Florida Drug Trends Update November 2015

Florida Drug Trends Update November 2015
Progress and Challenges James Hall Epidemiologist Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University This product is supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.

Overview – Part I Progress and Challenges Underage Drinking
Nicotine and E-cigarettes Vaping Marijuana -Wax and Dabbing VI. Novel Psychoactive Substances – Cannabinoids VII. Cocaine

Overview – Part II Methamphetamine Heroin and Clandestine fentanyl
Novel Psychoactive Substances - Synthetic Cathinones Other Novel Psychoactive Substances - Tryptamines - Piperazines, et al Non-Medical Misuse and Abuse of Medications Opioids Prescription Benzodiazepines Kratom

Progress Historical Declines in Underage Drinking and
Cigarette Use among Youth

Exhibit 1 Any Alcohol Use in Past 30 Days Among Youth
Aged Years in the USA and Florida: % Reporting Use in Past 30 Days Source: National Survey on Drug Use and Health Substate Data

Aged 12-20 years in the USA and Florida: 2002 - 2012
Exhibit 2 Binge Alcohol Use in Past 30-Days Among Youth Aged years in the USA and Florida: % Reporting Binge Drinking in Past 30 Days Source: National Survey on Drug Use and Health Substate Data

Exhibit 3 Comparison of Alcohol Use and Binge Drinking Among Florida High School Students as Tracked by the Youth Risk Behavioral Surveillance Survey (YRBSS) and the Florida Youth Substance Abuse Survey (FYSAS) YRBS High School % Reporting Alcohol Use FYSAS High School % Reporting Alcohol Use

Appendix A: Needs Assessment Exhibit 2
Exhibit 4 Current (Past 30-Day) Any Alcohol Use and Binge Drinking (past two weeks) Among Florida Middle and High School Students: 2014 Note: Binge Drinking rate is on any occasion in past two weeks Source: Florida Youth Substance Abuse Surveys Visit Data Central

27.1 % 9.4 %

12.5 % 3.4 %

DCF Managing Entity Regions
Northwest - Circuits 1,2,14 Northeast - Circuits 3-4,7-8 Central - Circuits 5,9,10,18 Sun Coast - Circuits 6, 12, 13, 20 Southeast - Circuits 15, 19 Broward - Circuit 17 Southern – Circuits 11, 16

Populations Age 12 and Above in Florida’s Managing Entity Regions

% Reporting Alcohol Use
Exhibit Current (Past 30-Day) Any Alcohol Use Among Florida Middle and High School Students: % Reporting Alcohol Use Source: Florida Youth Substance Abuse Surveys

% Reporting Binge Drinking
Exhibit 6 Percent of Florida Middle and High School Students Reporting Binge Drinking in Past Two Weeks % Reporting Binge Drinking Source: Florida Youth Substance Abuse Surveys

Table 3 Number of Primary Alcohol Treatment Admissions
Among Florida Juveniles and Young Adults in FY By Managing Entity Regions Age 17 and Under Young Adult Age 18-25 Total Northwest 32 393 425 Northeast 26 283 309 Central 18 155 173 Suncoast 188 432 620 Southeast 12 160 172 Broward 6 86 92 Southern 16 191 207 All Florida 298 1,700 1,998 Source: Florida Department of Children and Families July 2014 through June 2015

Admissions in FY 2014-2015 By Managing Entity Regions
Table 4 Number of Florida Primary Alcohol Treatment Admissions in FY By Managing Entity Regions Alcohol FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 2,383 2,877 1,504 4,565 1,305 980 1,605 15,219 Female 1,010 1,268 830 2,324 494 454 911 7,291 Total 3,393 4,145 2,334 6,889 1,799 1,434 2,516 22,510 By Age 17 and Under 32 26 18 188 12 6 16 298 18-25 393 283 155 432 160 86 191 1,700 26-34 768 937 458 1,286 315 309 571 4,644 35 and Up 2,200 2,899 1,703 4,983 1,312 1,033 1,738 15,868 % of all admits 39.7% 37.2% 31.6% 31.5% 33.1% 31.4% 35.6% 34.1% Source: Florida Department of Children and Families July 2014 through June 2015

Students reporting Cigarette Use in the Past 30-Days: 2004 - 2014
Exhibit Percent of Florida Middle and High School Students reporting Cigarette Use in the Past 30-Days: % Reporting Cigarette Use Source: Florida Youth Substance Abuse Surveys

6.4 % 1.7%

% Reporting Cigarette Use
Exhibit Current (Past 30-Day) Cigarette Use Among Florida Middle and High School Students: % Reporting Cigarette Use Source: Florida Youth Substance Abuse Surveys

