Current Drug Trends from the Epidemiological State Rep
21
Draft as of January 7, 2011 1 The South Florida Report January 2011 Community Epidemiology Work Group James N Hall 2 James N. Hall South Florida Drug Observatory Nova Southeastern University Palm Palm Beach Beach Flagle r Highla nds Hardee Polk Ma rtin St. Lucie O k ee c hobee Indian River Putnam Alac hua B r ad for d Union C olumbia Gilchris t Levy Dixie Suwannee Ha milton S t. Johns Cla y Duval Nassau Ba ke r Pinellas Pasco Manatee Hillsborough Bre v a r d Osc e ola Orange Seminole Collie r Hendry Le e Glades De Soto Sarasota Palm Beach La ke Sumter Hernando Citrus Ma rion Taylor Ma dis on Je f ferson Wakulla Leon Fra nklin Libe rty Gadsden Ja cks on Calhoun Gulf Bay W as h ington Escambia Santa Rosa Okaloosa Walton Broward Dade Holmes Monroe Volusia Lafayette Charlotte 1.3 Million FL=18.5 Million Miami Miami Broward Broward 1.8 Million 25 Million Miami Miami- Dade Dade 2.5 Million US Census Bureau 2009 Population Estimates
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epidemiological presentation from Jim Hall. You will find “The South Florida Report January 2011.”
Transcript of Current Drug Trends from the Epidemiological State Rep
Draft as of January 7, 2011
1
The South Florida Report
January 2011
CommunityEpidemiologyWork Group
James N Hall
2
James N. HallSouth Florida Drug
ObservatoryNova Southeastern University
Palm Palm
BeachBeach
Flagler
HighlandsHardee
Polk
Martin
St. Lucie
Okeechobee
Indian River
PutnamAlachua
Bradfor
dUnionColu
mbia
Gilchris t
Levy
Dixie
Suwannee
Hamilton
St.JohnsClay
Duval
Nas sau
Baker
Pinellas
Pasco
Manatee
Hillsborough
Breva rd
Osceola
Orange
Seminole
Collier
HendryLee
Glades
De SotoSarasota
Palm Beach
LakeSumterHernando
Citrus
Marion
Taylor
Madison
Jeffe
rson
Wakulla
Leon
Franklin
Liberty
Gadsden
Jacks on
Calhoun
Gulf
BayWash
ington
Escambia
Santa Rosa
OkaloosaW
alton
Broward
Dade
Holmes
Monroe
Volusia
Lafayette
Charlotte
1.3 MillionFL=18.5 Million
MiamiMiami
BrowardBroward1.8 Million
2 5 Million MiamiMiami--
DadeDade
2.5 Million
US Census Bureau2009 Population Estimates
Draft as of January 7, 2011
2
DATA SOURCES JANUARY 2011
• Florida Medical Examiners Commission 2010 Interim Report on Drugs Identified In Deceased Persons by Florida p g yMedical Examiners from Florida Department of Law Enforcement
• Emergency department (ED) DAWN weighted estimates from SAMHSA Center for Behavioral Health Statistics and Quality are for 2004-2009 and reported separately for the Miami-Dade and Ft. Lauderdale Divisions of DAWN
• 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 Jan -June 2010.
DATA SOURCES JANUARY 2011 (CONT.)
• Comparison of Primary Treatment Admissions in Florida as reported to Treatment Episode Data Set p p(TEDS) from SAMHSA Center for Behavioral Health Statistics and Quality for 1999 and 2009
• National Forensic Laboratory Information System (NFLIS), Drug Enforcement Administration (DEA), for January – June 2010January June 2010
• Florida Youth Substance Abuse Survey 2010, Florida Department of Children and Families.
