 X 1h 1 81 189 1 18 149 151 16 16 155 198 184 186 94 11 138 1 136 15 157 146 135 17 115 116 1 3 4 5 6 7 8 9 1 11 X 1h 1 Rate of Cocaine Emergency Department Reports Per 1,, & Counties, and : 4-11 6 5 4 3 1 41.5 547.4 = Significant Difference with 11 & 413.3 46.8 37.8 6.1 7.8 311.4 184. 199.4 147.3 157.8 16.4 163.7 183.9 183.8 158.6 16.1 137.9 13.7 4 5 6 7 8 9 1 11 SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 4-11 Jim Hall upfrontin@aol.com 1

South Florida Drug Trends Summer 13 # of primary Treatment Admissions # Cause of Death Occurrences # Lethal Heroin Deaths Top 1 Most Frequently Identified Drugs of Total Analyzed Drug Reports from South Florida s Reports CY 1 Drug 1 Number 1 % % Δ vs. 11 Cocaine 11,411 48.% Down 16 % Marijuana/Cannabis 5,388.8% Up 8 % Rx Opioids 975 4.1% Down 31 % Rx Benzodiazepines 88 3.7% Down 16 % Heroin 696.9% Up 1 % Hallucinogen 54.% Up 16 % Methylone (N-Methyl-3,4- Methylenedioxycathinone) 388 1.6% Up 15 % Phenylimidothiazole Iso Undeterm 46 1.% Down 9 % Caffeine 37 1.% Down 17 % Methamphetamine 17.7% Up 17 % All Other Analyzed Drugs,754 11.6% Up 5 % Total 3,671 1.% SOURCE: US DEA: DQS on May 7, 13 NUMBER OF HEROIN-RELATED DEATHS IN FLORIDA: Jan Jun 1 4 Florida 38 36 76 61 35 3 5 15 1 5 61 17 39 46 3 18 53 5 49 35 18 1 96 11 13 111 6 38 58 3 6 4 17 13 4 17 8 5 1 7 4 SOURCE: Florida Medical Examiners Commission Reports -1 Primary Heroin Treatment Admissions and Counties, FL: 9-1 35 3 5 15 1 5 9 7 15 183 161 156 169 15 9 1 1 11 3 1 4 59 61 711 1 8 In the first three months of 13, Florida Department of Law Enforcement heroin-related charges totaled 948, up 3-% from same three-month period last year, that number was 77. SOURCE: Florida Department of Children and Families Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida Jan 8 to Jun 1 9 8 7 6 5 4 3 1 533 476 465 337 336 38 65 34 715 336 358 81 67 64 341 35 1H8 H8 1H9 H9 1H1 H1 1H11 H11 1H1 39 74 Oxycodone Methadone Morphine Hydrocodone Fentanyl Source: FDLE Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 7 - Jun 1 Reports NUMBER of Oxycodone OCCURRENCES Including Present & Cause of Death Oxycodone Reports Detected among Decedents in South Florida: 7-1 6 5 4 3 1 All 3 Counties 475 513 489 38 4 5 36 76 38 171 144 165 184 177 1 174 1 88 119 66 75 45 68 46 7 8 9 1 11 x1h1 SOURCE: Florida Medical Examiners Commission Interim Report 1 Jim Hall upfrontin@aol.com

South Florida Drug Trends Summer 13 Rate per 1, Rate per 1, Rate of NMU Rx Opioid Emergency Department Reports Per 1,, & Palm Beach Counties, and : 4-11 15 1 5 & = Significant Difference with 11 156.6 153.3 135 1.6 118.7 17.3 95.1 95.8 77.9 73.6 83 4.4 59 19.7 3.7 7. 3.7 9. 33.4 33.4 4 5 6 7 8 9 1 11 SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 4-11 E 18 16 14 1 1 8 6 4 Rates per 1, of Oxycodone Nonmedical Use Emergency Department Reports by Age Groups DAWN Ft. Lauderdale Division vs. : 11 65. 18-186.9 184.3 1.4 91.9 88.7 1-4 5-9 3-34 157.5 & 78.3 66.8 57.4 35-44 45-54 14.8 5.9 5.7 55-64 SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates. Top 1 Most Frequently Identified Drugs of Total Analyzed Drug Reports from South Florida s Reports CY 1 Drug 1 Number 1 % % Δ vs. 11 Cocaine 11,411 48.% Down 16 % Marijuana/Cannabis 5,388.8% Up 8 % Rx Opioids 975 4.1% Down 31 % Rx Benzodiazepines 88 3.7% Down 16 % Heroin 696.9% Up 1 % Hallucinogen 54.% Up 16 % Methylone (N-Methyl-3,4- Methylenedioxycathinone) 388 1.6% Up 15 % Phenylimidothiazole Iso Undeterm 46 1.% Down 9 % Caffeine 37 1.% Down 17 % Methamphetamine 17.7% Up 17 % All Other Analyzed Drugs,754 11.6% Up 5 % Total 3,671 1.% SOURCE: US DEA: DQS on May 7, 13 South Florida Rx Opioid Reports 11 vs. 1 Dade, and Counties 11 (5/8/1) and 1 Prescription Opioids Reports 11 1 OXYCODONE 1, 679 HYDROCODONE 115 1 METHADONE 66 33 BUPRENORPHINE 47 8 MORPHINE 3 51 CODEINE 5 31 HYDROMORPHONE 4 151 TRAMADOL 7 11 OXYMORPHONE 3 1 PROPOXYPHENE 3 FENTANYL 1 BENZYLMORPHINE 1 DIHYDROCODEINE 1 DIHYDRONORMORPHINONE 1 TOTAL OPIOIDS 1,55 975 Percent of those Age 1 & Above Who Report Nonmedical Use of Pain Relievers in Past Year 5,33,785 Dose Units in 6 months Source: NSDUH 8-1 Substate Data 4.87 % Percent Range:.96 % to 8.11 % Jim Hall upfrontin@aol.com 3

