1. Sentinel for Prevention
Sentinel for Prevention Workshop
Sentinel for Prevention
Emerging Trends
Community Surveillance
Jim Hall Center for Applied Research on Substance Use and Health Disparities Nova Southeastern University
Jim Hall

2. Flakka Frenzy

3. Emerging Synthetic Drugs
Novel Psychoactive
Substances (NPS)
Emerging Synthetic Drugs
More Than Just Flakka

4. Drugs Not “spice,” “bath salts,” nor “incense” Psychoactive Substances
Change the Brain’s Functions
Complex Chemistry
Complicated Neuropharmacology
The Menu:

5. Classes of Novel Psychoactive Substances (NPS)
Phenethylamines – includes Methamphetamine
Cathinones – Stimulants & Hallucinogens
Cannabinoids
Tryptamines
Piperazines
Opiates
Benzodiazepine Analogs

6. 12 Kinds of Synthetic Cathinones In Florida Crime Labs in 2014
Cathinones – Synthetic Khat
MDPV
Methylone
Alpha-PVP
Ethylone
Butylone
7 Others

7. The World Tour
Europe
Australia
New
Zealand

8. Sentinel for Prevention Workshop
Tracking in Florida
Crime Lab Analysis
Medical Examiner Toxicology Testing
Confirmed Chemical Content
Jim Hall

9. 184 Emerging Synthetic Drug Deaths in Florida – 2 x 1st Half of 2014
144
25 alpha- PVP Deaths
Sept – June 15, 2015
In Broward County
# of Drug Occurrences 36
Source: FDLE – Florida Medical Examiners Commission, November 2014

10. 35,090 Emerging Synthetic Drug Crime Lab Reports in Florida: 2010-2014
10,367
9.823
*Other Phenethylamines
than Cathinones
6,430
Number of Crime Lab Reports
4,338
Source: Analysis of US DEA - National Forensic Laboratory System Data

11. The Changing Face of Ecstasy, Molly, Flakka, et al in Florida Crime Lab Reports 2010-2014
Cathinones
(Phenethylamine)
Number of Crime Lab Reports
Source: Analysis of US DEA - National Forensic Laboratory System Data

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

13. Molly
Now
Ethylone
Methylone is
beta-ketone MDMA

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

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

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

18. Sentinel for Prevention Workshop
South Florida Crime a-PVP Lab Cases:
Toxic Effects:
Tachycardia,
Agitation,
Psychosis,
Violent behavior,
Excited Delirium
Hyperthermia
Kidney failure
Death
Jim Hall (786)

19. Drug Testing for Flakka
NMS Labs
Integral Lab Solutions
(561)
Local Medical Examiner

20.
Click on:
Initiatives
Facing Flakka

22. 22 Kinds of Synthetic Cannabinoids In Florida Crime Labs in 2014
Sentinel for Prevention Workshop
22 Kinds of Synthetic Cannabinoids In Florida Crime Labs in 2014
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

23. Pharmacology of Synthetic Cannabinoids
Effects almost immediate
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

24. 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

25. Percent of Florida High School Students Reporting any Lifetime and Past 30-Day Use of Synthetic Marijuana: 2012 vs.2014
Past 30-Day Use
Source: Florida Youth Substance Abuse Survey 2012

27. Sentinel for Prevention Workshop
785
1,301
381
140
Jim Hall

28. The Future ?? Synthetic Opiates Benzodiazepine-Analogs Etizolam
Not Controlled in USA
Order it on line

29. Dangers of Synthetic Drugs
Excited Delirium, Kidney Failure, Death
More Addictive and Deadly ever month
“Guinea Pig” drugs
Both Short and Long-term Psychosis
Linked to Violent Behavior
Information Dissemination:
“It’s Poison and it can kill you”

30. Prescription Drug Abuse in Florida
Responding to an Epidemic:
2000 to 2014

31. Ft. Lauderdale Pill Mill
…….The doctor is in

32. Florida’s Response to 2014

33. Florida’s Response to Rx Drug Abuse
July 2010 – Senate Bill 2272 Legal authority to close “Pill Mills” and limited practitioner dispensing of CS Schedule II to 3-day supply
August 2010 – Tamper-resistant OxyContin®.
March 2011 – Law Enforcement Strike Force
July House Bill 7095 Comprehensive law bans practitioner dispensing of CS II and new regulations. Permits PDMP to operate.

