orange south florida drug trends summer 2013 p hernando

South Florida Drug Trends Summer 2013

Jim Hall [email protected] 1

The South Florida Report

June 2013

National Institute on Drug Abuse

Community Epidemiology Work Group

James N. Hall Report # 57

South Florida Drug Observatory

Nova Southeastern University

Flagler

Highlands

Hardee

Polk

Martin

St. Lucie

Okeechobee

Indian River

PutnamAlachua

Bra

dfor

dUnion

Col

umbia

Gilchrist

Levy

Dixie

Suwannee

Hamilton

St.JohnsClay

Duval

Nas sau

Baker

Pinellas

Pasco

Manatee

Hillsborough

Bre

vard

Osceola

Orange

Seminole

Collier

HendryLee

Glades

De SotoSarasota

Palm Beach

LakeSumter

Hernando

Citrus

Marion

Taylor

Madison

Jeffe

rson

Wakulla

Leon

Franklin

Liberty

Gadsden

Jacks on

Calhoun

Gulf

BayW

ashin

gton

Escambia

Santa

RosaOkaloosa

Walton

Broward

Dade

Holmes

Monroe

Volusia

Lafayette

Charlotte

1.8 Million

1.4 Million

2.6 Million

19.3 Million

US Census Bureau 2012 Population Estimates

Data Sources June 2013

• Florida Medical Examiners Commission 2012 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 2004-2011

• Florida Department of Children and Families treatment data from all publicly-funded adult and youth treatment programs for Miami-Dade and Broward Counties primary admissions for all treatment modalities January - December 2012.

• National Forensic Laboratory Information System (NFLIS), Drug Enforcement Administration (DEA), for January – December 2012

• SAMHSA National Survey on Drug Use and Health Substate Estimates 2008-2010 of Substance Abuse and Mental Disorders

• Florida Poison Information Center – Miami Poison Exposure Calls for Emerging Synthetic Drugs January 2011 to April 2013

June 2013 South Florida Most Recent Indicator Changes

• Marijuana: High and Increasing • Cocaine: 5-Year Decline Reversing • Rx Opioids: Deaths Declining 17-% • Benzodiazepines: Deaths Declining 17-%

• 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”

HIG

H

Mo

der

ate

Lo

wer

Levels of Indicator Intensity: HIGH Moderate Lower

June 2013

Number of Cocaine Reports Detected Among Decedents in Florida: 2000 - 2012

NUMBER of COCAINE

OCCURRENCES Including

“Present” & “Cause of

Death”

SOURCE: Florida Medical Examiners Commission Interim Report Jan-Jun 2012

1,105

1,307 1,614 1,702

1,943 2,052 2,179 1,791

1,462

1,402

1,444

1,336

0500

1,0001,5002,0002,500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2X 1h2012

State of Florida

149 151 189

160 162 182

281

201

155 198 184 186

94 121 138

120 136 150 157 146 135 127 115 116

0

50

100

150

200

250

300

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2X 1h2012

Miami-Dade

Broward

Rate of Cocaine Emergency Department Reports Per 100,000 Miami-Dade, Broward &

Palm Beach Counties, and USA: 2004-2011

184.2 147.3

132.7

199.4

162.4 163.7 183.9 183.8 158.6 137.9

157.8

162.1

401.5

547.4

413.3 406.8 307.8

262.1 227.8

311.4

0

100

200

300

400

500

600

2004 2005 2006 2007 2008 2009 2010 2011

Broward & Palm Beach

USA

Miami-Dade

SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates 2004-2011

Rat

e p

er 1

00,0

00

= Significant

Difference with 2011



Top 10 Most Frequently Identified Drugs of Total Analyzed Drug

Reports from South Florida Crime Labs Reports CY 2012

Drug 2012 Number 2012 % % Δ vs. 2011

Cocaine 11,411 48.2% Down 16 %

Marijuana/Cannabis 5,388 22.8% Up 8 %

Rx Opioids 975 4.1% Down 31 %

Rx Benzodiazepines 882 3.7% Down 16 %

Heroin 696 2.9% Up 21 %

Hallucinogen 524 2.2% Up 16 %

Methylone (N-Methyl-3,4-Methylenedioxycathinone) 388 1.6% Up 1500 %

Phenylimidothiazole Iso Undeterm 246 1.0% Down 9 %

Caffeine 237 1.0% Down 17 %

Methamphetamine 170 0.7% Up 17 %

All Other Analyzed Drugs 2,754 11.6% Up 5 %

Total 23,671 100.0%

SOURCE: US DEA: National Forensic Laboratory Information System DQS on May 7, 2013

