drug abuse in iowa · 2018-05-08 · iowa drug-impaired traffic fatalities drug & mixed...

Drug Abuse in Iowa Responding to Evolving Challenges

Iowa Office of Drug Control Policy

May 2018

1

Most Common Drugs Used: All Iowans Primary Substance of Choice by Iowans in Treatment

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Alcohol

Marijuana

Meth

Other

Heroin

Cocaine

2

47.1%

25.1%

17.6%

6.3%

2.5%

1.4%

Iowa Department of Public Health, 2017

Iowa has the lowest rate of current illicit drug use &

5th highest rate of binge alcohol drinking in the U.S. National Survey on Drug Use & Health, 2015-2016 (12+)

Iowa Youth Substance Abuse 6th, 8th and 11th Grade Users, Last 30-Days

0%

5%

10%

15%

20%

25%

2002 2005 2008 2010 2012 2014 2016

Alcohol

Tobacco

Other Drug

Marijuana

Rx

Meth

12%

9%

4%

4%

3%

3

Iowa Youth Survey, 2016

1%

Iowa Drug-Impaired Traffic Fatalities Drug & Mixed Drug/Alcohol-Related Traffic Deaths

0

10

20

30

40

50

60

70

80

90

4

Iowa Departments of Transportation & Public Safety, 2017

84

Rx opioids detected in

fatally-injured drivers:

7.2%-2015 vs. 1.0%-1995. 2017 American Journal of Public Health

U.S. drug-impaired fatal crashes now outnumber alcohol-

impaired fatalities (43% vs. 38%).

Marijuana is the most-cited drug involved in fatal crashes:

35.6% in U.S. & 51% in Iowa. 2015 NHTSA & 2016 IDOT

(41 of 84 also involved alcohol + 65 alcohol only fatalities)

Iowa “Drug-Related” Prison Admissions Primary Drug Involved

0

200

400

600

800

1,000

1,200

5

Iowa Justice Data Warehouse, 2017

Rx Heroin

All

Drugs

Meth

Marijuana

Cocaine/Crack

Other

586

902

58% of state prisoners & 63% of jail inmates in the U.S.

abused drugs vs. 5% of the general population. USDOJ, Bureau of Justice Statistics, 2017

Iowa Drug & Alcohol-Related ED Visits Monthly Averages

6

0

500

1,000

1,500

2,000

2,500

3,000

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

1,704/mo.


2,709/mo.

(*Caution advised interpreting trends due to reporting changes in 2015)

Marijuana

46% (62.8%)

Meth/

Amphetamines

29% (22.9%)

Opioids

12% (9.7%)

Iowa’s Workplace Small Sampling of Positive Drug Tests Reported 2017 (vs. 2002)

7

In the general

U.S. workforce,

the rate of

amphetamine,

marijuana &

heroin detection

increased

annually over the

last 5 years in

urine testing.

2016 Quest Diagnostics

Benzodiazepines

7% (NA)

Cocaine

4% (9.7%)

Other

2% (NA)


Alcohol & Tobacco/Nicotine

8

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwiC8Y7W4_zLAhXBn4MKHeDFCU0QjRwIBw&url=http://blog.doctoroz.com/dr-oz-blog/weighing-the-evidence-on-electronic-cigarettes&bvm=bv.118817766,d.amc&psig=AFQjCNGDMf9SXEYfMO9fIrtv7vWvsN5y9Q&ust=1460124837118936

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwixhaCt5PzLAhWmkYMKHXZwCoAQjRwIBw&url=http://www.virginvapor.com/products/easy-electronic-cigarette-starter-kit&bvm=bv.118817766,d.amc&psig=AFQjCNGDMf9SXEYfMO9fIrtv7vWvsN5y9Q&ust=1460124837118936

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwisy4nN5PzLAhXCmoMKHVoXCrIQjRwIBw&url=http://brewprof.com/growlers-apocalypse/&psig=AFQjCNEF-wh_ehhqHRMhovS13ICiqaHbog&ust=1460127407003771

Current Alcohol Use Last 30-Days

0%

10%

20%

30%

40%

50%

60%

70%

12+ 12-17 18-25 26+

U.S.

