Harolyn Tarr, MPH Manager and Principal Epidemiologist Detroit Department of Health and Wellness Promotion

 Review the burden of heroin and prescription drug mortality (deaths) and morbidity (hospitalizations and treatment)  Review patterns in narcotic law arrests in Macomb County  Understand heroin and prescription drug use among youth and young adult population in Macomb County

 Drug abuse is associated with numerous negative health and social outcomes which include:  increased mortality, injuries, overdose, sexually transmitted infections, spontaneous abortions, hepatitis, liver and cardiovascular diseases, and other life-threatening conditions.  Social consequences of drug abuse are also significant which include:  loss of employment and productivity, school failure, increased crime and imprisonment, decreased safety, family disintegration, domestic abuse, child abuse, and mental and physical disabilities (Williams, 2007).  NIDA (2008) estimates the total overall cost of drug abuse in the United States to exceed half a trillion dollars; approx. $181 billion for illicit drugs, $168 billion for tobacco, and $185 billion for alcohol. National Institute on Drug Abuse (NIDA)

 Opioids sometimes referred to as narcotics is a drug that produces analgesic and sedative effects.  Although Opioids are often prescribed and manufactured as medications, they can be manufactured and obtained illegally.  Opioids are generally separated into two categories:  1) Heroin and  2) Opioids other than heroin, which consist almost entirely of prescription pain relievers

 Opioid abuse poses the greatest drug-related threat to Macomb County.  Opioid poisonings accounted for 59 percent of drug-related deaths in Macomb County in  Between 2004 and 2008, there was a 102 percent increase in opioid poisoning deaths in the County. Source: Michigan Department of Community Health, Division of Vital Statistictics

Table 1. Macomb County Number of Drug-related Deaths by Selected Drug Category, Drug Type Cocaine Heroin Prescription Drug Methadone (Illicit)83693 Unspecified Narcotics02351 Michigan Department of Community Health, Division of Vital Statistics,

 Heroin is notably the greatest drug threat to communities and its abuse remains widespread, affecting both suburban and urban areas.  Demand for heroin is high and easily accessible.  The popularity of heroin is due, in part, to increased availability, low cost, and high purity which can be effectively snorted or smoked rather than injected.  Heroin is sold on the street in small glassine bags with some type of marking or brand name on the package. Office of National Drug Control Policy Clearinghouse, 2008

 Heroin deaths, hospitalizations, and treatment admissions are on an increasing trend.  The County-wide heroin poisoning death rate was 6.26 in 2008, a 200 percent from 2004 to  In 2008, heroin accounted for 63 percent of the total opioid related poisoning deaths in the County.

 Heroin deaths and hospitalizations are higher among males compared to females:  Deaths Rate: 5.74 deaths per 100,000 population among males and 1.38 deaths per 100,000 population among females.  Hospitalization Rate: 7.3 hospitalizations per 100,000 for males and 4.0 hospitalizations per 100,000 population for females.

 Persons aged years had the highest heroin poisoning death rate at 8.97 deaths per 100,000 population, followed by persons age years at 6.01 per 100,000 population.  Persons aged years are hospitalized at a higher rate (14.5 hospitalizations per 100,000) compared to persons aged years (9.1 hospitalizations per 100,000 population) and persons years (4.6 hospitalizations per 100,000 population).

Heroin Poisoning Deaths by Macomb Zip Codes and Cities, Combined Years ZIP CodeCity2007 Population# of Deaths 5 year Death Rate per 100, Eastpointe Clinton Township Clinton Township Mount Clemens Roseville Saint Clair Shores Warren Warren Warren Sterling Heights Sterling Heights Utica Zip codes with five or more deaths occurring during

Heroin Poisoning Hospitalizations by Macomb Zip Codes and Cities, Combined Years ZIP CODECity2007 Population # of Hospitalization year Hospitalization Rate per 100,000 population 48015Center Line Eastpointe Fraser Clinton Township Clinton Township Mount Clemens Harrison Township New Baltimore Romeo Roseville Saint Clair Shores Saint Clair Shores Saint Clair Shores Warren Warren Warren Warren Warren Sterling Heights Sterling Heights Sterling Heights Sterling Heights Utica Utica

 The city of Warren had the highest number of heroin poisoning deaths (37 total deaths at 5.5 deaths per 100,000 population) during the period of  However, the city of Roseville had a higher heroin death rate at 5.7 deaths per 100,000 (14 total deaths) over the five year period.  Warren and Roseville also experience the highest hospitalization rates, and 10.6 per 100,000 population, respectively.