34. Sentinel for Prevention Workshop
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
Jan Jun Reports
Jim Hall

35. Number of Hospital Cases for Non-Fatal Rx Opioid Poisonings in Florida: 2007 -2013
9,571
9,524
8,851
8,626
8,442
8,153
6,754
Number of Rx Opioid Poisoning Patients
Source: Analysis of data from the Florida Agency for Health Care Administration

36. Rx Opioid Poisoning Hospital Cases in Florida With and Without a Diagnosis of Opioid Dependency: n= 59,992
9 %
Source: Analysis of data from the Florida Agency for Health Care Administration
91 %

37. Number of Unique Patients Identified By Threshold Levels
Number of Prescribers and Number of Pharmacies
by Quarter
5 Prescribers &
5 Pharmacies
3,000
2,864
51-%
Decrease
Level 5
514
500
Level 7
1,097
1,415
Level 6
427
Level 8
178
Levels 9, 10 15
Source: Annual Report
Florida’s Prescription Drug
Monitoring Program (PDMP)

38. Number of Heroin Deaths in Florida: 2000 –1st H2014
SOURCE: Florida Medical Examiners Commission Reports st H 2014

40. Heroin and Morphine Deaths in Florida 2010 -2X 1st Half 2014
Sentinel for Prevention Workshop
Heroin and Morphine Deaths in Florida X 1st Half 2014
Total
Morphine
Number of Deaths
Heroin
SOURCE: Florida Medical Examiners Commission Reports
Jim Hall

41. Heroin from Mexico Increased production Higher purity and potency
Lower Price
acetyl-fentanyl laced Heroin

42. prescription diversion control.
Florida’s increasing heroin use should not be attributed to the crackdown on pill mills and reductions in doctor shopping. Without these supply-side strategies, heroin use would have likely increased even more, because prescription opioid abusers constitute the breeding ground for the nation’s heroin epidemic in the 21st Century.
However, Florida’s failure was in not expanding treatment and prevention resources while enforcing
prescription diversion control.
Alcoholism and Drug Abuse Weekly May 4, 2015

43. “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.

44. Dabbing
Just a Little Dab
will do you….in

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

46. Answer: 
The Oxford Dictionaries named "vape" 2014's Word of the Year, the verb used to describe inhaling and exhaling vapors produced by an electronic cigarette or similar device.
Vape is an abbreviation of vapor or vaporize, according to Oxford Dictionaries. 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.”

47. The pen is mightier than the pipe?

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

50. 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.

51. Kratom Commercial Packaging

52. Legal Status of Kratom
Kratom is legal in Florida, however anything dubbed as a “legal high” comes under suspicion and is being watched by law enforcement.
Kratom is not listed in the Controlled Substances Act. The DEA added Kratom to the list of Drugs and Chemicals of Concern.

53. Community Surveillance
You can’t prevent what you don’t understand

54. Community Surveillance
Problems Partners Planning Prevention Progress

55. Community Surveillance
Problems
What are our local problems and what do we know about them?

56. Barefoot Epidemiology

57. Epidemiology Epidemiology is the study of the Distribution and
Determinants
of health-related conditions or events (including disease and wellness), in terms of
People,
Place, and
Time.