Iowa

National Survey on Drug Use & Health, 2014/2015

9

Current Binge Drinking Last 30-Days

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

12+ 12-17 18-25 26+

U.S.

Iowa

10


Current Tobacco Use Last 30-Days

0%

5%

10%

15%

20%

25%

30%

35%

40%

12+ 12-17 18-25 26+

U.S.

Iowa

11


Iowa Youth Cigarette vs. E-Cigarette Use Last 30-Days

0%

1%

2%

3%

4%

5%

6%

7%

8%

9%

10%

6th 8th 11th

Iowa Cigs

Iowa E-Cigs

Iowa Youth Survey 2016

12

13

Marijuana

Marijuana Laws & Use by Teens

Law types by State, including DC

CNN/Money, 2018

Past Month Use by 12-17 Year Olds

NSDUH, 2015-2016

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Health Group Positions on Marijuana

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• Major public health organizations (American Cancer

Society, American Glaucoma Foundation, American

Medical Association, American Psychiatric Association,

National Pain Foundation, National Multiple Sclerosis

Society, National Association of School Nurses, et al.) do

not support smoked marijuana.

• The American Academy of Pediatrics “opposes marijuana

use by children & adolescents…the use of ‘medical’

marijuana outside the regulatory process of the

FDA…&…legalization of marijuana.”

Iowans’ Current Marijuana Use Most Iowans are NOT current marijuana users (past 30 days)

16

Use

5.38%

Do Not Use

94.62%

Use

5.47%

Do Not Use

94.53%

Iowa Youth 12-17 years old

currently using marijuana.

Iowans 12 & older

currently using marijuana.


6th Lowest in U.S. 3rd Lowest in U.S.

Iowa Youth Marijuana Attitudes Among Iowa 11th Graders

0%

5%

10%

15%

20%

25%

30%

17

One in four Iowa High School Juniors Perceive No Risk

Smoking Marijuana Once or More a Week…

Iowa Youth Survey, 2016

12%

25%

…and 22% of Iowa 6th

Graders See No Risk.

Marijuana’s Increasing THC Potency Trends in Plant Material Seized in U.S. (<1% THC in 1972)

0%

2%

4%

6%

8%

10%

12%

14%

University of Mississippi Marijuana Project, 2016

3.75%

12.71%

Colorado THC levels averaged 17.1% for plant products

(62.1% for “concentrates”) 2015 Rocky Mountain HIDTA

18

Concentrates Less is More

“Budder”

“Shatter”

“Ear Wax”

“Green Crack”

wax

Hash Oil Capsules

Butane Hash Oil

(BHO)

19

New Marijuana in Iowa

20

~1 of every 12 marijuana

samples sent to Iowa’s

crime lab in 2016

involved marijuana

“preparations” (high-THC

concentrates such as

hash oils, waxes &

marijuana-infused

edibles).

Iowa Department of Public Safety, 2016

8.5%

“Preparations”

90%

Plant Materials

1.5% Residue

Meth

21

Iowa Meth Labs

0

200

400

600

800

1000

1200

1400

1600

(Gold = “One Pot” Labs)

22

1,500

2 36


Iowa Meth Purity Crime Lab Fiscal Year Averages

0%

20%

40%

60%

80%

100%

120%

2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

35%

23

97%


Iowa Meth Treatment Admissions

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000

9,000

10,000 9,193

24

4,062


Iowa’s meth treatment rate is the highest

in the U.S. (213/100,000 vs. 53/100,000) U.S. Treatment Episode Data System, 2014

Opioid

& Rx

Abuse

25

Opioid OD Death Rates 2016

26

CDC, 2017

2002 2014

2016 Iowa Drug OD Death Rate:

10.6 per 100,000, 47th in U.S.