Draft as of January 7, 2011
3
SOUTH FLORIDA TRENDSBETWEEN 2ND HALF 2009 & 1ST HALF 2010
• Cocaine Declining : Street Purity Down, Price Up. • Heroin Consequences: Stable and low
Rx Opioids: Consequences Stable at high levels• Rx Opioids: Consequences Stable at high levels• Increasing Injecting Drug Use of Rx Opioids• Methamphetamine: Low and Stable• Marijuana: Student Use Up Perceived Risks Down• Benzodiazepine: Deaths ED Reports • Emerging Issues: Emerging Issues:
• Role of street purity and price in decline of cocaine • New Injecting Drug Users naïve about infected syringes • Retail network for current and future unregulated
synthetic drugs
Number of Cocaine Reports Detected Among Decedents in South Florida: Jan. 2000 - June 2010
281
201
250
300
144 149 151
189
160 162182
155
828094
121138
120136
150 157146
135138
50
100
150
200
Miami-Dade
NUMBER of COCAINE
OCCURRENCESIncluding
“Present” &“Cause of
Death”
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X 1h'10
Broward
SOURCE: Florida Medical Examiners Commission Interim Report 2010
Draft as of January 7, 2011
4
Number of Cocaine Reports Detected Among Decedents in Florida: Jan. 2000 - June 2010
1,034 1,105 1,3071,6141,702 1,943 2,052 2,179
1,7911,462
1 2061 0001,5002,0002,500
All Florida1,206
0500
1,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X 1h'10
144 149 151189
160 162182
281
201
155138150
200
250
300
NUMBER of COCAINE
OCCURRENCESIncluding
“Present” &“Cause of
Death”
8280 94121
138120 136 150 157 146 135
0
50
100
2000 2001 2002 2003 2004 2005 2006 2007 2008 20092X 1h'10
Miami-DadeBroward
SOURCE: Florida Medical Examiners Commission Interim Report 2010
Number of Cocaine Reports Among Deceased Persons by Polysubstance Use Status in Florida: 2001 - 2010
2000
ons
s
500
1000
1500Cocaine Plus
Cocaine Only# of
Coc
aine
Det
ectio
Am
ong
Dece
dent
s
SOURCE: Florida Dept. of Law Enforcement, Florida MedicalExaminers Commission Reports 2001- 2010
2001 2002 2003 2004 2005 2006 2007 2008 2009 2X 1h '10
Cocaine Plus 801 942 1142 1269 1443 1520 1639 1,367 1,159 490CocaineOnly 304 365 472 433 500 532 540 424 303 113
0
#
Draft as of January 7, 2011
5
Number of Cocaine Reports Detected Among Decedents in South Florida: Jan. 2000 - June 2010
281
201
250
300
144 149 151
189
160 162182
155
828094
121138
120136
150 157146
135138
50
100
150
200
Miami-Dade
NUMBER of COCAINE
OCCURRENCESIncluding
“Present” &“Cause of
Death”
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X 1h'10
Broward
SOURCE: Florida Medical Examiners Commission Interim Report 2010
Draft as of January 7, 2011
6
NUMBER OF ESTIMATE ED REPORTS BY DRUG IN MIAMI-DADE AND
FT. LAUDERDALE DAWN DIVISIONS: 2009
16,000te
s
459
3,375
2,870
192
252
8202,899
1,5872,900
4 000
6,000
8,000
10,000
12,000
14,000
of E
D R
epor
t Es
tim
at
Benzodiazepine
Opioids
MDMA (Ecstasy)
Marijuana
H i6,459
4,475
0
2,000
4,000
Miami-Dade Ft. Lauderdale
# o Heroin
Cocaine
SOURCE: SAMHSA-CBHSQ Dawn Estimates 2009 October 5, 2010DAWN Divisions
541.1
500
600
Rates per 100,000 of Cocaine Emergency Dept. Reports Miami-Dade County: 2004-2009
0
397.7 407.7 400.5
302.5
258.3200
300
400
Rat
es p
er 1
00,0
0
Miami-Dade
0
100
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
Draft as of January 7, 2011
7
541.1
500
600
Rates per 100,000 of Cocaine Emergency Dept. Reports Miami-Dade County, and USA: 2004-2009