Students Reporting Cigarette Use in Past 30-Days 2004 2006 2008 2010
Table 5 Percent of Florida Middle and High School Students Reporting Cigarette Use in Past 30-Days 2004 2006 2008 2010 2012 2014 Northwest 14.2 13.2 12.7 11.4 9.1 6.3 Northeast 12.9 10.4 9.7 9.5 7.5 5.9 Central 11.9 10.7 10.1 9.9 7.2 5.6 Suncoast 13.3 11.1 10 6.8 5 Southeast 8.5 4.7 3.9 Broward 7.8 5.4 4.2 2.7 Southern 8.2 8.4 6 6.4 5.2 2.9 All Florida 10.6 8.8 6.6 4.9 Source: Florida Youth Substance Abuse Surveys

Challenges Maintaining Historical Declines in Underage
Drinking and Cigarette Use among Youth Everything else including: E-Cigarettes, Vaping, Marijuana, Synthetic Cannabinoids, Cocaine, Synthetic Cathinones, Methamphetamine, Heroin, Novel Psychoactive Drugs, Prescription Drug Abuse, and Kratom

Question: What was the Oxford English Dictionary's 2014 Word of the Year?

Answer: The Oxford Dictionary’s 2014's Word of the Year was "vape,“ the verb used to describe inhaling and exhaling vapors produced by an electronic cigarette or similar device. Vape originated as an abbreviation of vapor or vaporize, according to the Oxford Dictionary. Oxford explained: “You are thirty times more likely to come across the word vape than you were two years ago, and usage has more than doubled in the past year.”

Electronic Smoking Device

The Monitoring the Future (MTF) Survey reported more teens used e-cigarettes than traditional, tobacco cigarettes in 2014. E-cigarettes may serve as a point of entry into the use of nicotine. The percentages of all youth in each grade who used e-cigarettes in the prior 30-days, but had never smoked a cigarette in their lives, ranged nationally from 4 percent to 7 percent in 8th, 10th, and 12th grades.

% Reporting Marijuana Use
Exhibit 8 Current (Past 30-Day) Marijuana Use Among Florida Middle and High School Students: % Reporting Marijuana Use Middle and High Combined Middle School Source: Florida Youth Substance Abuse Surveys

Exhibit 9 Comparison of Current (Past 30 Day) Marijuana Use Among Florida High School Students as Tracked by the Youth Risk Behavioral Surveillance Survey (YRBSS) and the Florida Youth Substance Abuse Survey (FYSAS) % Reporting Marijuana Use YRBS High School % Reporting Marijuana Use FYSAS High School

% Reporting Marijuana Use
Exhibit Current (Past 30-Day) Marijuana Use Among Florida Middle and High School Students: % Reporting Marijuana Use Source: Florida Youth Substance Abuse Surveys

Reporting Current (Past 30-Day) Marijuana Use 2004 2006 2008 2010 2012
Table 6 Percent of Florida Middle and High School Students Reporting Current (Past 30-Day) Marijuana Use 2004 2006 2008 2010 2012 2014 Northwest 12.9 12.6 13.4 11.7 11.2 Northeast 13 10.8 11.3 14.3 12.3 12.2 Central 10.5 12.5 12.4 Suncoast 13.6 12.7 13.8 Southeast 10.7 9.2 10.3 12.8 Broward 10.2 7.3 9.4 10.6 11 Southern 8.8 9.5 11.6 All Florida 11.5 11.4 11.1 Source: Florida Youth Substance Abuse Surveys

17.9 % 3.7 %

Exhibit 11 Any Marijuana Use in Past 30 Days Among Persons
Aged 12 and Above in the USA and Florida: % Reporting Use in Past 30 Days Source: National Survey on Drug Use and Health Substate Data

Table 7 Number of Florida Primary Marijuana Treatment
Admissions in FY By Managing Entity Regions Marijuana FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 1,491 1,332 826 2,749 1,146 738 786 9,068 Female 624 639 407 1,090 454 338 370 3,922 Total 2,115 1,971 1,233 3,839 1,600 1,076 1,156 12,990 By Age 17 and Under 576 964 604 2,210 775 295 553 5,977 18-25 711 409 259 823 415 340 304 3,261 26-34 466 360 198 463 242 250 182 2,161 35 and Up 362 238 172 343 168 191 117 1,591 11,019 % of all admits 24.7% 17.7% 16.5% 17.5% 29.5% 23.6% 16.4% 19.7% Source: Florida Department of Children and Families July 2014 through June 2015

“Budder” Beware: Dangers of 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.

