epidemiological presentation from Jim Hall. You will find “The South Florida Report January 2011.”

1. Draft as of January 7, 2011
The South Florida
Report
January 2011
Community
Epidemiology
Work Group
James N. Hall
N
South Florida Drug
Observatory
Nova Southeastern University
2
Santa
Holmes Jacks on
W
n
Rosa
gto
alto
Okaloosa
hin
Gadsden Nas sau
n
n
Escambia
as
so
Calhoun Hamilton
W
ffer
Leon Madis on
Bay
ia
Je
Baker Duval
mb
Liberty Wakulla
lu
Laf Suwannee
Co
Taylor
rd
ay Union St.
d fo
Franklin ette Clay
Gulf Johns
B ra
Gilchris t Alachua Putnam
Dixie
Palm
Flagler
Levy Marion
Volusia
FL=18.5
Citrus
Lake Seminole
Sumter
Hernando
Orange
1.3 Million
Pasco
Brev
Hillsborough Osceola
ard
Polk
Pinellas Indian River
Ok
Million
Manatee Hardee
e ec
ho
Highlands St. Lucie
be
Sarasota De Soto
e
Martin
Charlotte Glades
Hendry Palm Beach
Lee
Beach
Broward
Collier
Dade
Monroe
1.8 Million Broward
2.5
2 5 Million Miami-
US Census Bureau
2009 Population Estimates Dade
1

2. Draft as of January 7, 2011
DATA SOURCES JANUARY 2011
• Florida Medical Examiners Commission 2010 Interim
Report on Drugs Identified In Deceased Persons by Florida
p g y
Medical 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 2010
• Florida Youth Substance Abuse Survey 2010, Florida
Department of Children and Families.
2

3. Draft as of January 7, 2011
SOUTH FLORIDA TRENDS
BETWEEN 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
• Increasing Injecting Drug Use of Rx Opioids
• Methamphetamine: Low and Stable
• Marijuana: Student Use Up Perceived Risks Down
• Benzodiazepine: Deaths ED Reports
• 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
300
281
250
201
200 189
182
NUMBER of 160 162 155
149 151
COCAINE 150
144
OCCURRENCES 150
157
146 138
Including 138 136 135
“Present” & 100 121 120
“Cause of 94
Death” 80 Miami-Dade 82
50
Broward
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X
1h'10
SOURCE: Florida Medical Examiners Commission Interim
Report 2010
3

4. Draft as of January 7, 2011
Number of Cocaine Reports Detected Among
Decedents in Florida: Jan. 2000 - June 2010
2,500
1,943 2,052 2,179
2,000 1,702 1,791
1,3071,614 1,462
1,500 1,034 1,105
All Florida
1,000
1 000 1,206
1 206
500
NUMBER of
0
COCAINE
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X
OCCURRENCES 1h'10
Including 300
281
“Present” & 250
“Cause of 189 182 201
200
Death” 149 151 160 162 155
144 138
150
150 157 146
100 138 136 135
121 120
94 Miami-Dade 82
50 80
Broward
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 20092X 1h'10
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
# of Cocaine Detectio
Among Decedents s
1500
Cocaine Plus
1000
500
Cocaine Only
0
2X 1h
2001 2002 2003 2004 2005 2006 2007 2008 2009
'10
Cocaine Plus 801 942 1142 1269 1443 1520 1639 1,367 1,159 490
CocaineOnly 304 365 472 433 500 532 540 424 303 113
SOURCE: Florida Dept. of Law Enforcement, Florida Medical
Examiners Commission Reports 2001- 2010
4

5. Draft as of January 7, 2011
Number of Cocaine Reports Detected Among
Decedents in South Florida: Jan. 2000 - June 2010
300
281
250
201
200 189
182
NUMBER of 160 162 155
149 151
COCAINE 150
144
OCCURRENCES 150
157
146 138
Including 138 136 135
“Present” & 100 121 120
“Cause of 94
Death” 80 Miami-Dade 82
50
Broward
0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2X
1h'10
SOURCE: Florida Medical Examiners Commission Interim
Report 2010
5

