San Francisco Bay Area Drug Trends and Effective Intervention Strategies Alice Gleghorn, Ph.D County Alcohol and Drug Program Administrator San Francisco Department Of Public Health

HEROIN PRICE* AND PURITY *Price unit = per milligram pure 2001 $1.4010% 2002 $0.9912% 2003 $0.9811% 2004 $0.9811% 2005 $0.8912% 2006 $0.6910% 2007 $1.28 8% 2008 $ % 2009 $ % 2010 $ % 2011 $ % Source: DEA 2011 Heroin DMP, March 2011

Lab analysis of “Gunpowder” sample in 2012 found heroin, lidocaine, codeine, and morphine

San Francisco ED Reports Source: DAWN 2011(weighted data) Drugs Heroin 2,4243,1381,9941,9931,6161,2241, Opiates/opioids 1,0552,1721,7031,3691,7842,0432,4742,614 -Opiates,unspec NarcoticAnalges 8391,8041,3321,1521,5041,6491,8631, Buprenorphine/ ******** ---Codeine/combo 69******* ---Fentanyl/combo *****124* Hydrocodone/co Hydromorphone *****141* Methadone Morphine/comb Oxycodone/co

San Francisco ED Reports , % change Source: DAWN 2011 Percent Change (p < 0.05) vs vs vs Heroin2,4241, Opiates 1,0552,4742, Opiates, unspec Narcotic analges 8391,8631, Fentanyl/comb **171 --Hydrocodone/co Hydromorphone/ **180 --Methadone Morphine/comb Oxycodone/comb Drug Abuse Warning Network, 2011: Selected Tables of National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA, 2013

5 Bay Area Counties: 2012 Prescription Quantities By Drug Name

5 Bay Area Counties: Prescription Quantities Hydrocodone/APAP CURES Data provided by Mike Small, CA DOJ

Primary Drug Treatment Problem: Percent of total admissions 5 Bay Area Counties; FY Source: DHCS CalOMS Data System, Craig Chaffee

San Francisco Treatment Service Episode by Primary Drug Problem : FY0607 through FY1112 (Source: CBHS BIS Admission Data)

SAN FRANCISCO COUNTY PRIMARY DRUG AT TREATMENT ADMISSION PERCENTAGE BY AGE, [I] [I] [i] [i] Source: CalOMS Tx Data, Department of Alcohol and Drug Programs

1997: Treatment On Demand Treatment Expansion: Significant, sustained local funding increase Commitment to Harm Reduction approach: Reaching people wherever they are to reduce death and drug-related harm “Heroin Issues” subcommittee: –1. Hep C Prevention –2. Alternative Treatment modalities –3. Soft-Tissue Infection –4. OVERDOSE DEATH PREVENTION

TOD Heroin Issues Committee Actions: 1) Train Community Outreach & Syringe Exchange on overdose prevention education 2) Conduct broad public education campaign to increase overdose awareness 3) Target overdose response training for people at-risk of heroin overdose in jails, probation, and drug treatment programs 4) Test the feasibility and effectiveness of training heroin users to administer naloxone as an overdose death prevention tool

Drug Overdose Prevention Education (DOPE) Focus Overdose Risk Factors Recognizing Overdose signs Overdose response: –Call 911, Rescue Breathing, Recovery Position,& Follow Up Medical care Naloxone Pilot Program –2003- Naloxone distribution and refills 2010 – Intra-Nasal device Target populations –SROs, Jail, SEPs, –Residential and Opiate Treatment Programs –AB 109 (Prisoners released to communities) –Pharmacy/Primary Care, Pain medication

Deaths Involving Drug Abuse – DAWN SF Metropolitan Area Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 ( update) Heroin deaths: 1997= 297; 2010= 8