Marijuana Pens

22 Kinds of Synthetic Cannabinoids
Novel Psychoactive Substances 22 Kinds of Synthetic Cannabinoids JWH Series – (John W. Huffman) 8 types in Florida AM 2201 UR-144 XLR-11 PB-22 AB-FUBINACA AB-PINACA And 8 Others in Florida Jim Hall

Exhibit 13 Synthetic Cannabinoids Crime Lab Cases in Florida: 2010-2014
2,087 1,996 1,209 Number of Crime Lab Reports 9 Source: Analysis of US DEA - National Forensic Laboratory System Data

Novel Psychoactive Substances (NPS)

Pharmacology of Synthetic Cannabinoids
Effects felt almost immediately Onset of action is seconds to minutes Duration of effects: last 30 minutes – 1 hour Tolerance and Dependency develops More drug needed for same effect Full and potent agonists at CB1 Receptors Greater receptor affinity than THC ( Xs) As compared to THC, synthetic cannabinoids produce much more intense responses with smaller amounts of the drug Quest Diagnostics

Novel Psychoactive Substances
785 167 182 1,301 381 140 Jim Hall

% Reporting Synthetic Marijuana Use
Exhibit Percent of Florida High School Students Reporting any Past 30-Day Use of Synthetic Marijuana by DCF Managing Entity Regions: 2012 vs. 2014 % Reporting Synthetic Marijuana Use 2015 = 1.0 % Source: Florida Youth Substance Abuse Surveys 2012 and 2014

2000-2014 Exhibit 22 Number of Cocaine Deaths in Florida :
Source: Florida Medical Examiners Commission 2014 Annual Report

NADDI Southern Regional Training
Exhibit 23 Rates per 100,000 of Cocaine-Related Deaths by Florida Managing Entity Regions: 2014 Rate per 100,000 population Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report Jim Hall

Exhibit 24 Cocaine Deaths in Florida by Managing Entity
Regions # of Cocaine Deaths Source: Florida Medical Examiners Commission 2014 Annual Report

Table 13 Number of Florida Primary Cocaine Treatment
Admissions in FY By Managing Entity Regions Cocaine FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 353 350 250 502 584 327 178 2,554 Female 232 426 274 472 320 179 238 2,141 Total 585 776 524 974 904 506 416 4,685 By Age 17 and Under 7 5 10 22 4 57 18-25 72 79 64 123 122 52 63 575 26-34 139 233 149 304 253 124 117 1,319 35 and Up 367 459 301 525 325 2,734 % of all admits 6.8% 6.9% 7.1% 4.4% 16.6% 11.1% 5.9% Source: Florida Department of Children and Families July 2014 through June 2015

Overview – Part II Methamphetamine Heroin and Clandestine fentanyl
Novel Psychoactive Substances - Synthetic Cathinones Other Novel Psychoactive Substances - Tryptamines - Piperazines, et al Non-Medical Misuse and Abuse of Medications Opioids Prescription Benzodiazepines Prescription Stimulants - Over the Counter Kratom

Exhibit 25 Number of Methamphetamine-Related Deaths
in Florida: # of Methamphetamine -Related Deaths Source: Florida Medical Examiners Commission Annual Reports

Table 14 Number of Florida Primary Methamphetamine
Treatment Admissions By Managing Entity Regions FY Metham-phetamine FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 386 140 43 420 21 33 4 1,047 Female 467 139 45 563 1 17 1,249 Total 853 279 88 983 22 50 2,296 By Age 17 and Under 15 3 6 24 2 54 18-25 179 57 16 294 5 9 566 26-34 357 101 46 393 8 931 35 and Up 302 118 20 272 745 % of all admits 10.0% 2.5% 1.2% 4.5% 0.4% 1.1% 0.3% 3.5% Source: Florida Department of Children and Families July 2014 through June 2015

Exhibit 19 Number of Heroin Deaths in Florida: 2000 to 2014
Source: Florida Medical Examiners Commission 2014 Annual Report

Exhibit 20 Rates per 100,000 of Heroin-Related Deaths by Florida Managing Entity Regions: 2014 Rate per 100,000 population Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report Jim Hall

Managing Entity Regions: 2002-2014
Exhibit 21 Number of Heroin-Related Deaths by Florida Managing Entity Regions: # of Heroin Deaths Source: Florida Youth Substance Abuse Surveys