NUMBER OF HEROIN-RELATED DEATHS IN FLORIDA: Jan 2000 – Jun 2012

276

328 326

261

180

122

96 110

132

111

58

40

70 61

39 46 32

18

22 20 26

38 30

26

10 20

17

53 50 49 35

17 13 4 17 8 5 2

4 0

50

100

150

200

250

300

350

400 Florida

Miami-Dade

Broward

SOURCE: Florida Medical Examiners Commission Reports 2000-2012

# L

eth

al H

ero

in D

ea

ths

Number of Primary Heroin Treatment Admissions Miami-Dade and Broward Counties, FL: 2009-2012

150 183

227

161

105

156 169

292

0

50

100

150

200

250

300

350

1 2 3 4 5 6 7 8

# o

f p

rim

ary

Trea

tmen

t A

dm

issi

on

s

SOURCE: Florida Department of Children and Families

2009 2010 2011 2012 2009 2010 2011 2012

Miami-Dade Broward In the first three months of 2013,

Florida Department of Law Enforcement heroin-related charges totaled 948, up 23-% from same three-month period last year, that number was 772.

Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida Jan 2008 to Jun 2012

476 465

533

652 715

801

607 640

392

337 336

380 340 336

358 341 350

274

0

100

200

300

400

500

600

700

800

900

1H08 2H08 1H09 2H09 1H10 2H10 1H11 2H11 1H12

Oxycodone

Methadone

Morphine

Hydrocodone

Fentanyl

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2007 - Jun 2012 Reports

# “C

ause

of

Dea

th”

Occ

urr

ence

s

Number of Oxycodone Reports Detected among Decedents in South Florida: 2007-2012

NUMBER of Oxycodone

OCCURRENCES Including

“Present” & “Cause of Death”

SOURCE: Florida Medical Examiners Commission Interim Report 2012

144 165 184 177

240

88 119

171 225 236

174 120

45 46 66

100

75 68

308

382

475 513

489

276

0

100

200

300

400

500

600

2007 2008 2009 2010 2011 2x1H12

Palm Beach

Broward

Miami-Dade

All 3 Counties



Rate of NMU Rx Opioid Emergency Department Reports Per 100,000 Miami-Dade, Broward & Palm

Beach Counties, and USA: 2004-2011

77.9 95.8

107.3 118.7

59 73.6 83

95.1 120.6

135 153.3

156.6

19.7 30.7 27.2 30.7 29.2 33.4

42.4

0

50

100

150

200

2004 2005 2006 2007 2008 2009 2010 2011


USA

Miami-Dade


Rat

e p

er

10

0,0

00

= Significant Difference

with 2011

33.4

Rates per 100,000 of Oxycodone Nonmedical Use

E Emergency Department Reports by Age Groups

DAWN Ft. Lauderdale Division vs. USA: 2011

186.9 184.3

157.5

78.3

14.8

50.965.2

100.4 91.9 88.7

66.8 57.4 50.7

0

20

40

60

80

100

120

140

160

180

200

18-20yrs.

21-24yrs.

25-29yrs.

30-34yrs.

35-44yrs.

45-54yrs.

55-64yrs.

Rate

per

100,0

00

SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.


USA

Top 10 Most Frequently Identified Drugs of Total Analyzed Drug

Reports from South Florida Crime Labs Reports CY 2012

Drug 2012 Number 2012 % % Δ vs. 2011

Cocaine 11,411 48.2% Down 16 %

Marijuana/Cannabis 5,388 22.8% Up 8 %

Rx Opioids 975 4.1% Down 31 %

Rx Benzodiazepines 882 3.7% Down 16 %

Heroin 696 2.9% Up 21 %

Hallucinogen 524 2.2% Up 16 %

Methylone (N-Methyl-3,4-Methylenedioxycathinone) 388 1.6% Up 1500 %

Phenylimidothiazole Iso Undeterm 246 1.0% Down 9 %

Caffeine 237 1.0% Down 17 %

Methamphetamine 170 0.7% Up 17 %

All Other Analyzed Drugs 2,754 11.6% Up 5 %

Total 23,671 100.0%

SOURCE: US DEA: National Forensic Laboratory Information System DQS on May 7, 2013

Number of

South

Florida

Rx Opioid

Crime Lab

Reports

2011 vs. 2012

Source: US DEA-National Forensic Laboratory Information System (NFLIS) for Miami-Dade, Broward and Palm Beach Counties 2011 (5/8/12) and 2012 (5/7/13)

Prescription Opioids Reports

2011

2012

OXYCODONE 1,202 679

HYDROCODONE 115 122

METHADONE 66 33

BUPRENORPHINE 47 28

MORPHINE 30 51

CODEINE 25 31

HYDROMORPHONE 24 151

TRAMADOL 7 11

OXYMORPHONE 3 10

PROPOXYPHENE 3 0

FENTANYL 1 0

BENZYLMORPHINE 1 0

DIHYDROCODEINE 1 0

DIHYDRONORMORPHINONE 0 10

TOTAL OPIOIDS 1,525 975

5,233,785 Dose Units in 6 months

Percent of those Age 12 & Above Who Report

Nonmedical Use of Pain Relievers in Past Year

Source: NSDUH 2008-10 Substate Data

USA 4.87 %

Percent Range:

2.96 % to 8.11 %



Florida Substate DCF Regions

All Florida 4.22 %

Nonmedical Use of Pain Relievers

in Past Year

Source: NSDUH 2008-10 Substate Data

643,726 Floridians Aged 12 and above

5.38 %

2.96 % Broward

3.11 %

Percent of Persons Aged 12 and Above Reporting Nonmedical Use of Rx Pain Relievers in the Past Year:

2002-2010

SOURCE: SAMHSA-CBHSQ(2012): Substate Estimates from the 2002-2010

National Surveys on Drug Use and Health

Perc

en

t R

ep

ort

ing

Past

Year

Use

4.764.89

5.03 4.874.82 5.01

4.354.22

4.46

3.823.43

2.96

0

1

2

3

4

5

6

2002-04 2004-06 2006-08 2008-10

USA

Florida

Broward

Number of Alprazolam and Diazepam Occurrences Among Deceased Persons in

Florida Jan 2008 to Jun 2012

354 351 378

444 439

542 461 486

323

105 100 127 121 136 141 126 180

101

0

100

200

300

400

500

600

1H08 2H08 1H09 2H09 1H10 2H10 1H11 2H11 1H12

Alprazolam

Diazepam

# “C

ause

of

De

ath

” O

ccu

rre

nce

s

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2007 - Jun 2012 Reports

Number of

South Florida

Rx Benzodiazepine

Crime Lab

Reports 2011 vs. 2012


Reports for Rx Benzodiazepines

2011

2012

ALPRAZOLAM 981 729 CLONAZEPAM 72 74 DIAZEPAM 42 46 LORAZEPAM 22 14 TEMAZEPAM 4 17 TRIAZOLAM 0 2 BROMAZEPAM 1 0 FLURAZEPAM 1 0

TOTAL 1,123 882

Rate of Marijuana Emergency Department Reports Per 100,000 Miami-Dade, Broward &

Palm Beach Counties, and USA: 2004-2011

97 94.4 105.7 128.6

96.2 94.6 97.4 102.4 123.1 122.7

149 146.2 159.2

217.6 180.1

148 138.6 137 126

187.8

0

50

100

150

200

250

300

2004 2005 2006 2007 2008 2009 2010 2011


USA

Miami-Dade


Rat

e p

er 1

00,0

00


with 2011

Number of Primary Treatment Admissions for Juveniles and Adults by Drug in Broward and

Miami-Dade Counties: Jan - Dec 2012

Source: Florida Department of Children and Families

505

292

93

607

1,360

1,260

1,748

122

161

58 941

1,069

139

1,576

0 500 1000 1500 2000

Other/Unknown

Heroin

Rx Benzo's

Cocaine/Crack

Alcohol

Rx Opioids

Marijuana

Miami-Dade Broward

Number of Primary Admissions



The pen is mightier than the pipe?

Number of Cannabinmimetics

Poison Control Exposure Calls

2011 2012 Jan-Apr 2013

Source: Florida Poison Information Center – Miami 1-800-222-1222

Cannabinmimetics Poison Exposure

Calls

# of Poison

Exposure

Calls

Jan-Dec 2011

# of Poison

Exposure

Calls

Jan-Dec 2012

# of Poison

Exposure

Calls

Jan-Apr 2013

State of Florida 517 537* 78

Broward County 38 37 2

Miami-Dade County 36 45 6

Palm Beach County 29 24 1

* The total of 537 includes 271 in Jan-Apr 2012

Number of

Cannabinmimetic

Poison Control

Exposure Calls

Jan-Apr 2013

Source: Florida Poison Information

Center – Miami 1-800-222-1222

Number of

South Florida

Synthetic

Cannabinoids

Crime Lab

Reports 2011

vs. 2012


Synthetic Cannabinoids 2011 2012

AM-2201 114

JWH-018 19 27

XLR-11 25

JWH-081 6

UR-144 5

JWH-122 4

JWH-250 4

JWH-073 2

RCS-8 2

JWH-203 1

TOTAL 19 190

Rate of MDMA Emergency Department Reports Per 100,000 Miami-Dade, Broward & Palm


7.3 8.3

10.4 13.1

3.5 3.8 5.6

4.2 5.9

7.4 7.1 7.2

8.8 8.7

6 8

12.1

7.8

15.6

0

5

10

15

20

25

2004 2005 2006 2007 2008 2009 2010 2011


USA

Miami-Dade


Rat

e p

er 1

00,0

00


with 2011



Number of

South Florida

Synthetic

Cathinones

Crime Lab

Reports 2011

vs. 2012


Synthetic Cathinones 2011 2012

Methylone 27 388

4-MEC 3 36 3,4-METHYLENEDIOXY-DIMETHYLCATHINONE 0 2

Mephedrone 12 2

TOTAL 42 428

46-% Decrease in MDMA Crime Lab Reports 2010 (n= 555) vs 2010 (n=299)