South Florida Drug Trends Summer 13 # Cause of Death Occurrences Rate per 1, Percent Reporting Past Year Use Florida Substate DCF Regions 5.38 % All Florida 4. % 643,76 Floridians Aged 1 and above Nonmedical Use of Pain Relievers in Past Year Source: NSDUH 8-1 Substate Data.96 % 3.11 % Percent of Persons Aged 1 and Above Reporting Nonmedical Use of Rx Pain Relievers in the Past Year: -1 6 5 4 3 1 4.8 5.1 4.76 4.89 4.46 3.8 Florida 4.35 5.3 4.87 3.43 4..96-4 4-6 6-8 8-1 SOURCE: SAMHSA-CBHSQ(1): Substate Estimates from the -1 National Surveys on Drug Use and Health Alprazolam and Diazepam Occurrences Among Deceased Persons in Florida Jan 8 to Jun 1 6 5 4 3 1 354 351 15 1 378 444 439 54 Alprazolam Diazepam 17 11 136 141 16 461 486 18 33 11 1H8 H8 1H9 H9 1H1 H1 1H11 H11 1H1 Source: FDLE Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 7 - Jun 1 Reports South Florida Rx Benzodiazepine Reports 11 vs. 1 Dade, and Counties 11 (5/8/1) and 1 Reports for Rx Benzodiazepines 11 1 ALPRAZOLAM 981 79 CLONAZEPAM 7 74 DIAZEPAM 4 46 LORAZEPAM 14 TEMAZEPAM 4 17 TRIAZOLAM BROMAZEPAM 1 FLURAZEPAM 1 TOTAL 1,13 88 Rate of Marijuana Emergency Department Reports Per 1,, & Counties, and : 4-11 3 5 15 1 5 159. = Significant Difference with 11 17.6 18.1 148 138.6 137 13.1 1.7 96. 94.6 97.4 1.4 97 94.4 & 187.8 149 146. 16 18.6 15.7 4 5 6 7 8 9 1 11 SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 4-11 Primary Treatment Admissions for Juveniles and Adults by Drug in and Counties: Jan - Dec 1 Marijuana Rx Opioids Alcohol Cocaine/Crack Rx Benzo's Heroin Other/Unknown 139 58 93 161 9 1 55 67 1,6 1,69 1,36 941 1,576 1,748 5 1 15 Primary Admissions Source: Florida Department of Children and Families Jim Hall upfrontin@aol.com 4

South Florida Drug Trends Summer 13 Rate per 1, The pen is mightier than the pipe? Cannabinmimetics Poison Cannabinmimetics Poison Control 11 1 Jan-Apr 13 Jan-Dec 11 Jan-Dec 1 Jan-Apr 13 State of Florida 517 537* 78 County 38 37 County 36 45 6 County 9 4 1 * The total of 537 includes 71 in Jan-Apr 1 Source: Florida Poison Information Center Miami 1-8--1 Cannabinmimetic Poison Control Jan-Apr 13 Source: Florida Poison Information Center Miami 1-8--1 South Florida Cannabinoids Reports 11 vs. 1 Dade, and Counties 11 (5/8/1) and 1 Cannabinoids 11 1 AM-1 114 JWH-18 19 7 XLR-11 5 JWH-81 6 UR-144 5 JWH-1 4 JWH-5 4 JWH-73 RCS-8 JWH-3 1 TOTAL 19 19 Rate of MDMA Emergency Department Reports Per 1,, & Palm Beach Counties, and : 4-11 5 15 1 5 & 8.8 8.7 3.5 3.8 6 5.6 8 4. 1.1 7.3 5.9 = Significant Difference with 11 15.6 1.4 8.3 13.1 7.8 7.4 7.1 7. 4 5 6 7 8 9 1 11 SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 4-11 Jim Hall upfrontin@aol.com 5