0
397.7 407.7 400.5
302.5
258.3
162.2 163.6183.7 183.5
158.4200
300
400
Rat
es p
er 1
00,0
0
Miami-Dade
USA137.7
0
100
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
USA
541.1
500
600
Rates per 100,000 of Cocaine Emergency Dept. Reports Broward (2008), Miami-Dade, and USA: 2004-2009
0
397.7 407.7 400.5
302.5
258.3
162.2 163.6183.7 183.5
158.4183.9
147200
300
400
Rat
es p
er 1
00,0
0
Miami-Dade
USA
Broward
137.7
0
100
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
USA
Draft as of January 7, 2011
8
Number of South Florida* Crime Lab Reports for Cocaine and All Other Drugs: 2007-Jun ‘10*Miami-Dade, Broward, & Palm Beach Counties Combined
Legend Cocaine All Other Drugs
15,309
19,156
20,913
9,403
10,083
2009
2008
20072007 Cocaine 67%
2008 Cocaine 65%
2009 Cocaine 62%
10,449
13,196 10,312
0 10,000 20,000 30,000 40,000
2X1h '10
Source: US DEA National Forensic Laboratory Information SystemNumber of Crime Lab Samples
2010 Cocaine 57%
Percent of Primary Treatment Admissions by Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% 1999 Alcohol Only 2009
28%
20%
5%3% 1% 6.50% Alcohol w/drug
Crack Cocaine
Other Cocaine
Marijuana
Heroin
Opioids
18%
11%2%
16%
2% 1%5%
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
13%
18%5%
p
Amphetamines
Tranquilizers
Other/Unknown
10%
4%
31%
Draft as of January 7, 2011
9
Percent of Primary Treatment Admissions by Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% 1999 Alcohol Only 2009
28%
20%
5%3%
1% 6.50% Alcohol w/drug
Crack Cocaine
Other Cocaine
Marijuana
Heroin
Opioids
18%
11%2%
16%
2% 1%5%
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
13%
18%5%
p
Amphetamines
Tranquilizers
Other/Unknown
10%4%
31%
PRICE AND PURITY OF ALL USA LAW ENFORCEMENT COCAINE PURCHASES
JANUARY 2006 - JUNE 2009
$174.3868.65$180
$200
70
80
$158.01
$116.36$94.05
61.33
51.648.6
$60
$80
$100
$120
$140
$160
$180
Pric
e/Pu
re G
ram
30
40
50
60
70
Perc
ent P
ure
Price/Pure Gram
Source: Based on unpublished US DEA System to Retrieve Information from Drug Evidence (STRIDE) Data
$0
$20
$40
2006 2007 2008 1H 2009
P
0
10
20Purity
Draft as of January 7, 2011
10
Percent of Primary Treatment Admissions by Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% 1999 Alcohol Only 2009
28%
20%
5%3%
1% 6.50% Alcohol w/drug
Crack Cocaine
Other Cocaine
Marijuana
HeroinOpioids
18%
11%2%
16%
2% 1%5%
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
13%
18%5%
p
Amphetamines
Tranquilizers
Other/Unknown
10%4%
31%
NUMBER OF HEROIN-INDUCED DEATHS IN MIAMI-DADE & BROWARD COUNTIES, FL: 1996- JUN 2010
6070
Miami-Dade
eath
s
0102030405060
Broward
108Le
thal
Her
oin
De
0
SOURCE: Florida Medical Examiners Commission Interim Report 2010
8
# L
Draft as of January 7, 2011
11
NUMBER OF HEROIN-INDUCED DEATHS IN FLORIDA: 1996 - JUNE 2010
250300 Florida
Miami-Dadeeath
s
50100150200250 Miami Dade
Broward
50 Let
hal H
eroi
n D
0
SOURCE: Florida Medical Examiners Commission Interim Report 2010
#
NUMBER OF OPIATENUMBER OF OPIATE--RELATEDRELATED DEATHS DEATHS BY BY HEROINHEROIN OROR RX OPIOID RX OPIOID IN IN FLORIDA: 2000FLORIDA: 2000--20102010
40004500
Heroin 3 Rx Opioids3,986
0500
100015002000250030003500
3 Rx OpioidsThe 3 Rx Opioids are
Methadone,Hydrocodone, andOxycodone
3 Rx Opioids
Heroin60276
869
Opi
ates
Det
ecte
d m
ong
Dece
dent
s
SOURCE: Florida Medical Examiners Commission Reports 2000-2010
