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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
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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