Issues Impacting Broward Youth September 2014 Drug Abuse Patterns and Trends Update

James N. Hall, Epidemiologist Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University

Alcohol Use in Past 30-Days Source: CDC Youth Online High School YRBS Broward County, FL % 8% BrowardPrevention.org

Current (past 30-day) Alcohol Use Among Broward County Middle and High School Students Source: Florida Youth Substance Abuse Surveys

Current (past 30-day) Binge Drinking Among Broward County Middle & High School Students Source: Florida Youth Substance Abuse Surveys

Current Alcohol Use Among Broward Middle and High School Students by Gender Source: Florida Dept. of Children & Families Florida Youth Substance Abuse Surveys

Percent of Broward County High School Students Reporting Alcohol Use by Age 13 or Younger Source: Florida Youth Substance Abuse Surveys % Reporting Use by Age 13

Marijuana Data Bank 2014 Consumption Consequences Contributing Factors Colorado

Types of Drugs Used by Past Month Illicit Drug Users Aged 12 or Older: 2013 Marijuana and Some Other Drug n= 4,082,000 Marijuana Only n= 15,728,000 Only Drug is Other Than Marijuana n= 4,763,000 24,573,000 Illicit Drug Users (9.4%) Source: 2013 National Survey on Drug Use and Health

Annual Numbers of New Users of Marijuana USA: Thousands of New Users All Ages Sources: National Household Survey on Drug Use and National Survey on Drug Use and Health Under % ( 1.4 million in 2012) million

Percent of High School Students Reporting Any Past 30-Day Marijuana Use USA & Broward County: Source: Centers for Disease Control and Prevention: Youth Risk Behavior Surveillance Percent Reporting Current Use

% of high School Students reporting Past 30 Day Use Past 30 Day Use of Marijuana among Broward County high school Students From YRBS (Odd # Years) and FYSAS (even # Years) Sources: Youth Risk Behavior Surveillance System (US CDC&P) and Florida Youth Substance Abuse Survey (FL-DCF)

Percent Reporting Current Use Source: Centers for Disease Control and Prevention: Youth Risk Behavior Surveillance Percent of Broward High School Students Reporting Any Past 30-Day Marijuana Use By Demographic Groups:

Current (past 30-day) Marijuana Use Among Broward County Middle and High School Students Source: Florida Youth Substance Abuse Surveys

Percent of Broward County High School Students Reporting Marijuana Use by Age 13 or Younger Source: Florida Youth Substance Abuse Surveys % Reporting Use by Age 13

Addiction is a Developmental Disease: It Starts Early 57% 1.5% 5.5% < >25 36% First Marijuana Use, (Percent of Initiates) Source: US Dept HHS: SAMHSA National Survey on Drug Use & Health 2011 Percent of First Time Marijuana Users By Age

A major concern about marijuana use among youth is the link between its early first use and life-long drug dependency and addiction problems. Nearly 13 percent of adults who met the criteria for drug abuse or dependency in the past year first used marijuana by age 14 or younger as compared to 2 percent of those who did not use marijuana for the first time until age 18 or older. (Source: US Department of HHS: SAMHSA 2011 National Survey on Drug Use and Health, Released August 2012.)

Percent of Past Year Drug Dependence or Abuse Among Adults Aged 18 or Older By Age of First Marijuana Use: 2011 Source: SAMHSA-National Surveys on Drug Use and Health yrs. Or Younger 18 or Older

Percent of Past Year Serious Mental Illness Among Lifetime Marijuana Users Aged 18 or Older By Age of First Marijuana Use: 2002 and 2003 Source: SAMHSA-National Surveys on Drug Use and Health < 12 yrs yrs yrs. 18 or Older

Perceived Attitudes about Marijuana Among Broward County Middle and High School Students Source: Florida Youth Substance Abuse Surveys

Percent of high school students having ridden or driven in the past 30 days with or as driver having used marijuana or alcohol RODE with Driver who had used marijuana or alcohol DROVE after using marijuana or drinking alcohol % Reporting Source: FL-DCF Florida Youth Substance Abuse Survey

“Budder” Beware: Dangers of Marijuana Wax Marijuana Wax “Budder,” or Butane hash oil, or even “ear wax hash” Produced by soaking marijuana plant material in a solvent such as butane which extracts various cannabinoids of the plant.