South Florida Drug Trends Summer 13 Rate per 1, South Florida Cathinones Reports 11 vs. 1 46-% Decrease in MDMA Reports 1 (n= 555) vs 1 (n=99) 64-% Decrease in MDMA Reports 11 (n= 99) vs 1 (n=17) Cathinones 11 1 Methylone 7 388 4-MEC 3 36 3,4-METHYLENEDIOXY- DIMETHYLCATHINONE Mephedrone 1 TOTAL 4 48 (NFLIS) for, and Counties 11 (5/8/1) and 1 Molly Poison Control Jan-Apr 1 vs. Jan-Apr 13 Molly Poison Jan- Apr 1 Jan- Apr 13 State of Florida 47 County 8 19 4 Source: Florida Poison Information Center Miami 1-8--1 Methylone is beta-ketone MDMA South Florida Other New Drugs Reports 11 vs. 1 Dade, and Counties 11 (5/8/1) and 1 OTHER EMERGING PSYCHOACTIVE SUBSTANCES 11 1 BZP 13 113 5-MEO-DIPT 133 89 TFMPP 83 86 MDPV 3 58 DMT 6 4 C-B 4- METHOXYMETHAMPHETAMINE 5-MEO-MIPT ALPHA-PVP MMDA 1 ALPHA-METHYLTRYPTAMINE 1 TRYPTAMINE 1 TOTAL 386 361 Rate of Illicit Stimulant Emergency Department Reports Per 1,, & Palm Beach Counties, and : 4-11 8 7 6 5 4 3 1 55.5 46.6 36.1 & 8. 3. 3.5 44.8 51.3 7.1 1.9 1.6 6.7 6.4 5.9 6.3 7.1 8 5. 6. 5.6 4 5 6 7 8 9 1 11 SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 4-11 South Florida Key Findings June 13 June 13 # 1 key change is that deaths related to nonmedical misuse of prescription opioids declined 17-pecent in Florida during the first half of 1 which translates to 8 fewer deaths per week across the State attributable to prescription drug overdoses. # key issue is the increase in injecting drug use among new, young adult cohort of prescription opioid injectors, heroin initiates, and methamphetamine users. A public health threat of increased HIV and Hepatitis C transmission is already occurring. Percent of Addiction Treatment Clients Reporting Injecting Drug Use by Primary Drug at Admission: & Counties 1 Treatment Primary Drug % % Prescription Opioid % 58 % Heroin 85 % 9 % Methamphetamine 18 % 5 % Source: Florida Department of Children and Families Jim Hall upfrontin@aol.com 6

South Florida Drug Trends Summer 13 Lower HIGH Moderate South Florida Most Recent Indicator Changes June 13 Marijuana: High and Increasing Cocaine: 5-Year Decline Reversing Rx Opioids: Deaths Declining Benzodiazepines: Deaths Declining Ecstasy: Mostly Mollys tests as bk-methylone Heroin: Increases related to Rx Opioids crackdown Cannabinmimetics: Types & Problems + Pot Pens Methamphetamine: Low but Returning Key Issue for Gay Males and Heavy Club Drug Users Levels of Indicator Intensity: HIGH Moderate Lower Surveillance Support Committee NIDA Community Epidemiology Work Group United States Drug Observatories Seattle Maine Honolulu San Francisco Denver Los Angeles Phoenix San Diego Albuquerque Minneapolis/St. Paul Texas Boston Detroit New York Chicago Cincinnati Philadelphia Washington D.C. St. Louis Atlanta Ft. Lauderdale/ Miami 4 NIDA Community Epidemiology Work Group Honolulu Changes The in Drug 1 US Trends Drug Summer Observatories 13 Among 17 of 1 US Drug Observatories Seattle % Reporting % Reporting Increasing Trends Decreasing Trends Minneapolis/St. Paul Substance Heroin 65 % 6 % Maine Boston Key Findings Detroit New York Methamphetamine June 13 53 % Chicago Cincinnati Philadelphia San Francisco Denver Washington D.C. Prescription 9 % St. Louis 18 % Los Opioids Angeles Phoenix Albuquerque Emerging Psychoactive Substances San Diego Atlanta 9 % 18 % Marijuana 1 Texas % 1 % Cocaine 1 % 88 % Ft. Lauderdale/ Miami NIDA Community Epidemiology Work Group Observations The 1 US Drug June Observatories 13 New Drug Markets: Seattle Maine Suburban Smaller Cities Minneapolis/St. Paul Rural Areas Boston Key Findings Detroit New York Heroin and Methamphetamine Improved and Increased Chicago Production June 13 Cincinnati Philadelphia San Francisco from Mexico now in Denver Washington D.C. MDMA Disappearing, but not Ecstasy St. Louis Los Angeles The Second Decade Albuquerque of the 1 st Century looks like the Second Phoenix Half of the 19 San Diego th Century when their was Atlanta Honolulu Morphine sold as Folk Medicine and Snake Oil The new Pharmaceutical Texas Heroin Invention of the Syringe to make morphine less addictive Ft. Lauderdale/ Miami Jim Hall upfrontin@aol.com 7