64-% Decrease in MDMA Crime Lab Reports 2011 (n= 299) vs 2012 (n=107)

Number of ‘Molly”

Poison Control Exposure Calls Jan-Apr 2012 vs. Jan-Apr 2013

Source: Florida Poison Information Center – Miami 1-800-222-1222

Molly Poison Exposure

Calls

# of Poison

Exposure

Calls Jan-

Apr 2012

# of Poison

Exposure

Calls Jan-

Apr 2013

State of Florida 2 47

Broward County 0 8

Miami-Dade 0 19

Palm Beach 0 4

Methylone is beta-ketone MDMA

Number of

South

Florida

Other New

Drugs

Crime Lab

Reports

2011 vs.

2012


OTHER EMERGING PSYCHOACTIVE SUBSTANCES 2011 2012

BZP 130 113

5-MEO-DIPT 133 89

TFMPP 83 86

MDPV 32 58

DMT 6 4

2C-B 2 2 4-METHOXYMETHAMPHETAMINE

2

5-MEO-MIPT 2

ALPHA-PVP 2

MMDA 1 ALPHA-METHYLTRYPTAMINE 1 TRYPTAMINE 1

TOTAL 386 361

Rate of Illicit Stimulant Emergency Department Reports Per 100,000 Miami-Dade, Broward & Palm


5.2 6.2

7.1 8

55.5 46.6

36.1 28.2 30.2 30.5

44.8 51.3

7.1 10.9 6.7 6.4 5.9 6.3

5.6

10.6

0

10

20

30

40

50

60

70

80

2004 2005 2006 2007 2008 2009 2010 2011


USA

Miami-Dade


Rat

e p

er 1

00,0

00

South Florida Key Findings June 2013

• # 1 key change is that deaths related to nonmedical misuse of prescription opioids declined 17-pecent in Florida during the first half of 2012 which translates to 8 fewer deaths per week across the State attributable to prescription drug overdoses.

June 2013

• # 2 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:

Miami-Dade & Broward Counties 2012

Source: Florida Department of Children and Families

Treatment Primary Drug

Miami-Dade %

Broward %

Prescription Opioid 22 % 58 %

Heroin 85 % 90 %

Methamphetamine 18 % 25 %



South Florida Most Recent Indicator Changes

• 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”

HIG

H

Mo

der

ate

Lo

we

r

Levels of Indicator Intensity: HIGH Moderate Lower

June 2013

Surveillance Support Committee

42

NIDA Community Epidemiology Work Group

Texas

Cincinnati

Atlanta

Ft. Lauderdale/

Miami

St. Louis

Chicago

Detroit

Minneapolis/St. Paul

BostonNew York

Philadelphia

Washington D.C.

Phoenix

Denver

Seattle

Los Angeles

San Diego

San Francisco

Honolulu

Maine

United States Drug Observatories

Albuquerque

2


Texas

Cincinnati

Atlanta

Ft. Lauderdale/

Miami

St. Louis

Chicago

Detroit


BostonNew York

Philadelphia

Washington D.C.

Phoenix

Denver

Seattle

Los Angeles

San Diego

San Francisco

Honolulu

Maine

The 21 US Drug Observatories

Albuquerque

Key Findings June 2013

Substance % Reporting Increasing Trends

% Reporting Decreasing Trends

Heroin 65 % 6 %

Methamphet-amine

53 % 0

Prescription Opioids

29 % 18 %

Emerging Psycho-active Substances 29 % 18 %

Marijuana 12 % 12 %

Cocaine 12 % 88 %

Changes in Drug Trends Summer 2013 Among 17 of 21 US Drug Observatories

2


Texas

Cincinnati

Atlanta

Ft. Lauderdale/

Miami

St. Louis

Chicago

Detroit


BostonNew York

Philadelphia

Washington D.C.

Phoenix

Denver

Seattle

Los Angeles

San Diego

San Francisco

Honolulu

Maine

The 21 US Drug Observatories

Albuquerque

Key Findings June 2013

Observations June 2013 • New Drug Markets:

• Suburban • Smaller Cities • Rural Areas

• Heroin and Methamphetamine Improved and Increased Production from Mexico now in USA

• MDMA Disappearing, but not “Ecstasy”

• The Second Decade of the 21st Century looks like the Second Half of the 19th Century when their was • Morphine sold as “Folk Medicine” and “Snake Oil” • The new Pharmaceutical – “Heroin” • Invention of the Syringe to make morphine less addictive

orange south florida drug trends summer 2013 p hernando

Documents