Provisional

Report:

Iowa rate

increased

10.2%

during 12

months

ending July

2017 vs.

previous

year.

27

Opioid Misuse: Top Line Trends in U.S.

Drug ODs claim 174 U.S. lives daily, 115 from opioids.

Surging synthetic opioids (e.g., fentanyl/analogs) are now

the leading cause of opioid OD deaths in the U.S.,

followed by heroin & Rx. CDC 2016

About 3 out of 4 new heroin users

report previous Rx opioid misuse. CDC 2016

The U.S. has <5% of the world’s population, but

consumes ~75% of its Rx, including 81% of its

oxycodone & >99% of its hydrocodone. UN 2010

Opioid OD Deaths: 1999-2016 By Type of Opioid (Rx, Heroin, Fentanyl, etc.)

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CDC, 2017

(Hydrocodone & Oxycodone, etc.)

(Fentanyl, Fentanyl

analogs, etc.)

U.S. deaths = 1 every 12.5 minutes

(42,249 in 2016).

Iowa deaths = 1 every 2.1 days

(180 in 2016). CDC & IDPH

Most-Prescribed Iowa Controlled Substances CIIs-CIVs per Iowa’s Prescription Monitoring Program (PMP) in 2017

Hydrocodone-23% (opioid)

Iowa Pharmacy Board/PMP, 2017

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Tramadol-17% (opioid)

Oxycodone-5% (opioid)

Alprazolam-11% (anti-anxiety)

Clonazepam-7% (anti-anxiety)

Lorazepam-7% (anti-anxiety)

Methylphenidates-6% (stimulant)

Zolpidem-5% (sedative)

All Others-6% (various)

Morphine-2% (opioid)

Amphetamines-9% (stimulant)

Diazepam-2% (anti-anxiety)

2017 C2-4 Rx doses dropped

9.7% to 271,499,890 vs. 2016 Iowa Board of Pharmacy/PMP, 2017

Iowa Opioid Treatment Admissions Heroin + Non-Heroin Opiates/Synthetics Primary at Admission

0

200

400

600

800

1,000

1,200

1,400

1,600

1,368

467

U.S. Treatment Episode Data System, 2017

30

Top 2017 “Exposure” Calls:

#1 Analgesics (Pain Meds)

#2 Sedatives

#3 Antidepressants Iowa Poison Control Center, 2018

239

897

Non-Heroin

Opiates/Synthetics

Heroin

2017 Iowa Opioid Treatment Admits:

3,261…up 436% vs. 608 in 2005. Iowa Department of Public Health, 2017

Iowa 12+ Pain Reliever Misuse (4.05%) 44th in U.S. National Survey on Drug Use & Health, 2015-2016

Iowa Opioid-Related Hospital ED Visits Opioid Use as Causal or Contributing Factor: Monthly Averages

0

50

100

150

200

250

300

2006 2007 2008 2009 2010 2011 2012 2013 2014 *2015 *2016


265/mo.

31

43/mo.

Iowa had lowest rate of opioid-related hospital ED admissions &

inpatient stays, but hospitalizations rose 11% from 2009-2014. Agency for Healthcare Research & Quality, 2014

Heroin exposure calls to Iowa’s Poison Hotline more than

tripled in 6 years, from 10 in 2011 to 36 in 2017. Iowa Poison Control Center, 2018

Cost of Iowa opioid abuse health

care: $121m ($39 per-capita). Matrix Global Advisors, LLC, 2015

(*Caution advised interpreting trends due to reporting changes in 2015)

2017 Midwest opioid OD ED visits rose 70%

(avg.) vs. 30% in most states vs. 2016. CDC, 2018

Iowa Opioid OD Deaths Primary Cause of Deaths vs. Contributing Factor (Related) Deaths

0

50

100

150

200

250


32

Opioid-“Related” Deaths

Opioid-“Caused” Deaths

*205 (63 Heroin-

Related)

*99 (30 Heroin)

*2017 provisional year-end data. “Related” totals include “caused” deaths.