 Non-medical use of prescription drugs is an emerging trend and has captured national and media attention.  Studies have showed a significant increase in prescription for pain relievers such as Vicodin, Hydrocodone, OxyContin over the past five years.  Data from the Michigan Automated Prescription Service (MAPS) reports that 15,989,795 prescriptions were written in 2006; this number increased to 17,254,281 in 2008  National studies also confirmed that giving away and loaning of prescription pain relievers are prevalent among youth and young adult populations. State Epidemiology Workgroup, 2010

 Prescription pain relievers accounted for 32 percent of the total opioid involved poisoning deaths in  Prescription pain reliever death rates have been on a declining trend since 2006 while hospitalization rates due to prescription pain reliever poisonings are currently on an increasing trend.

Macomb County Number of Drug-related Deaths by Selected Drug Category, Drug Type Cocaine Heroin Prescription Drug Methadone (Illicit)83693 Unspecified Narcotics02351 Michigan Department of Community Health, Division of Vital Statistics,

 In 2008 death rate due to prescription pain reliever poisonings was 1.57 deaths per 100,000.  Hospitalization rates was 16.3 hospitalizations per 100,000 population, a rate two times higher than the heroin hospitalization rate.

 Prescription pain reliever poisoning deaths were higher among males (2.8 deaths per 100,000 population) when compared to females (1.81 deaths per population).  However, hospitalizations are higher among females (7.9 hospitalizations per 100,000 population) when compared to males (6.42 hospitalizations per 100,000 population) for the five year period of

 Deaths were highest among persons aged years (4.75 deaths per 100,000 population), followed by persons aged years (3.83 per 100,000 population) for the period of 2004 to  Hospitalizations were highest among persons aged years (12.0 per 100,000 populations), followed by persons 65 years and older (11.19 per 100,000) for the period of 2004 to 2008.

 For the period of 2004 to 2008, the city of Warren had the highest number of prescription pain reliever poisoning deaths (26 deaths, a rate of 3.87).  However, the city of Eastpointe had a higher death rate (5.4 deaths per 100,000 population), followed by Roseville (5.0 deaths per 100,000 population) and Sterling Heights (4.88 deaths per 100,000 population).

Pain Reliever Poisoning Deaths by Macomb Zip Codes and Cities, Combined Years Zip CodeCity2007 Population # of Deaths Year Death Rate per 100,000 Population 48021Eastpointe Clinton Township Macomb Roseville Saint Clair Shores Warren Warren Warren Sterling Heights

Prescription Pain Reliever Poisoning Hospitalizations by Macomb Zip Codes and Cities, Combined Years ZIP CODECity2007 Population # of Hospitalization year Hospitalization Rate per 100,000 population 48015Center Line Eastpointe Fraser Clinton Township Clinton Township Clinton Township Macomb Mount Clemens Macomb Harrison Township New Baltimore New Haven New Baltimore Richmond Romeo Roseville Saint Clair Shores Saint Clair Shores Saint Clair Shores Warren Warren Warren Warren Warren Washington Sterling Heights Sterling Heights Sterling Heights Sterling Heights Utica Utica Utica

 Macomb County ranked second among the regional coordinating agencies for highest number of opiate involved treatment admissions.  There was a 12.2 percent increase in opiate involved treatment admissions from 2008 (5,673 admissions) to 2009 (5,058 admissions).  Of the 2009 total treatment admissions in Macomb County for all substance type, heroin admissions were highest (36 percent), followed by admissions due to alcohol abuse (31 percent); and 11 percent of the treatment admissions were due to prescription pain relievers.

 A higher proportion of males (59.8 percent) were in treatment compared to females (42.2 percent) for opiate involved drug abuse in 2009  Persons aged years accounted for the largest proportion (22.3 percent) of those in treatment for opiate involved drugs, followed by persons age years (16.4 percent).

