Prescription Drug Abuse/Misuse in Florida 2010 Florida Prevention Conference Orlando, Florida September 30, 2010 Hal Johnson, MPH Substance Abuse Program.

Prescription Drug Abuse/Misuse in Florida

2010 Florida Prevention ConferenceOrlando, Florida

September 30, 2010

Hal Johnson, MPHSubstance Abuse Program Office

Florida Department of Children and Families

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Outline

• ARCOS Rx Drug distribution volumes• FDLE – Medical Examiner data• Agency for Health Care

Administration Emergency Department data

• DOH/AHCA Pain Clinic Registrants• Florida Youth Substance Abuse

Survey Data

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Automation of Reports and Consolidated Orders

System (ARCOS)• Department of Justice

– Drug Enforcement Administration– Office of Diversion Control

• Rx drug manufacturers and distributors

• Schedules I and II, and narcotic and Gamma-Hydroxybutyric Acid (GHB) substances in Schedule III

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Codeine 5,920 5,345 4,793 4,944 4,982 -15.8Meperidine 2,358 2,097 1,716 1,608 1,681 -28.7Methadone 1,995 2,589 2,794 3,491 8,258 +319.9Morphine 5,466 6,061 6,020 6,771 7,879 +44.1Fentanyl base 136 145 129 145 164 +20.6

Oxycodone 14,624 15,020 15,506 21,575 * +47.51

Hydromorphone 286 334 377 430 * +50.31

Hydrocodone 9,395 10,676 10,750 12,474 * +32.81

Buprenorphine * * 54 97 188 +247.52

* Data not available in ARCOS published data tables1 % change is from 2003 to 20062 % change is from 2005 to 2007Source: DEA ARCOS system

2003 2004 2005 2006 2007% change

2003 - 2007

Table 1. Grams of opiate analgesics sold/distributed to Florida retailers and dispensers per 100,000 population, 2003 - 2007.

5Source: DEA ARCOS System

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Medical Examiner Data

• Florida Department of Law Enforcement

• Medical Examiners Commission

– Reviews appointments/re-appointments of District Medical Examiners

– Publishes semi-annual drug death report

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

+62.5%

8Source: Drugs Identified in Deceased Person by Florida Medical Examiners, 2005 through 2009 Reports.

94% higher than benzodiazepines

78% higher than benzodiazepines

+45.8%

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AHCA data description

• 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)

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

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

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

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

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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

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Geographic “Problem” Areas

• Examine ED visit rates by county• Large counties

– Substantially higher than FL– Slightly higher & next to substantially

higher• Smaller counties

– Substantially higher & next to large problem county

– Substantially higher in clusters• Limited to 15-20 counties

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Florida counties with high rates of opiate overdoses

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Florida counties with high rates of benzodiazepine overdoses

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“Pill Mill” Locations

• 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• Hillsborough – 119• Broward - 142

• Source: http://www.doh.state.fl.us/mqa/medical/me_pain.html

# Registered Pain Clinics per 100,000

Population

6.01-9.914.81-6.003.54-4.802.00-3.53

1-3 clinicsNo clinics

FL State = 4.94/100k

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Florida Youth Substance Abuse Survey

• Pain killer trends

• Amphetamine trends

• Depressant trends

• Steroid trends

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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?

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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

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

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

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Summary

• Volume of Rx opiates distributed in Florida is increasing dramatically

• Opiate-related deaths increased 48.5% 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

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• 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

• The rate of benzo overdoses is highest in large metro areas and lowest in non-metro areas

Summary

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Summary

• 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

• Benzodiazepine use in combination with alcohol and/or other drugs is dangerous and is common among ED overdose diagnoses

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Summary

• 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

• There are nearly 1,000 registered pain clinics in Florida – 4.94 per 100,000 population

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• 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

• Youth use of amphetamines and steroids is very low

Summary

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Contact Information

Hal JohnsonDCF – Substance Abuse Program Office

[email protected]

FYSAS: www.dcf.state.fl.us/programs/samh/publications/fysas/

SEW: www.dcf.state.fl.us/programs/samh/SubstanceAbuse/sew.sh

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