Managing Entity Regions: 2000-2014
Table 10 Number of Heroin-Related Deaths by Florida Managing Entity Regions: 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Northwest 2 1 6 16 Northeast 10 11 7 3 5 4 14 21 23 Central 43 44 36 49 27 22 8 25 19 30 56 131 Suncoast 59 69 87 73 47 29 34 41 Southeast 60 38 18 13 9 58 Broward 17 51 28 Southern 61 35 40 33 Total All Florida 208 271 250 230 150 109 78 93 119 95 48 57 108 199 447 Source: Florida Youth Substance Abuse Surveys

Table Number of Florida Primary Heroin Treatment Admissions in FY By Managing Entity Regions Heroin FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 79 340 847 1,271 320 303 509 3,669 Female 76 239 644 937 129 150 314 2,489 Total 155 579 1,491 2,208 449 453 823 6,158 By Age 17 and Under 4 5 7 2 18 18-25 40 139 337 501 62 80 202 1,361 26-34 75 275 692 1,064 180 212 372 2,870 35 and Up 161 457 636 207 247 1,909 % of all admits 1.8% 5.2% 20.2% 10.1% 8.3% 9.9% 11.7% 9.3% Source: Florida Department of Children and Families July 2014 through June 2015

Managing Entity Region Heroin as % of All Admissions
Heroin Primary Treatment Admission as Percent of All Admissions in Florida’s Managing Entity Regions: FY Managing Entity Region Heroin as % of All Admissions Northwest 1.8% Northeast 5.2% Central 20.2% Suncoast 10.1% Southeast 8.3% Broward 9.9% Southern 11.7% All Florida 9.3% Source: Florida Department of Children and Families July 2014 through June 2015

Fentanyl The fast-acting painkiller has been used as a surgical analgesic for decades, but in the last few years, synthetically made versions of the drug exported from clandestine labs in China and Mexico have made their way to the street.

292 199 Source: Florida Medical Examiner Commission Data

DEA Fentanyl Alert March 2015
State and local crime labs reported 3,344 fentanyl submissions in 2014, up from 942 in 2013. In addition, DEA has identified 15 other fentanyl-related compounds.

Fentanyl Analogs Acetyl fentanyl temporarily made Schedule I on July 17, 2015 Deaths have been reported in 2013 and 2014 from six states including California, Louisiana, North Carolina, Oregon, Pennsylvania, and Rhode Island Emergency room admissions and deaths are underreported due to testing limitations Small changes in the amount and purity of the substance could potentially lead to overdose and death

Rates Per 100,000 of Fentanyl-Related Deaths
by Florida Managing Entity Regions: 2014

Cathinone Stimulants Often Have Trendy Names and Slick Packaging
Head trip Radiance Ivory Wave Power surge Sextasy Vanilla Sky White lightening Zoom Cloud 9 Cloud 10 Red Dove Blue silk Moon dust NRG (4-MEC)

Major Synthetic Cathinones 2014-2015
Cathinones – Synthetic Khat MDPV Methylone Alpha-PVP Ethylone Butylone 7 Others

The World Tour Europe Australia New Zealand

Tracking NPS Crime Lab Analysis Medical Examiner Toxicology Testing Confirmed Chemical Content Jim Hall

She Makes Me Want to Dance
Looking for Molly She Makes Me Want to Dance

Changes in MDMA and Synthetic Cathinones
Number of National Crime Lab Reports for MDMA and Synthetic Cathinones: USA Number of Crime Lab Reports Source: US DEA - National Forensic Laboratory Information System (NFLIS) 2014 Annual Data Jim Hall (786)

The Changing Face of Ecstasy, Molly, Flakka, et. al
The Changing Face of Ecstasy, Molly, Flakka, et. al. in Florida Crime Lab Reports Number of Crime Lab Reports Source: Analysis of US DEA - National Forensic Laboratory System Data

Molly Now Ethylone Methylone is beta-ketone MDMA

Source: Metro-Dade Police Department Crime Lab
Ethylone Candy Source: Metro-Dade Police Department Crime Lab

a-pyrrolidinovalerophenone
“Flakka” Flaca – Skinny Flaka – Beautiful, elegant woman who charms all Elsewhere called “Gravel” alpha-PVP a-pyrrolidinopentiophenone a-pyrrolidinovalerophenone

= 10,000 doses @ 15 cents per 1/10th gram dose
Flakka Economics 101 1 kg cost $1, online = 10, cents per 1/10th gram dose @ $ = $30,000 to $50,000 But requires 10,000 sales…. …. Back to the streets

South Florida Crime a-PVP Lab Cases: Toxic Effects: Tachycardia Agitation Psychosis Violent behavior Excited Delirium Hyperthermia Kidney failure Death Jim Hall