# of
OA
m
Draft as of January 7, 2011
12
Prescription Opioid Nonmedical Use and Heroin
• Rx Opioid frequently misused by heroin users
• Not a significant number of Rx Opioid misusers also using heroin…
• Increasing Injecting Drug Use among Rx Opioid nonmedical users in their 20s. nonmedical users in their 20s. • Born 1981 to 1990; Entered Adolescence 1994 – 2003• After major interventions for HIV Injecting Drug Users• Priority Public Health Issue: Infected Syringes - Young
Adults
Number of Oxycodone Reports Detected Among Decedents in Florida: Jan. 2007 - June 2010
NUMBER of Oxycodone
OCCURRENCESIncluding
568685 705
869 941 1,007 1,117
400600800
10001200
Floridag“Present” &“Cause of
Death” 0200400
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
SOURCE: Florida Medical Examiners Commission Interim Report 2010
Draft as of January 7, 2011
13
Number of Oxycodone Reports Detected Among Decedents in Florida: Jan. 2007 - June 2010
568 685 705869 941
1,007 1,117
400600800
10001200
FloridaNUMBER of
OxycodoneOCCURRENCES
Including “Present” &“Cause of
Death”
0200
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
6084 88 77
88
96
91
70 47
124
89
136
103
60
80
100
120
140
160 Palm BeachBrowardMiami-Dade
SOURCE: Florida Medical Examiners Commission Interim Report 2010
49
936
1630 30 36 33
0
20
40
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
Percent of Primary Treatment Admissions by Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% 1999 Alcohol Only 2009
28%
20%
5%3%
1% 6.50% Alcohol w/drug
Crack Cocaine
Other Cocaine
Marijuana
Heroin
Opioids
18%
11%2%
16%2% 1%
5%
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
13%
18%5%
OpioidsAmphetamines
Tranquilizers
Other/Unknown
10%
4%
31%
Draft as of January 7, 2011
14
2500
3000
3500on
Tre
atm
ent
on O
pioi
ds
1999 n= 2,1652009 12 103
Number of Primary Addiction Treatment Admissions for Prescription Opioids in Florida by Age: 1999 vs. 2009
500
1000
1500
2000
ber o
f Prim
ary
Add
ictio
dmiss
ions
for
Pre
scrip
tio 2009 n= 12,103
12-17 yrs
18-20 yrs
21-25 yrs
26-30 yrs
31-35 yrs
36-40 yrs
41-45 yrs
46-50 yrs
51-55 yrs
56-60 yrs
61-65 yrs
66 & over
1999 n= 2,165 19 54 160 255 385 437 478 227 93 22 9 62009 n= 12,103 424 944 3243 3038 1670 1017 678 569 351 133 24 12
0Num
bA
d
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
Number of Oxycodone Reports Detected Among Decedents by Age Groups in Florida: Jan-Jun 2010
ort
s
600
700
State of Florida 1 117
of
Oxyco
do
ne
Rep
o
200
300
400
500
131
238
423
320
State of Florida 1,117
Source: FDLE Florida Medical Examiners Commission Interim Report 2010
# o
0
100
<18 yrs. 18-25 yrs. 26-34 yrs. 35-50 yrs. >50 yrs.
1 5
131
Draft as of January 7, 2011
15
48.4
52.850
60
Rates per 100,000 of Nonmedical Use Oxycodone Emergency Dept. Reports Miami-Dade, Broward, and USA: 2004-2009
0 Broward
10 2 1414.2
17.921.7
25.434.5
37.8
20
30
40
Rat
es p
er 1
00,0
0
USA
Broward
5.3
8.2
8 8.710.2
0
10
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
.
Miami-Dade
Rates per 100,000 of Oxycodone Nonmedical Use Emergency Department Reports by Age Groups
DAWN Ft. Lauderdale Division vs. USA: 2009
153 158.1160180
106
92.667.9 69.1
73.588.6
117.3
80.2
62.9 61.1 47.1406080
100120140160
ate
per 1
00,0
00 Broward & Palm Beach
USA
43
02040
18-20 yrs.21-24 yrs.25-29 yrs.30-34 yrs.35-44 yrs.45-54 yrs.55-64 yrs.
