Prescription Drug Abuse/Misuse in Florida 2010 Florida Prevention Conference Orlando, Florida September 30, 2010 Hal Johnson, MPH Substance Abuse Program Office Florida Department of Children and Families

Outline ARCOS Rx Drug distribution volumes ARCOS Rx Drug distribution volumes FDLE – Medical Examiner data FDLE – Medical Examiner data Agency for Health Care Administration Emergency Department data Agency for Health Care Administration Emergency Department data DOH/AHCA Pain Clinic Registrants DOH/AHCA Pain Clinic Registrants Florida Youth Substance Abuse Survey Data Florida Youth Substance Abuse Survey Data 2

Automation of Reports and Consolidated Orders System (ARCOS) Department of Justice Department of Justice –Drug Enforcement Administration –Office of Diversion Control Rx drug manufacturers and distributors Rx drug manufacturers and distributors Schedules I and II, and narcotic and Gamma-Hydroxybutyric Acid (GHB) substances in Schedule III Schedules I and II, and narcotic and Gamma-Hydroxybutyric Acid (GHB) substances in Schedule III 3

4

Source: DEA ARCOS System 5

Medical Examiner Data Florida Department of Law Enforcement Florida Department of Law Enforcement Medical Examiners Commission Medical Examiners Commission –Reviews appointments/re-appointments of District Medical Examiners –Publishes semi-annual drug death report 6

Source: Drugs Identified in Deceased Person by Florida Medical Examiners, 2005 through 2009 Reports %

Source: Drugs Identified in Deceased Person by Florida Medical Examiners, 2005 through 2009 Reports. 8 94% higher than benzodiazepines 78% higher than benzodiazepines +45.8%

AHCA data description Quarterly Reporting by EDs and Hospitals Quarterly Reporting by EDs and Hospitals –Mandated by Florida Statutes –EDs – all visits not admitted to affiliated hospital –Inpatient hospitals – all discharges –Diagnoses recorded by ICD-9 codes (International Classification of Diseases) 9

Source: Florida Agency for Health Care Administration ED data sets and Inpatient data sets. 10

Source: Florida Agency for Health Care Administration ED data sets and Inpatient data sets. 11

Source: Florida Agency for Health Care Administration ED data sets and Inpatient data sets. 12

13 Source: Florida Agency for Health Care Administration ED data sets and Inpatient data sets.

Benzodiazepine poly- substance use Of those ED visits with a Benzo overdose: –59.0% also tested positive for an other drug or alcohol –53.9% tested positive for another drug –28.2% tested positive for Rx opiates –15.3% tested positive for a psychotropic –14.3% were diagnosed as alcohol intoxicated 14

Geographic “Problem” Areas Examine ED visit rates by county Examine ED visit rates by county Large counties Large counties –Substantially higher than FL –Slightly higher & next to substantially higher Smaller counties Smaller counties –Substantially higher & next to large problem county –Substantially higher in clusters Limited to counties Limited to counties 15

Florida counties with high rates of opiate overdoses 16

Florida counties with high rates of benzodiazepine overdoses 17

“Pill Mill” Locations 930 registered pain clinics in Florida 930 registered pain clinics in Florida –26 counties NO pain clinics –11 counties have 1-3 clinics –Remaining counties have 6 to over 100 Palm Beach – 115 Palm Beach – 115 Hillsborough – 119 Hillsborough – 119 Broward Broward Source : Source : 18

# Registered Pain Clinics per 100,000 Population clinics No clinics FL State = 4.94/100k

Florida Youth Substance Abuse Survey Pain killer trends Pain killer trends Amphetamine trends Amphetamine trends Depressant trends Depressant trends Steroid trends Steroid trends 20

21 On how many occasions in the past (30 days/year) have you used prescription pain relievers such as Oxcontin, Vicodin or Darvocet, without a doctor’s orders?

22 On how many occasions in the past (30 days/year) have you used depressants or “downers” like quaaludes, Xanax, barbiturates or tranquilizers? Xanax added to list

23 On how many occasions in the past (30 days/year) have you used amphetamines (including Ritalin, Adderall, etc.) without a doctor’s orders?

24 On how many occasions in the past (30 days/year) have you used steroids without a doctor’s orders?

Summary Volume of Rx opiates distributed in Florida is increasing dramatically Volume of Rx opiates distributed in Florida is increasing dramatically Opiate-related deaths increased 48.5% from Opiate-related deaths increased 48.5% from Benzo-related deaths increased 62.5% from Benzo-related deaths increased 62.5% from The rate of deaths related to opiates is % higher than benzodiazepines across years The rate of deaths related to opiates is % higher than benzodiazepines across years 25

ED visits for Rx opiates and benzodiaze- pines increased 50% from ED visits for Rx opiates and benzodiaze- pines increased 50% from There is an approximately equal number of opiate and benzo overdose ED visits There is an approximately equal number of opiate and benzo overdose ED visits The rate of benzo overdoses is highest in large metro areas and lowest in non-metro areas The rate of benzo overdoses is highest in large metro areas and lowest in non-metro areas 26 Summary

Summary White Floridians are 4 times more likely to overdose on opiates and benzos than black Floridians White Floridians are 4 times more likely to overdose on opiates and benzos than black Floridians For both opiates and benzos, there is a bi- modal age distribution of overdoses – peaking at and For both opiates and benzos, there is a bi- modal age distribution of overdoses – peaking at and Benzodiazepine use in combination with alcohol and/or other drugs is dangerous and is common among ED overdose diagnoses Benzodiazepine use in combination with alcohol and/or other drugs is dangerous and is common among ED overdose diagnoses 27

Summary Rates of opiate and benzodiazepine overdoses are highest in the peninsular coastal counties Rates of opiate and benzodiazepine overdoses are highest in the peninsular coastal counties Rates of benzodiazepine overdoses are also relatively high in the western panhandle and in the Jacksonville area Rates of benzodiazepine overdoses are also relatively high in the western panhandle and in the Jacksonville area There are nearly 1,000 registered pain clinics in Florida – 4.94 per 100,000 population There are nearly 1,000 registered pain clinics in Florida – 4.94 per 100,000 population 28

The densest concentration areas of “pill mills” are around Tampa Bay and Palm Beach/Fort Lauderdale The densest concentration areas of “pill mills” are around Tampa Bay and Palm Beach/Fort Lauderdale Prevalence of Rx drug use among Florida youth is low and decreasing Prevalence of Rx drug use among Florida youth is low and decreasing Youth use of amphetamines and steroids is very low Youth use of amphetamines and steroids is very low 29 Summary

Contact Information Hal Johnson DCF – Substance Abuse Program Office FYSAS: SEW: 30