 There were 43,496 arrests made for non- indexed crimes.  Of those, approximately 20 percent were due to arrests made for violation of narcotic laws (3,980 total arrests), violation of liquor laws (915 arrests) or driving under the influence of alcohol or narcotics (3,530 arrests).

 Consistent with Michigan and the U.S. trends, males are arrested at a higher rate compared to females for narcotic law violations:  80 percent of the narcotic law arrests among males (2,670 arrests) and 20 percent for females (666 arrests).  Persons aged consist of only 4.1 percent of the total population in 2006, however 35 percent of the total narcotic law arrests (1,100) made were among this age group.  There were 142 narcotic law arrests made to persons under 18 years of age.

 Geographically, there were more narcotic law arrests made by the city of Warren Police Department compared to all other Department in the County.  In 2006, 25 percent (1,008 total) of the narcotic law arrests were made by the city of Warren Police Department. Eastpointe had the second highest number of arrests made (327 arrests); followed by St. Clair Shores with 245 total arrests.  There were no narcotic law arrests reported in the cities of Armada, Memphis, or Mount Clemens. In addition, the Macomb Sheriff made 504 arrests, Countywide.

 In 2008, 8.0 percent (20 million people) of persons 12 or older were current illicit drug users (NSDUH).  Of youth aged 12-17, 9.3 percent reported current illicit drugs user within the past month.  Nationally, marijuana continues to be the most frequently used illicit drug among persons 12 or older at 6.7 percent, followed by psychotherapeutics at 2.9 percent; inhalants (1.1 percent) and hallucinogens (1.0 percent).  In 2008, 1.9 percent of persons aged 12 or older reported non-medical use of pain relievers, nationally.

 Five (5) percent of youth age reported current illicit drug use other than marijuana during the period , an 8.5 percent increase from the period of in Macomb County (NSDUH).  Illicit drug use was highest among person aged years (9.6 percent) compared to persons aged years (5.0 percent) and person aged 26 or older (2.8 percent).  Macomb County residents aged years also presented higher current illicit drug use rates when compared Michigan (9.3 percent) and the U.S. (8.5 percent) rates for current use (NSDUH).

 There was an increase in heroin use among Macomb high school students from 1.9 percent in 2007 to 3.4 percent in 2009 (YRBS).  Macomb students also reported higher heroin use than the national rate (2.5 percent) but lower than Michigan’s rate of five (5) percent.  There was a decrease in current non-medical use of prescription pain relievers among Macomb students from the period of 2008 to 2010 (MiPHY).

 Persons aged years also reported higher rates of past year non-medical use of pain relievers (15.4 percent) when compared to persons aged years (7.6 percent) and persons 26 or older (4.3 percent) for the period of (NSDUH).  Rates among this age group was higher in Macomb when compare to the U.S. (12.2 percent) and Michigan (13.9 percent).

 Boyd et. al found that 36 percent (or 965) of the students who had a prescription for;  sleeping medication (Ambien, Halcion, Restoril),  sedative or anxiety medication (Ativan, Xanax, Valium, Klonopin),  stimulant medication for attention-deficit/hyperactivity disorder (Ritalin, Adderall)  pain medication (Vicodin, OxyContin, Tylenol 3).  Opioid pain medications were more widely prescribed (46 percent lifetime and 33 percent past year prescription).  Girls were significantly more likely to a have a prescription for pain medication and more likely to use them non- medically than boys.

 The study also showed current medical users were 2.9 times more likely to get approached to divert their medications and there was evidence of trading medications.  Students were also more likely to give away or loan medications rather than trade or sell:  25 percent of those with pain medication prescription;  21 percent with stimulants;  20 percent of those with sleep medications;  and 15 percent with prescription for sedatives.  Overall 24 percent of those with prescription medication gave away or loaned the medication with higher percentage of giving away reported among girls compared to boys.

 Conduct ongoing community assessments;  Utilize data to target those in greatest need;  Build collaborative partnerships;  Utilize evidence-based and best practice interventions;  Tap into the best analytical thinkers (federal, state, community-based organization, academic institutions);  Provide effective, progressive leadership

 Contact Information Harolyn Tarr, MPH Manager and Principal Epidemiologist Detroit Department of Health and Wellness Promotion Office of Health Information, Planning, Policy, Evaluation, and Research (HIPPER) 1151 Taylor St. Room 354C Detroit, MI Phone: (313)