Flakka Frenzy Excited Delirium Jim Hall

186 Emerging Synthetic Drug Deaths in Florida 2014
134 # of Drug Occurrences 43 Source: FDLE – Florida Medical Examiners Commission, November 2014

Flakka-Related Deaths Broward County, Florida 44 Confirmed
September 2014 – August 2015

Flakka Hospital Cases Broward County, Florida 15-20 per Day
March – September 2015

Clinical Issues for Flakka Clients
Cognitive Impairment “I can’t think” 20 minute private sessions Decreased reading comprehension Use of pictures instead of paragraphs Continuous Paranoia - Quiet, private room - No bright lights The Matrix Model

Number of alpha-PVP Crime Lab Cases

Number of 2014 alpha-PVP Crime Lab Cases Top Ten US Counties
Source: Sun Sentinel and US DEA National Forensic Laboratory Information System (NFLIS)

Click on: Initiatives Facing Flakka

On the Lookout for alpha-PHP
September 2015 Update: On the Lookout for alpha-PHP alpha-pyrrolidinyl-hexaphenone

Other Synthetic Drugs Tryptamines Piperazines
Related to Psilocin, DMT, Serotonin Piperazines BZP TFMPP Opiates – Clandestine Fentanyl Benzodiazepine Analog - Etizolam

Exhibit 15 Number of Nonmedical Rx Opioids and
Exhibit Number of Nonmedical Rx Opioids and Benzodiazepine Reports Detected in Deceased Persons in Florida 2005 –2014 # of Drugs Detected Among Decedents Strike Force House Bill 7095 Takes effect CS-II Dispensing Limits and OxyContin Tamper Resistant Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Annual Reports

Exhibit 16 Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida 2008 to 2014 CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force House Bill 7095 Takes effect # “Cause of Death” Occurrences Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Reports Jim Hall

Exhibit 17 Rates per 100,000 of Selected Rx Opioid Deaths by Florida Managing Entity Regions: 2014 Rate per 100,000 population Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report Jim Hall

Exhibit Number of Selected 5 Rx Opioid-Related Deaths by Florida Managing Entity Regions: 2014 280 214 428 1,174 1,016 607 232 Number of 5 Rx-Opioid Related Deaths Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report Jim Hall

Table Number of Florida Primary Rx Opioid Treatment Admissions in FY By Managing Entity Regions Rx Opioid FY Northwest Northeast Central Suncoast Southeast Broward Southern State Totals By Gender Male 468 1,365 604 2,978 118 379 641 6,552 Female 471 1,453 729 2,968 75 285 620 6,601 Total 939 2,818 1,333 5,946 193 664 1,261 13,153 By Age 17 and Under 1 8 156 9 184 18-25 171 648 314 1,315 37 100 274 2,859 26-34 436 1,364 589 2,723 85 324 598 6,118 35 and Up 331 798 422 1,752 70 239 380 3,992 % of all admits 10.9% 25.3% 18.0% 27.2% 3.6% 14.5% 17.9% 19.9% Source: Florida Department of Children and Families July 2014 through June 2015

# of Drugs Detected Among Decedents
Exhibit 26 Number of all Rx Benzodiazepine Occurrences Detected in Deceased Persons in Florida – 2014 # of Drugs Detected Among Decedents Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Annual Reports

Exhibit 27 Per Capita Rates by Florida Management Regions of 2014
Occurrences in Deceased Persons of the 2 Benzodiazepines, Alprazolam (n= 1,316) and Diazepam (n=586) Rate per 100,000 population Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report

Table 15 Number of 2014 Occurrences in Deceased Persons of the
2 Benzodiazepines, Alprazolam (n= 1,316) and Diazepam (n=586) by Florida Managing Entity Regions Alprazolam Diazepam Total Northwest 109 36 145 Northeast 193 113 306 Central 122 428 Suncoast 380 164 544 Southeast 112 90 202 Broward 76 22 98 Southern 140 39 179 All Florida 1,316 586 1,902 Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners 2014 Annual Report

Kratom: To Ban or Not to Ban?
Photo Source: FoxNews.com

Kratom Large tree indigenous to Thailand and Malaysia
Leaves are usually chewed but it can be found in a dried form to create powder, tinctures and resins and is sold in the US as a powder, or in capsules, and as liquid.

Kratom Commercial Packaging

Florida Drug Trends Update November 2015
Progress and Challenges James Hall Epidemiologist Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University This product is supported by Florida Department of Children and Families Substance Abuse and Mental Health Program Office funding.

Florida Drug Trends Update November 2015

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