6. Draft as of January 7, 2011
NUMBER OF ESTIMATE ED REPORTS BY
DRUG IN MIAMI-DADE AND
FT. LAUDERDALE DAWN DIVISIONS: 2009
16,000
tes
14,000
# of ED Report Estimat
12,000 Benzodiazepine 2,900
1,587
10,000 192 820 Opioids
2,899
8,000 3,375 MDMA (Ecstasy) 252
6,000 Marijuana 2,870
459
4,000
4 000 Heroin
H i
o
6,459
2,000 Cocaine 4,475
0
Miami-Dade Ft. Lauderdale
DAWN Divisions
SOURCE: SAMHSA-CBHSQ Dawn Estimates 2009 October 5, 2010
Rates per 100,000 of Cocaine Emergency Dept. Reports
Miami-Dade County: 2004-2009
600
541.1
500
Rates per 100,000
397.7 Miami-Dade 407.7 400.5
400
302.5
300
258.3
200
R
100
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
6

7. Draft as of January 7, 2011
Rates per 100,000 of Cocaine Emergency Dept. Reports
Miami-Dade County, and USA: 2004-2009
600
541.1
500
Rates per 100,000
397.7 Miami-Dade 407.7 400.5
400
302.5
300
183.7 183.5 258.3
200 162.2 163.6 158.4
USA
R
100 137.7
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
Rates per 100,000 of Cocaine Emergency Dept. Reports
Broward (2008), Miami-Dade, and USA: 2004-2009
600
541.1
500
Rates per 100,000
397.7 Miami-Dade 407.7 400.5
400
302.5
300
258.3
183.7 183.5 Broward
200 162.2 163.6 183.9
158.4 147
USA
R
137.7
100
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
7

8. Draft as of January 7, 2011
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
2007 Cocaine 67%
2007 20,913 10,449
2008 Cocaine 65%
2008 19,156 10,083
2009 Cocaine 62%
2009 15,309 9,403
2010 Cocaine 57%
2X1h '10 13,196 10,312
0 10,000 20,000 30,000 40,000
Number of Crime Lab Samples
Source: US DEA National Forensic Laboratory Information System
Percent of Primary Treatment Admissions by
Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% Alcohol Only
1999 2009
Alcohol w/drug
3% 1% 6.50% 2% 1%
Crack Cocaine 5%
5%
Other Cocaine 18%
28%
Marijuana 16%
Heroin 2% 11%
20%
Opioids
p
13% 10%
Amphetamines
31%
5% 18% Tranquilizers
4%
Other/Unknown
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS)
as reported by the Florida Department of Children and Families 09/30/2010
8

9. Draft as of January 7, 2011
Percent of Primary Treatment Admissions by
Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% Alcohol Only
1999 2009
1% 6.50% Alcohol w/drug
3% 2% 1%
Crack Cocaine 5%
5%
Other Cocaine 18%
28%
Marijuana 16%
Heroin 2% 11%
20%
Opioids
p
13%
Amphetamines
31% 10%
Tranquilizers
5% 4%
18% Other/Unknown
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS)
as reported by the Florida Department of Children and Families 09/30/2010
PRICE AND PURITY OF ALL
USA LAW ENFORCEMENT COCAINE PURCHASES
JANUARY 2006 - JUNE 2009
$200 80
$180
68.65 $174.38
70
$160 61.33
$158.01 60
Price/Pure Gram
$140
Percent Pure
$120 51.6 50
$116.36 48.6
$100 40
$94.05
$80 30
$60 Price/Pure Gram
P
20
$40 Purity
$20 10
$0 0
2006 2007 2008 1H 2009
Source: Based on unpublished US DEA System to Retrieve Information
from Drug Evidence (STRIDE) Data
9

10. Draft as of January 7, 2011
Percent of Primary Treatment Admissions by
Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
0.50% Alcohol Only
1999 2009
1% 6.50% Alcohol w/drug
3% 2% 1%
Crack Cocaine 5%
5%
Other Cocaine 18%
28%
Marijuana 16%
Heroin 2% 11%
20%
Opioids
p
13%
Amphetamines
31% 10%
Tranquilizers
5% 4%
18% Other/Unknown
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 HEROIN-INDUCED DEATHS
IN MIAMI-DADE & BROWARD COUNTIES, FL: 1996- JUN 2010
eaths
70
Miami-Dade
60
# Lethal Heroin De
Broward
50
40
30
20
10
10
8
L
0
SOURCE: Florida Medical Examiners Commission Interim Report 2010
10