Ra
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
Draft as of January 7, 2011
16
Number of Alprazolam Reports Detected Among Decedents in Florida: Jan. 2007 - June 2010
652796 838
1,035 942 1,021 986
400600800
10001200
FloridaNUMBER of Alprazolam
OCCURRENCESIncluding
“Present” &“Cause of
Death”
0200
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
80
107
6981
77
5562 71 52
151
106
139
100
79
6360
80
100
120
140
160 Palm BeachBrowardMiami-Dade
SOURCE: Florida Medical Examiners Commission Interim Report 2010
4422
38
6344 53
36
0
20
40
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
89.3
101.9
95.2100
120
Rates per 100,000 of Nonmedical Use Rx BenzodiazepinesEmergency Dept. Reports Miami-Dade, Broward, and USA: 2004-2009
0 USA
57.6
74.1
61.455.5
61.5 63.449
64.1 65.5
72.575.2
40
60
80
Rat
es p
er 1
00,0
0
Miami-Dade
USA
Broward
0
20
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
.
Draft as of January 7, 2011
17
215.1
177 7200
250
Rates per 100,000 of Marijuana Emergency Dept. Reports Broward (2008-09), Miami-Dade, and USA: 2004-2009
0
157.7177.7
145.8136.3
135
96.1 94.6 97.3 102.3123
122.696.994.2
0
100
150
Rat
es p
er 1
00,0
0
BrowardUSA
Miami-Dade
0
50
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
.
Percent of Primary Treatment Admissions by Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% 1999 Alcohol Only 2009
28%
20%
5%
3%1% 6.50% Alcohol w/drug
Crack Cocaine
Other Cocaine
MarijuanaHeroin
Opioids
18%
11%2%
16%
2% 1%5%
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS) as reported by the Florida Department of Children and Families 09/30/2010
13%
18%5%
p
Amphetamines
Tranquilizers
Other/Unknown
10%4%31%
Draft as of January 7, 2011
18
Synthetic Cannabinoids•Widely Available
•Need for Laboratory Standards •Need for Laboratory Standards - Crime Labs- Urine Drug Tests
11.9
10
12
14
Rates per 100,000 of MDMA Emergency Dept. Reports Broward (2008-09). Miami-Dade County and USA: 2004-2009
0 Miami-Dade
8.8 8.6
5.9
7.97.7
3.5 3.8
5.64.2 5.9
7.47.3
8.3
4
6
8
10
Rat
es p
er 1
00,0
0
Broward
USA
0
2
2004 2005 2006 2007 2008 2009
R
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
Draft as of January 7, 2011
19
65 PERCENT OF BROWARD CRIME LAB ALLEGED ECSTASY IS BZP IN 2010
BZP
TFMPP ?
Be On ALERTMEPHEDRONE… “Meow Meow”
MDPV I-10 from New Orleans
Chlorophenylpiperazine -mCPP
Draft as of January 7, 2011
20
SubstanceSubstance DeathsDeaths ED ED ReportsReports
PrimaryPrimaryTx AdmitsTx Admits
Crime Crime LabsLabs
CocaineCocaine
South Florida Summary South Florida Summary JANUARY 2011JANUARY 2011
HeroinHeroin
Rx OpioidsRx Opioids
Rx Benzo’sRx Benzo’s
M thM th LL LL LL LLMethamMetham--phetaminephetamine
LowLow LowLow LowLow LowLow
MarijuanaMarijuana NANA
EcstasyEcstasyMiamiMiami--Dade BrowardDade Broward
BZP &BZP &MDMAMDMA
SOUTH FLORIDA EMERGING ISSUES:
• Role of street purity and price in decline of cocaine consequences
• New Injecting Drug Users naïve about infected syringes
• Retail network for current and future unregulated gsynthetic drugs
Draft as of January 7, 2011
21
The South Florida Report
January 2011
CommunityEpidemiologyWork Group
2
James N. HallSouth Florida Drug ObservatoryNova Southeastern University
