Patterns of Heroin and Other Substance Use in Youth and Young Adults in Suburban Cook County

Patterns of Heroin and Other Substance Use in Youth and Young Adults in Suburban Cook County 2014 School Nurse Conference Steven M. Seweryn, EdD, MPH April 24, 2014

Learning Objectives To become familiar with patterns and trends in heroin and other substance use nationally and locally Identify populations at increased risk for heroin and opiate use

NATIONAL CONTEXT: HEROIN AND OPIOID USE

US: Trends in Mortality: Drug Overdose vs Motor Vehicle Death Rates Motor Vehicle Traffic Drug Poisoning (Overdose) 25 20 Deaths per 100,000 population 15 10 5 0 1980 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Year NCHS Data Brief, December, 2011, Updated with 2009 and 2010 mortality data 4

18,000 16,000 US Overdose Deaths, 2010 Opioid analgesics #1 Heroin #5 14,000 12,000 Deaths 10,000 8,000 6,000 4,000 2,000 0 Drug Class Jones CM et al Pharmaceutical overdose deaths, United States, 2010. JAMA 2013 and CDC/NCHS NVSS MCOD 2010 5

OVERDOSE DEATHS: Opioid Analgesic Deaths: 11 years of increases Heroin: Deaths increasing in recent years 18,000 16,000 14,000 Number of deaths 12,000 10,000 8,000 6,000 Opioid analgesics Heroin 4,000 2,000 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Year CDC NCHS/NVSS Mutliple Cause of Death File 1999-2010 6

US: Nonmedical use of opioid analgesics and heroin have increased. SAMHSA NSDUH 2012

US: Chronic nonmedical use of opioid analgesics has increased 35 Rate per 1,000 population 12 years old 30 25 20 15 10 5 75% Increase 2002 2003 2009 2010 0 1 29 Days Past Year Nonmedical Use 30 99 Days Past Year Nonmedical Use 100 199 Days Past Year Nonmedical Use Frequency of Past Year Nonmedical Use 200 365 Days Past Year Nonmedical Use Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers United States, 2002 Jones 2004 CM. and Frequency 2008 2010. of Drug prescription Alcohol pain Depend. releiver (2013), nonmedical http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007 use, 2002-2003 and 2009-2010. Arch Intern Med. 2012 Sep 10;172(16):1265-7; 8

US: Increase in heroin use has occurred among people who were past year nonmedical users of opioid analgesics 700 Number of past year users among persons 12 years old (numbers in thousands) 600 500 400 300 200 100 379 588 176 171 58 115 46 100 99 202 2002 2004 2008 2010 0 Overall Past Year Heroin Use No Past Year NMU Opioids 1 29 Days Past 30 99 Days Past 100 365 Days Past Year NMU Opioids Year NMU Opioids Year NMU Opioids Jones, C.M., Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers United States, 2002 2004 and 2008 2010. Drug Alcohol Depend. (2013), http://dx.doi.org/10.1016/j.drugalcdep.2013.01.007 9

US:18-25 year olds have highest rates of chronic nonmedical use of opioid analgesics and heroin use Past year chronic nonmedical use Past year heroin use 8 7 6 Rate per 1,000 population 5 4 3 2 1 0 12 17 18 25 26 34 Age Group 35 49 50+ Jones CM. Frequency of prescription pain releiver nonmedical use, 2002-2003 and 2009-2010. Arch Intern Med. 2012 Sep 10;172(16):1265-7; SAMHSA NSDUH Public Use File 2011 10

Increasing number of Emergency Department (ED) visits due to nonmedical use of opioid analgesics and use of heroin 400,000 350,000 300,000 Number of ED visits 250,000 200,000 150,000 100,000 Opioid analgesics Heroin 50,000 0 2004 2005 2006 2007 2008 2009 2010 2011 Year SAMHSA DAWN ED Public Use Files 2004-2011 11

SUBURBAN COOK COUNTY HEROIN AND SUBSTANCE USE PATTERNS AND TRENDS 12

Recent Pattern: Increase in Heroin Deaths among Collar Counties Heroin Overdose Deaths: Collar Counties 2011 2012 2013 Will 30 53 35 DuPage 27 43 46 Kane 9 27 20

Suburban Cook County CCDPH: Regional Districts Other: North West Southwest South Skokie HD Evanston HD Oak Park HD Stickney Twnshp HD