13 OD deaths were caused by heroin mixed

with other drugs (meth, cocaine, fentanyl). Iowa State Medical Examiner, 2017

33


Iowa Opioid Deaths 2016 by County

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Iowa Opioid Hospital Admissions 2013-2016 by County

35


Iowa Opioid Treatment Admissions 2014-2017 by County

36


Iowa Illicit Opioid Law Enforcement Seizures Cases Submitted to the DCI Lab in 2017

Naloxone Use by Iowa EMS Providers # Times Administered to Reverse Opioid-Related ODs

0

100

200

300

400

500

600

700

800

2010 2011 2012 2013 2014 2015 2016 2017

Iowa Department of Public Health, Emergency & Trauma Services, 2017

*732

161

37

Some Iowa EMS crews carry 2x-3x doses

due to powerful illicit synthetic opioids (~1 naloxone “save”/month in Dubuque in 2017)

*2017 year-end data preliminary.

https://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=2ahUKEwjXlp24_bnZAhVE9YMKHTmiAYEQjRx6BAgAEAY&url=https://vitals.lifehacker.com/how-to-obtain-and-use-naloxone-the-drug-that-can-rever-1796260619&psig=AOvVaw28CAKm62WG1XAcxTMn4cac&ust=1519404622982727

Heroin

38

& Non-Medical

Synthetic Opioids (e.g., fentanyl analogs)

39

Opioid Misuse: Precursors

(Marijuana use appears to increase—>2x—rather than decrease, the risk of developing nonmedical

prescription opioid use & opioid use disorder. Offson, Wall, Liu, Blanco/American Journal of Psychiatry, September 2017)

Heroin, Fentanyl & Illicit Synthetic Opioids Law Enforcement Seizure Cases/Month per Iowa’s Crime Lab (average)

0

10

20

30

40

50

60

70

2010 2011 2012 2013 2014 2015 2016 2017 2018*

Illicit Synthetic Opioids/Fentanyl Analogs Only

Mixed (Heroin + Illicit Synthetic Opioid, etc.)

Fentanyl Only

Heroin Only


Iowa’s crime lab reports counterfeit

oxycodone tablets containing carfentanil &

cases of illicit opioids mixed with cocaine,

meth, ketamine, caffeine, etc.…

40

7.8

64.6*

The DEA reports a 117% increase in U.S. illicit

synthetic opioid lab submissions in 2017 vs. 2016,

including 7 new fentanyl analog compounds.

(*2018 year-to-date data through March)

51.3

41

Illicit Synthetic Opioids: Less is More

Drug Enforcement Administration, 2017

Often mixed with heroin,

illicit synthetic opioids (e.g.,

fentanyl analogs)—in tiny

amounts—can be much

more lethal vs. heroin.

Iowa’s 1st Carfentanil

OD death per SME:

February 2017

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwj__JXop5rRAhVozoMKHYwzDFoQjRwIBw&url=http://www.kgw.com/news/fentanyls-deadlier-cousin-a-few-grains-of-carfentanyl-can-kill/296315308&bvm=bv.142059868,d.cGw&psig=AFQjCNHt7y4eg5LyAb2ZxgOw_3ILIu-Nmw&ust=1483132007872444

http://www.google.com/url?sa=i&rct=j&q=&esrc=s&source=images&cd=&cad=rja&uact=8&ved=0ahUKEwjR0NTnqJrRAhUK2oMKHdIgAq4QjRwIBw&url=http://fox2now.com/2016/08/19/this-new-drug-is-10000-times-stronger-than-morphine-and-might-be-resistant-to-narcan/&bvm=bv.142059868,d.cGw&psig=AFQjCNHt7y4eg5LyAb2ZxgOw_3ILIu-Nmw&ust=1483132007872444

Response to Opioid Misuse “3 Rs” to Curb Supply & Demand

Rescue (Intervention)