58. Determinant Determinant – In English:
An influencing or causal element or factor
In Florida SARG speak:
An “Intervening Variable”

59. History of Epidemiology
Sentinel for Prevention Workshop
History of Epidemiology
1854 London (e.g., Charles Dickens)
Dr. John Snow, English Physician
Between August 31 and September 10,1854
Cholera Outbreak in Soho, London Killed 500
Conventional Wisdom: Transmitted by Air
Dr. Snow believed: Transmitted by Water
Plotted the Cholera Deaths in Soho
Information for Action

60. Broad Street Original map
by John Snow showing the clusters of cholera cases
in the Soho, London epidemic of 1854

61. Broad Street
From Information to…

62. The Broad Street Pump Handel And the Cholera Epidemic Ended
From Information to…
…Action
John Smith Removed
The Broad Street Pump Handel
And the Cholera Epidemic Ended

63. John Snow Memorial Pub What was Broad Street in 1854 is
today Broadwick Street. Shown here is the John Snow Memorial and the
John Snow Memorial Pub

64. Substance Abuse Epidemiology
Consequences
Consumption Patterns
Contributing Factors

65. Substance Abuse Epidemiology
Consequences
Deaths
Medical Emergencies
Addiction
Crime
Violent
Property

66. Substance Abuse Epidemiology
b) Consumption Patterns
Prevalence – Proportion of Given Population
Use
Frequency (Life, Annual, Past Month, Daily)
Intensity (e.g., Bing Drinking, Heavy Use)
Incidence – New Cases
Age of First Use (% by Age 13 or Younger)

67. Substance Abuse Epidemiology
Contributing Factors
Risk Factors
Protective Factors
“Prevention as Protection”

68. Community Surveillance
Problems – What are our local problems and what do we know about them?
Partners
Who needs to be with us and engaged in a mutual plan?

69. Applied Epi Data
Problems
Partners
Progress
Prevention
Planning

70. Community Surveillance
Problems – What are our local problems and what do we know about them?
Partners – Who needs to be with us and engaged in a mutual plan?
Planning
What local factors can we change that are contributing to each problem?

71. SARG Needs Assessment Logic Model
Problem Statement
Determinants
1. Consequence
Data
2. Consumption
Data
3. Contributing Factors
Data

72. SARG Needs Assessment Logic Model 1 in 4 local youth drink by age 13
Problem Statement
Serious lifelong consequences are linked to alcohol use by our children and youth.
Determinants
1. Consequence
Data
2. Consumption
Data
4. Problem Statement
3. Contributing Factors
Data
While use is declining, Bing
use unchanged
Higher rates of delinquency among young alcohol users
1 in 4 local youth drink by age 13

73. SARG Needs Assessment Logic Model
Serious lifelong consequences are linked to alcohol use by our children and youth
Determinants
1. Consequence
Data
2. Consumption
Data
Parent & Adult
Attitudes
5. Classify
Contributing Factors
as Key Determinants
4. Problem Statement
Youth Attitudes
And Beliefs
3. Contributing Factors
Data
While use is declining, Bing
use unchanged
Higher rates of delinquency among young alcohol users
# 1 Drug Youth
Dependency &
Juvenile Justice
Community
Norms
1 in 4 local youth drink by age 13
6. Goal
Early First Use of Alcohol
7. Objectives

74. Community Surveillance
Problems – What are our local problems and what do we know about them?
Partners – Who needs to be with us and engaged in a mutual plan?
Planning – What local factors can we change that are contributing to each problem?
Prevention
What strategies and programs will help us change the contributing factors?

75. The Comprehensive Community Prevention Action Plan
Select Strategies based on how to change identified contributing factors (i.e., Measurable Plan Objectives)
Who will do What Prevention Services for Whom?
Where and When will they do it?
Community Partners

76. Community Surveillance
Problems – What are our local problems and what do we know about them?
Partners – Who needs to be with us and engaged in a mutual plan?
Planning – What local factors can we change that are contributing to each problem?
Prevention – What strategies and programs will help us change the contributing factors?
Progress
How will we measure what we have done to change and solve the problem?

