1. 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

3. 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 $1.07 7.8% 2009 $2.09 5.8% 2010 $2.32 5.7% 2011 $1.40 3.9% Source: DEA 2011 Heroin DMP, March 2011

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

6. San Francisco ED Reports 2004-2011 Source: DAWN 2011(weighted data) Drugs20042005200620072008200920102011 Heroin 2,4243,1381,9941,9931,6161,2241,242731 Opiates/opioids 1,0552,1721,7031,3691,7842,0432,4742,614 -Opiates,unspec 243475446255317433659723 -NarcoticAnalges 8391,8041,3321,1521,5041,6491,8631,953 ---Buprenorphine/ ******** ---Codeine/combo 69******* ---Fentanyl/combo *****124*171 ---Hydrocodone/co 239440335299434351546529 ---Hydromorphone *****141*180 ---Methadone 311805560496514508521421 ---Morphine/comb 107180131121155188270283 ---Oxycodone/co 104251246217315449504543

7. San Francisco ED Reports 2004-2011, % change Source: DAWN 2011 Percent Change (p < 0.05) 200420102011 2011 vs. 2004 2011 vs. 2009 2011 vs. 2010 Heroin2,4241,242731 -70-40-41 Opiates 1,0552,4742,614148 -Opiates, unspec 243659723197 -Narcotic analges 8391,8631,953133 --Fentanyl/comb **171 --Hydrocodone/co 239546529122 --Hydromorphone/ **180 --Methadone 311521421 -17 --Morphine/comb 10727028316451 --Oxycodone/comb 104504543424 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

8. 5 Bay Area Counties: 2012 Prescription Quantities By Drug Name

9. 5 Bay Area Counties: Prescription Quantities Hydrocodone/APAP CURES Data provided by Mike Small, CA DOJ

10. Primary Drug Treatment Problem: Percent of total admissions 5 Bay Area Counties; FY2012-13 Source: DHCS 12-19-13 CalOMS Data System, Craig Chaffee

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

12. SAN FRANCISCO COUNTY PRIMARY DRUG AT TREATMENT ADMISSION PERCENTAGE BY AGE, 2011-12 [I] [I] [i] [i] Source: CalOMS Tx Data, Department of Alcohol and Drug Programs

13. 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

14. 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

15. 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

16. Deaths Involving Drug Abuse – DAWN SF Metropolitan Area -1994-2002 Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (092003 update) Heroin deaths: 1997= 297; 2010= 8