11. Draft as of January 7, 2011
NUMBER OF HEROIN-INDUCED DEATHS
IN FLORIDA: 1996 - JUNE 2010
# Lethal Heroin Deaths
300 Florida
250 Miami Dade
Miami-Dade
200 Broward
150
100
50 50
0
SOURCE: Florida Medical Examiners Commission Interim Report 2010
NUMBER OF OPIATE-RELATED DEATHS
OPIATE-
BY HEROIN OR RX OPIOID IN FLORIDA: 2000-2010
2000-
4500
4000
3,986
Heroin 3 Rx Opioids
3500
# of Opiates Detected
3000 3 Rx Opioids
mong Decedents
The 3 Rx Opioids are
2500 Methadone,
2000 Hydrocodone, and
1500 Oxycodone
869
1000
500 Heroin
0 276 60
O
Am
SOURCE: Florida Medical Examiners Commission Reports 2000-2010
11

12. Draft as of January 7, 2011
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.
• 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
1200
941 1,007 1,117
NUMBER of 1000 869
Oxycodone 800 685 705
OCCURRENCES 568
Including
g
600 Florida
400
“Present” &
200
“Cause of
0
Death”
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
SOURCE: Florida Medical Examiners Commission Interim
Report 2010
12

13. Draft as of January 7, 2011
Number of Oxycodone Reports Detected Among
Decedents in Florida: Jan. 2007 - June 2010
1200
1000
1,007 1,117
800 869 941
600
685 705
400 568 Florida
NUMBER of 200
Oxycodone 0
OCCURRENCES 1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
Including 160
Palm Beach 136
“Present” & 140
124
Broward
“Cause of 120
96 103
Death” 100 Miami-Dade 88 89
84 77 91
80 88
60
60 70 47
40 49
20 36 30 30 36 33
0
9 16
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
SOURCE: Florida Medical Examiners Commission Interim
Report 2010
Percent of Primary Treatment Admissions by
Substance for the State of Florida:
1999 (n= 84,524) Compared to 2009 (n= 77,604)
Alcohol Only
0.50% 1999 2009
1% 6.50% Alcohol w/drug
2% 1%
3% Crack Cocaine 5%
5%
16% 18%
Other Cocaine
28%
Marijuana
Heroin 2% 11%
20%
Opioids
13%
Amphetamines
31% 10%
5% Tranquilizers
4%
18% Other/Unknown
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

14. Draft as of January 7, 2011
Number of Primary Addiction Treatment Admissions
for Prescription Opioids in Florida by Age: 1999 vs. 2009
Numb of Primary Addictio Treatment 3500
dmissions for Prescriptio Opioids
3000
1999 n= 2,165
2500
on
2009 n= 12,103
12 103
on
2000
1500
1000
500
ber
Ad
0
12- 18- 21- 26- 31- 36- 41- 46- 51- 56- 61-
66 &
17 20 25 30 35 40 45 50 55 60 65
over
yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs yrs
1999 n= 2,165 19 54 160 255 385 437 478 227 93 22 9 6
2009 n= 12,103 424 944 3243 3038 1670 1017 678 569 351 133 24 12
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
700
orts
600
State of Florida 1,117
1 117
# of Oxycodone Repo
500
423
400
320
300
238
200
131
o
100
1 5
0
<18 yrs. 18-25 yrs. 26-34 yrs. 35-50 yrs. >50 yrs.
Source: FDLE Florida Medical Examiners Commission Interim Report 2010
14

15. Draft as of January 7, 2011
Rates per 100,000 of Nonmedical Use Oxycodone
Emergency Dept. Reports Miami-Dade, Broward, and USA: 2004-2009
60
52.8
50
Broward 48.4
Rates per 100,000
40 37.8
34.5
30 25.4
21.7 USA
20 17.9
14.2
14
R
8.2 10.2
10 2
10
5.3 8 8.7 Miami-Dade
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
.
Rates per 100,000 of Oxycodone Nonmedical Use
Emergency Department Reports by Age Groups
DAWN Ft. Lauderdale Division vs. USA: 2009
180
153 158.1
160
Ra per 100,000
140
Broward & Palm Beach
120 106
100 117.3
92.6
80 88.6 USA 80.2 67.9 69.1
60 73.5 61.1
ate
62.9 47.1
40 43
20
0
18-20 yrs.21-24 yrs.25-29 yrs.30-34 yrs.35-44 yrs.45-54 yrs.55-64 yrs.
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
15