Percent of High School Males Reporting Having Used Synthetic Marijuana Florida and Broward County Source: Florida Youth Substance Abuse Survey 2012

Thirty-four percent or 1/3 of High School Seniors who say that they have used marijuana in the past year who live in the states that have passed medical marijuana laws report that one of their sources of marijuana is another person's medical marijuana prescription. And 6 percent say they get it from their own prescription. It thus appears that state medical marijuana laws provide an additional avenue of accessibility to the drug for teens. (Source: US Department of HHS: NIH-NIDA 2013 Monitoring the Future Survey Released December 2013)

2006 to 2011 USA up 13 % Colorado Up 44% Ages years Source: SAMHSA-National Survey on Drug Use and Health 2011

The Question for Doctors……..

How a Bill becomes Law How a Pill becomes Medicine US Food and Drug Administration Clinical Trials FDA Medical Review FDA Medical Panel Approval

Kevin Sabet, Ph.D. Or Go To and Search “Commission on Substance Abuse”

Rx Nonmedical Use in Florida Responding to an Epidemic

Florida’s Response July 2010 – Senate Bill 2272 Legal authority to close “Pill Mills” and limited practitioner dispensing of CS Schedule II to 3-day supply August 2010 – Tamper-resistant OxyContin®. March 2011 – Law Enforcement Strike Force July House Bill 7095 Comprehensive law bans practitioner dispensing of CS II and new regulations. Permits PDMP to operate.

Lethal Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida Jan 2008 to Jun 2013 Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan Jun 2013 Reports # “Cause of Death” Occurrences House Bill 7095 Takes effect CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force

Number of Nonmedical Rx Opioids and Benzodiazepine Reports Detected among Decedents in Florida 2005 – 2x1h2013 # of Drugs Detected Among Decedents House Bill 7095 Takes effect CS-II Dispensing Limits and OxyContin Tamper Resistant Strike Force Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan Jun 2013 Reports

Number of Unique Patients Identified By Threshold Levels Number of Prescribers and Number of Pharmacies by Quarter Level 5 Level 6 Level 7 Level 8 Levels 9, Source: Annual Report Florida’s Prescription Drug Monitoring Program (PDMP) 3, Prescribers & 5 Pharmacies 2,864 1,415 1, % Decrease

Hydromorphone (e.g., Dilaudid ® ) STATE TOTAL GRAMS GRAMS/ 100K POP 1FLORIDA270, , DELAWARE10, , VERMONT6, CONNECTICUT34, VIRGINIA67, MONTANA8, NEW HAMPSHIRE10, MARYLAND43, WASHINGTON48, OREGON27, # of Deaths 2013 ARCOS Grams Sold Per 100/Population Source: US DEA ARCOS 3 Report 4 March 5, 2014 Source: Florida Medical Examiners Commission South Florida Crime Lab Cases Up 950-%

Exhibit 5 Number of Heroin-related Deaths in Florida: 2000 – 2x1h2013 SOURCE: Florida Medical Examiners Commission Reports # Heroin Occurrences

Top 10 Most Frequently Identified Drugs of Total Reports from South Florida Crime Labs Reports CY 2013 Drug 2013 % Δ vs Cocaine 10,147 Down 11 % Marijuana/Cannabis/THC 5,276 Down 2 % Methylone (N-Methyl-3,4- Methylenedioxycathinone) 1,194 Up 208 % Hallucinogen 984 Up 88 % Rx Opioids 933 Down 4 % Heroin 925 Up 33 % Rx Benzodiazepines 849 Down 4 % Methamphetamine 211 Up 24 % Phenylimidothiazole Isomer 154 Down 37 % Caffeine 131 Down 45 % All Other Analyzed Drugs 2,272 Down 18 % Total 23,069 Down 3 % SOURCE: US DEA: National Forensic Laboratory Information System DQS on May 9, 2014

South Florida Crime Labs Reports SOURCE: US DEA: National Forensic Laboratory Information System DQS on May 9, 2014 Emerging Psychoactive Substances 2011–2013 Number of Different Drugs

* The synthetic cathinones mephedrone and methylone act on the brain like MDMA * Number of Items

(DIED) Fake Drugs; Real Poisons Click On -Data Central Presentations: October 2012