77. SARG Needs Assessment Logic Model
Serious lifelong consequences are linked to alcohol use by our children and youth
Determinants
1. Consequence
Data
2. Consumption
Data
Parent & Adult
Attitudes
5. Classify as Key
Determinants
4. Problem Statement
Youth Attitudes
And Beliefs
3. Contributing Factors
Data
While use is declining, Bing use unchanged
Higher rates of delinquency among young alcohol users
Community
Norms
1 in 4 local youth drink by age 13
6. Goal
Early First Use of Alcohol
7. Objectives
10. Long-Term Outcomes
9. Intermediate-Term
Outcomes
8. Short -Term Outcomes
11. IMPACT

78. The Community Report TABLE OF CONTENTS
Section I. Introduction
Section II. Emerging Drugs and Patters of Drug Use
Section III. Update on Continuing Drug use problems
Section IV. Appendix with Data Tables

79. The Community Report Section IV
The Community Report Section IV. Appendix with Data Tables MS Excel Worksheets Available Online at coalitionwebsite.org
 Demographic/Socio-Economic Characteristics -US Census
Prevalence of Drug Use National Survey on Drug Use and Health Substate (NSDUH) Data
Prevalence of Drug Use by Age Groups NSDUH Substate
Prevalence of Drug Use Middle & High School Students Florida Youth Survey on Substance Abuse (FYSAS)
5 Year Trends in Local Treatment Admissions
Profile of Treatment Clients by Primary Drug

80. The Community Report Section IV
The Community Report Section IV. Appendix with Data Tables MS Excel Worksheets Available Online at coalitionwebsite.org
CDC&P Drug Poisoning Deaths
HIV/AIDS & Hepatitis Cases by Transmission Category
National Forensic Laboratory Information System (NFLIS) Crime Lab Cases: US DEA
NFLIS Crime Lab Cases for Novel Psychoactive Drugs
Drug-Related Deaths reported by Florida Medical Examiners Commission
Florida Poison Information Center Calls

81. The Community Report TABLE OF CONTENTS
Section III. Update on Continuing Drug use problems
Major Substances with Ongoing but
Stable Indicators of Abuse
Section IV. Appendix with Data Tables

82. The Community Report TABLE OF CONTENTS
Section II. Emerging Drugs and
Patters of Drug Use
New Issues and Substances with
Significant Increases in Indicators of Abuse
Section III. Update on Continuing Drug use problems
Major Substances with Ongoing but
Stable Indicators of Abuse
Section IV. Appendix with Data Tables

83. The Community Report TABLE OF CONTENTS
Section I Introduction
Highlights – Bullet Points
Area Description
Data Sources
Section II. Emerging Drugs and Patters of Drug Use
New Issues and Substances with Significant Increases in Indicators of Abuse
Section III. Update on Continuing Drug use problems
Major Substances with Ongoing but Stable Indicators of Abuse
Section IV. Appendix with Data Tables

84.
Data Central

85. The Coalition Surveillance Committee
Public Health
Criminal Justice
Community Programs
   
Why Here ?

86. The Coalition Surveillance Committee
Public Health Sector:
Department of Health
Infectious Disease Outreach
Workers
Tobacco Prevention
Pharmacist
Toxicologist
 Poison Information Center
Health Education Coordinator
Treatment - Front-Line Counselor School System - Behavioral Health & Substance Abuse Prevention Hospital – Emergency Department Medical Examiner Admissions Data FYSAS Guru Managing Entity: Treatment data

87. The Coalition Surveillance Committee
Criminal Justice Sector
Law Enforcement
Local Narcotics Officer
Local Crime Lab/s
FDLE
DEA Regional Office (NFLIS and ARCOS)
Alcohol Beverage and Tobacco
Department of Juvenile Justice Intake Counselor
  Courts – Drug Court

88. The Coalition Surveillance Committee
Community Programs
Prevention Programs 
MADD
SADD
  Youth Input
  Social Media Monitor

89. Community Surveillance
Problems Partners Planning Prevention Progress