16. Draft as of January 7, 2011
Number of Alprazolam Reports Detected Among
Decedents in Florida: Jan. 2007 - June 2010
1200 1,035 942 1,021 986
1000 796 838
800 652
600
400 Florida
NUMBER of 200
Alprazolam 0
OCCURRENCES 1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
Including 160 151
Palm Beach 139
“Present” & 140
Broward
“Cause of 120 107 106
Death” 100 Miami-Dade 100
80 77
80 69
79 81
60 62 71 52
63 55
40 44 53
44 36
20
38
22
0
1H '07 2H '07 1H '08 2H '08 1H '09 2H '09 1H '10
SOURCE: Florida Medical Examiners Commission Interim
Report 2010
Rates per 100,000 of Nonmedical Use Rx Benzodiazepines
Emergency Dept. Reports Miami-Dade, Broward, and USA: 2004-2009
120
101.9
100
USA 89.3 95.2
Rates per 100,000
80 74.1 72.5
64.1 75.2 Broward
65.5
61.5 63.4
60 57.6 61.4
49
55.5 Miami-Dade
40
R
20
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
.
16

17. Draft as of January 7, 2011
Rates per 100,000 of Marijuana Emergency Dept. Reports
Broward (2008-09), Miami-Dade, and USA: 2004-2009
250
215.1
200
Rates per 100,000
177.7
177 7
157.7 Miami-Dade
145.8
150 136.3
123 135
97.3 102.3 122.6
96.1 94.6 96.9
100 94.2
USA
Broward
R
50
0
0
2004 2005 2006 2007 2008 2009
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)
Alcohol Only
0.50% 1999 2009
1% 6.50% Alcohol w/drug
2% 1%
3% Crack Cocaine 5%
5% Other Cocaine 16% 18%
28%
Marijuana
Heroin 2% 11%
20%
Opioids
p
13%
Amphetamines
10%
Tranquilizers
5% 31% 4%
18% Other/Unknown
SOURCE: US Dept. HHS-SAMHSA, CBHSQ: Treatment Episodes Data Set (TEDS)
as reported by the Florida Department of Children and Families 09/30/2010
17

18. Draft as of January 7, 2011
Synthetic Cannabinoids
•Widely Available
•Need for Laboratory Standards
- Crime Labs
- Urine Drug Tests
Rates per 100,000 of MDMA Emergency Dept. Reports
Broward (2008-09). Miami-Dade County and USA: 2004-2009
14
11.9
12
Miami-Dade
Rates per 100,000
10
8.8 8.6
7.9
Broward
8.3
8 7.7
5.9 7.3 7.4
6 5.6
4.2 5.9
3.8
4 3.5 USA
R
2
0
2004 2005 2006 2007 2008 2009
SOURCE: US Dept HHS-SAMHSA, CBHSQ: DAWN Emergency Dept. Estimates.
18

19. Draft as of January 7, 2011
65 PERCENT OF BROWARD CRIME LAB
ALLEGED ECSTASY IS BZP IN 2010
BZP
TFMPP ?
Be On ALERT
MEPHEDRONE… “Meow Meow”
MDPV I-10 from New Orleans
Chlorophenylpiperazine -
mCPP
19

20. Draft as of January 7, 2011
South Florida Summary JANUARY 2011
Substance Deaths ED Primary Crime
Reports Tx Admits Labs
Cocaine
Heroin
Rx Opioids
Rx Benzo’s
Metham-
Metham
M th - Low
L Low
L Low
L Low
L
phetamine
Marijuana NA
Ecstasy BZP &
Miami-
Miami-Dade Broward MDMA
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
g
synthetic drugs
20

21. Draft as of January 7, 2011
The South Florida
Report
January 2011
Community
Epidemiology
Work Group
James N. Hall
South Florida Drug Observatory
Nova Southeastern University
2
21