Suburban Cook County Opiate and Heroin Mortality 2008 2010 Cause of Death 1 2008 2009 2010 Drug Poisoning/Overdose 216 210 216 Opiate Related 46 40 43 Heroin Related * 7 6 2013 Preliminary Count 2 : 41 Heroin Deaths District North 22 South 6 Southwest 9 West 4 Gender Male 34 Female 7 Age Group 10-19 3 20-29 18 30-39 7 40-49 9 50-59 4 Source: 1 - IDPH Death Master Pullfile2008-2010 2 IDPH Illinois Vital Records System, 2013

Emergency Room Chief Complaint Number of Visits by Year 2010-2013 Heroin Use Heroin Overdose Source: CCDPH Syndromic Surveillance System (ESSENCE)

Emergency Room Chief Complaint Visits by Age Group and Year 2010-2013 Heroin Use Heroin Overdose

Suburban Cook County Youth Risk Behavior Survey 2010: Proportion of 12 th Graders Ever Tried by Type of Drug Heroin Rx w/out Dr. Orders Marijuana SCC US Cigarettes Alcohol 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% Source: Youth Risk Behavior Survey, SCC 2010, US, 2011

Illinois Youth Survey 2012 Suburban Cook County Schools* Use in Past Year Substance Used 8th Grade 10th Grade 12th Grade Alcohol 36% 54% 69% Cigarettes 8% 12% 21% Marijuana 12% 28% 41% Any Illicit Drugs (excluding marijuana) 2% 4% 9% Heroin 1% 1% 1% Any Prescription Drugs 3% 5% 9% Prescription Painkillers 1% 3% 5% Over-the-Counter Drugs 3% 3% 4% Source: Illinois Youth Survey, 2012 *School participating: N=110

Suburban Cook County Youth Risk Behavior Survey 2010: Proportion of 12 th Graders Used in Past 30 Days by Type of Drug Cocaine 3.8% 3.0% SCC Cigarettes 16.5% 25.1% US Marijuana 26.1% 28.0% Alcohol 49.0% 48.4% 0% 20% 40% 60% 80% 100% Youth Risk Behavior Survey, SCC-2010, US--2011

Illinois Youth Survey 2012 Suburban Cook County Schools* Use Past 30 Days Substance Used 8th Grade 10th Grade 12th Grade Alcohol 20% 34% 51% Cigarettes 4% 7% 14% Marijuana 8% 19% 29% Any Prescription Drugs 1% 3% 5% Prescription Painkillers 1% 2% 4% Over-the-Counter Drugs 1% 2% 2% Source: Illinois Youth Survey, 2012 *School participating: N=110

Summary Drug overdose deaths are a leading cause of injury deaths Majority of overdose deaths are opioid related in including heroin Since 2008 increased number of heroin related ED visit and overdose deaths Youth age 18-25 years, males at highest risk Associated risk of heroin use among non-medical users of opioid prescription drugs High prevalence of alcohol use in school aged youth may impact later patterns of illicit drug use including heroin Small but consistent pattern of illicit and prescription drugs use reported among school aged youth

References Jones CM. Frequency of prescription pain releiver nonmedical use, 2002-2003 and 2009-2010. Arch Intern Med. 2012 Sep 10;172(16):1265-7; SAMHSA NSDUH Public Use File 2011 CCDPH. (2011). Suburban Cook County Youth Risk Behavior Survey, 2010. Retrieve from http://www.cookcountypublichealth.org/data-reports#riskfactors CCDPH, Epidemiology Program. (2013). Mortality data (unpublished). CCDPH, Communicable Disease Control Unit, Enhanced Surveillance Program. (2013). ESSENCE syndromic surveillance system data (unpublished). CDC. (2011). Youth Risk Behavior Surveillance System, 2010. Retrieved from http://www.cdc.gov/healthyyouth/yrbs/index.htm?s_cid=tw_cdc16 Kirby T, Barry AE. Alcohol as a gateway drug: a study of US 12th graders. J Sch Health. 2012 Aug;82(8):371-9. doi: 10.1111/j.1746-1561.2012.00712.x. University of Illinois, Center for Prevention Research and Development. 2012. Illinois Youth Survey, 2012. Retrieved from http://iys.cprd.illinois.edu/

Contact Information Steven M. Seweryn, EdD, MPH Director, Community Epidemiology and Health Planning Unit Interim Director, Prevention Services Unit 708-633-8335 (office) sseweryn@cookcountyhhs.org