the south florida report september 2013 - trustedpartnercdn.trustedpartner.com/docs/library... ·...

South Florida Drug Trends Update

Jim Hall [email protected] 1

The South Florida Report

September 2013

Community Epidemiology Drug Report

James N. Hall NIDA-CEWG Report # 57

Center for Applied Research on Substance Use and Health Disparities

Nova Southeastern University

http://www.state.fl.us/cf_web/



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 Fall 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

Fall 2013



South Florida’s Most Recent Indicator Changes

• Marijuana: High and Increasing • Cocaine: 5-Year Decline Reversing • Rx Opioids: Deaths Declining 12-% • Benzodiazepines: Deaths Declining 13-%

• Ecstasy: Mostly “Mollys” tests as bk-Methylone • Heroin: Epidemic Underway Deaths Up 120 %

• Cannabinmimetics: Types & Problems + “Pot Pens” • Methamphetamine: Low but Returning Key Issue for Gay Males and “Heavy Club Druggers”

HIG

H

Mo

der

ate

Lo

we

r

Levels of Indicator Intensity: HIGH Moderate Lower

Fall 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

1,318

0 0 0 0

500

1,000

1,500

2,000

2,500

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

State of Florida

149 151 189

160 162 182

281

201

155

198 184 198

94 121

138 120

136 150 157 146 135 127 115 129

0

50

100

150

200

250

300

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

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

10

0,0

00

= Significant

Difference with 2011

Main Global Cocaine Flows: 1998 and 2008

UNODC, World Drug Report , Drug Trafficking, 1998 & 2010

2008

165

124

267 63



$97.64

$175.16 67.1 %

48.1 %

Price and Purity of Cocaine in USA Jan 2007 – June 2012

2011

Jan 2007 vs. June 2012 Price Up 98 % Purity Down 28 %

Source: USDJ: DEA – STRIDE Data

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 62

117

61

39 46 32

18

22 20 26

38 30

26 15

33

17

53 50 49 35

17 13 4 17 8 5 3

9 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

Tre

atm

en

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.

Price and Purity of Heroin in USA Jan 2007 – June 2012

Oct. 2007 vs. June 2012 Price Up 56 % Purity Down 9 %

$695.76

$877.84

32.4 %

36.8 %




Oxycodone

Methadone

Hydrocodone

Just 40 more to go

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

87 119

171 225 236

174 126

45 46 66

100

75 58

308

382

475 513

489

271

0

100

200

300

400

500

600

2007 2008 2009 2010 2011 2012

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

4.76 4.89

5.03

4.87 4.82 5.01

4.35 4.22

4.59 4.53 4.05

3.55

4.46 3.82

3.43

2.96 3.49 3.59

3.23 3.11

0

1

2

3

4

5

6

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

USAFloridaPalm BeachBrowardMiami-Dade

SOURCE: SAMHSA (2012): Substate Estimates from the 2002-2010 National Surveys on Drug Use and Health (Office of Applied Studies).

Per

cen

t R

epo

rtin

g P

ast

Year

Use



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

10

0,0

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



Source: US DHHS – SAMHSA Treatment Episode Data Sets

Current (past 30-day) Marijuana Use Among Broward County Middle and High School Students

2000-2012

Source: Florida Youth Substance Abuse Surveys 2000-2012

17.2

13.9 14.5

11.4

14 15.3

19

4.5 5.2 5

2.5 3.5 4.3

3.7

0

2

4

6

8

10

12

14

16

18

20

2000 2002 2004 2006 2008 2010 2012

% R

ep

ort

ing

Cu

rre

nt

Us

e

High School Middle School



Findings form the 2012 National Survey on Drug Use and Health

US Department HHS: SAMHSA-Center for Behavioral Health Statistics and Quality

(CBHSQ) Released August 2013

Source: 2012 NSDUH



Past Month Illicit Drug Use among Persons

Aged 12 and Older, by Age, 2002-2012

20.2 20.3 19.4

20.1 19.8 19.8 19.7

21.4 21.6 21.4 21.3

11.6 11.2 10.6

9.9 9.8 9.6 9.3 10.1 10.1 10.1

9.5

5.8 5.6 5.5 5.8 6.1 5.8 5.9 6.3 6.5 6.3 7

5

7

9

11

13

15

17

19

21

23

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

Source: US Dept. HHS – SAMHSA National Survey on Drug Use and Health 2012

Perc

en

t U

sin

g In

P

ast

Mo

nth

Young Adult 18 to 25 yrs.

Children & Youth 12 to 17 yrs.

Adult 26 yrs. and Older

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



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

10

0,0

00


with 2011



Number of

South Florida

Synthetic

Cathinones

Crime Lab



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

10

0,0

00

Price and Purity of Methamphetamine in USA Jan 2007 – June 2012

July 2007 vs. June 2012 Price Down 72 % Purity up 128 %

$158.96

$81.28

59.4 %

92.9 %




South Florida Key Findings June 2013

• # 1 key change is that heroin overdose deaths increased 89-percent in Florida between 2011

and 2012 while deaths related to nonmedical misuse of prescription opioids declined 12-pecent

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’s Most Recent Indicator Changes

• Marijuana: High and Increasing • Cocaine: 5-Year Decline Reversing • Rx Opioids: Deaths Declining 12-% • Benzodiazepines: Deaths Declining 13-%

• Ecstasy: Mostly “Mollys” tests as bk-Methylone • Heroin: Epidemic Underway Deaths Up 120 %

• Cannabinmimetics: Types & Problems + “Pot Pens” • Methamphetamine: Low but Returning Key Issue for Gay Males and “Heavy Club Druggers”

HIG

H

Mo

der

ate

Lo

we

r

Levels of Indicator Intensity: HIGH Moderate Lower

Fall 2013



Current (past 30-day) Alcohol Use Among Broward County Middle and High School Students

2000-2012

Source: Florida Youth Substance Abuse Surveys 2000-2012

44 39.9

36 34.1 37.3

34.1

31.3

19.8 20.1 24

18.7 16.8

14.8

11.2

0

5

10

15

20

25

30

35

40

45

50

2000 2002 2004 2006 2008 2010 2012

% R

ep

ort

ing

Cu

rre

nt

Us

e

High School Middle School

Rate of Hospital Alcohol and Illicit Drug-Related Emergency

Department Reports per 100,000 Population by Age Groups: Ft. Lauderdale Division of Drug Abuse Warning Network (DAWN) Hospitals

97.9

244.3 207.4

354.7

290.7 295.1 310.3

118.3

300

738.4

464

684.6

498.6 550.2

431.7

139.4

0

100

200

300

400

500

600

700

800

12-17yrs

18-20yrs.

21-24yrs.

25-29yrs.

30-34yrs.

35-44yrs.

45-54yrs

55-64yrs.

Alcohol-in-Combo*

Illicit Drug

* Alcohol ED

reports involve

Alcohol plus at

least one other

drug. Alcohol-only

reports are not

included

Rat

e p

er 1

00

,00

0

SOURCE: US Dept. HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. (ED) Estimates 2011



Surveillance Support Committee



The South Florida Report

September 2013

Community Epidemiology Drug Report

James N. Hall NIDA-CEWG Report # 57

Center for Applied Research on Substance Use and Health Disparities

Nova Southeastern University

the south florida report september 2013 - trustedpartnercdn.trustedpartner.com/docs/library... ·...

Documents