-PMP: Enhancements ongoing & more proposed

-Naloxone: Access improving to reverse ODs

Recovery (Treatment & Aftercare)

-Substance Use Disorder & Medication Assisted Treatment: MAT

expansion continues

-Peer Recovery Mentors: Training underway for OD referrals

-Support: CRUSH & other groups forming

Reduction (Prevention & Enforcement)

-CDC Opioid Prescribing Guidelines: More prescribers adopting

-Patient Instruction: Take as directed & respect medicines

-Education: Information for youth & adults

-Safeguards: Secure storage & proper disposal

Get Help 24/7: Call 855-581-8111, Text 855-895-8398 or go to YourLifeIowa.org

42

Iowa “Take-Back” Initiative Amount (in Pounds) of Rx Drugs Collected

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

43

1,569

12,257

Next National Prescription Drug Take Back Day:

Fall 2018!

DEA, 2018

Collected in first 15 one-day events:

56+ tons (30+ pounds per minute) in Iowa &

9+ million pounds (2+ tons per minute) in U.S.

Iowa Permanent Rx “Take Back” Sites Controlled Prescription Drug Disposal Locations

44

231 Sites in all 99 Counties (117 Law Enforcement Centers, 114 Pharmacies) vs. 47 in January 2016

ODCP, 2017

odcp.iowa.gov/

rxtakebacks Search: Iowa Rx Takebacks

Iowa Medication Assisted Treatment Provider Locations

45

84 Iowa MAT Providers in 2018 vs. 31 in 2015


Governor’s Priorities to Curb Opioid Misuse

1. Increase Prescriber Use of the Prescription Monitoring Program (e.g., faster, friendlier & more complete PMP database; proactive notices to

prescribers & dispensers of inappropriate patient use; integration)

2. Reduce Opioid Prescribing to Prevent Misuse (e.g., partial

prescriptions; CDC guidelines to reduce opioids for certain chronic pain;

electronic Rx; prescriber activity reports; education/prevention)

3. Strengthen Interventions for Iowans Misusing or Addicted to

Opioids (e.g., naloxone access & use; Good Samaritan incentive for reporting

ODs; peer coaches & mentors)

4. Enhance Medication Assisted Treatment for Opioid Addicted

Iowans (e.g., expand MAT providers & access; reduce insurance barriers)

46

Iowa Opioid-Related Legislation & News

HF 2377: Comprehensive Opioid Response (Passed House & Senate, with *amendment)

1. Automatic PMP registration at time of professional licensure or license renewal.

2. Mandatory PMP queries on patients when prescribing opioids.

3. Proactive PMP notices of possible improper use of controlled substances.

4. Next business day controlled substance dispensing to PMP.

5. Reporting to PMP of non-pharmacy controlled substance dispensing (*veterinarians exempt).

6. Reporting to PMP of naloxone use by first responders.

7. Annual PMP prescriber “report cards.”

8. License surcharge of up to 25% to pay for PMP enhancements.

9. Continuing education requirements for all opioid prescribers re: CDC guidelines.

10. Penalties for inappropriate opioid prescribing.

11. Universal electronic prescribing of all prescriptions by January 2020.

12. Banning new illicit synthetic opioids, similar to emergency federal action.

13. Good Samaritan protection to encourage 911 calls to report overdoses.

Proposals Not in HF 2377:

• Monitoring Schedule V controlled substances.

• Opioid prescription limits.

• Needle exchanges.

• Rx opioid surcharge.

• Additional treatment resources.

Other News: ~50 Iowa counties join suit; state AGs probe; USDOJ targets...Rx opioid makers.

47

STAY SAFE!

Iowa Governor’s Office of Drug Control Policy

Visit Our Website: https://odcp.iowa.gov

48

Get Help 24/7: Call 855-581-8111, Text 855-895-8398 or go to YourLifeIowa.org

https://odcp.iowa.gov/

drug abuse in iowa · 2018-05-08 · iowa drug-impaired traffic fatalities drug & mixed...

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