1. 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

2. 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

3. 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. 4

5. Source: DEA ARCOS System 5

6. 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

7. Source: Drugs Identified in Deceased Person by Florida Medical Examiners, 2005 through 2009 Reports. 7 +62.5%

8. 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%

9. 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

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

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

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

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

14. 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

15. 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 15-20 counties Limited to 15-20 counties 15

16. Florida counties with high rates of opiate overdoses 16

17. Florida counties with high rates of benzodiazepine overdoses 17

18. “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 - 142 Broward - 142 Source : http://www.doh.state.fl.us/mqa/medical/me_pain.html Source : http://www.doh.state.fl.us/mqa/medical/me_pain.html 18

19. # Registered Pain Clinics per 100,000 Population 6.01-9.91 4.81-6.00 3.54-4.80 2.00-3.53 1-3 clinics No clinics FL State = 4.94/100k

20. 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. 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. 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. 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. 24 On how many occasions in the past (30 days/year) have you used steroids without a doctor’s orders?

25. 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 2005-2009 Opiate-related deaths increased 48.5% from 2005-2009 Benzo-related deaths increased 62.5% from 2005-2009 Benzo-related deaths increased 62.5% from 2005-2009 The rate of deaths related to opiates is 78- 94% higher than benzodiazepines across years The rate of deaths related to opiates is 78- 94% higher than benzodiazepines across years 25

26. ED visits for Rx opiates and benzodiaze- pines increased 50% from 2006-2008 ED visits for Rx opiates and benzodiaze- pines increased 50% from 2006-2008 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

27. 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 25-29 and 45-54 For both opiates and benzos, there is a bi- modal age distribution of overdoses – peaking at 25-29 and 45-54 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

28. 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

29. 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

30. Contact Information Hal Johnson DCF – Substance Abuse Program Office 850-413-6768hal_johnson@dcf.state.fl.us FYSAS: www.dcf.state.fl.us/programs/samh/publications/fysas/ SEW: www.dcf.state.fl.us/programs/samh/SubstanceAbuse/sew.shtml 30