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Current Trends in Substance Abuse: Minnesota and nationally dept of corrections St Paul, Minnesota June 24, 2011

This report examines the current trends in substance abuse in Minnesota, including illicit drug use, marijuana use, prescription drug abuse, and alcohol consumption. It provides data from national surveys and state-specific studies, highlighting the prevalence and patterns of substance abuse among different age groups. The report also discusses the risks associated with heroin use and the misuse of prescription medications.

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Current Trends in Substance Abuse: Minnesota and nationally dept of corrections St Paul, Minnesota June 24, 2011

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  1. Current Trends in Substance Abuse: Minnesota and nationally dept of corrections St Paul, Minnesota June 24, 2011 Carol Falkowski Minnesota Department of Human Services carol.falkowski@state.mn.us

  2. Past month use of selected illicit drugs among persons age 12 or older: 2002-2009                                                                                             8.7 Source: National Surveys on Drug Use and Health, SAMHSA. ,                                                                                                                                                                                                                                                                                                                                                + Difference between this estimate and the 2008 estimate is statistically significant at the .05 level. 8.7 6.6 2.8 0.7 0.4 2009

  3. Specific drug used when initiating illicit drug use among past year initiates of illicit drugs aged 12 or older: 2009 Source: National Survey on Drug Use and Health, SAMHSA, 2009.                                                                                                                                                    Note: The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day.

  4. Illicit Drug Use in Past Month among Persons Aged 12 or Older by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007. No differences across age groups

  5. Marijuana Use in Past Month among Persons Aged 12 or Older by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007..

  6. Marijuana Use in Past Month among Persons Aged 12 -17 by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  7. Marijuana Use in Past Month among Persons Aged 18 -25 by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  8. Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  9. Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  10. Adults reporting at least one drink in past 30 days DC = 68.1% CT = 67 % WI = 66.8%NH = 64.7% VT = 64.5% RI = 64 % MA = 63% MN = 61.5% ND = 60.5% Nationwide = 53.9% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Prevention and Control, 2009.

  11. Adults reporting at binge drinking in past 30 days WI = 23.9 %ND = 21.4% MN = 20.2 % Nationwide = 15.5% Source: Behavioral Risk Factor Surveillance System, Centers for Disease Prevention and Control, 2009.

  12. Alcohol Use in Past Month among Persons Aged 12 or Older, by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  13. Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State Source: SAMHSA, Office of Applied Studies, National Survey on Drug Use and Health, 2006 and 2007.

  14. 1992 – 2010Minnesota Student Survey The Minnesota Student Survey is conducted every three years among students in Minnesota public schools, including charter schools and tribal schools in grades 6, 9, and 12. Of the 335 public operating school districts, 295 agreed to participate (88%). Student participation was voluntary. Pen and pencil surveys were anonymous. Across the state, approximately 79% of public school sixth graders, 75% of public school ninth graders, and 59% of public school twelfth graders participated in the 2010 Minnesota Student Survey. Overall participation across the three grades was approximately 71% of total enrollment.

  15. Processed from morphine, a naturally occurring substance extracted from the seed pod of poppy plants West of Mississippi – Mexican heroin/ East of Mississippi - Columbian heroin Heroin enters the brain, is converted to morphine, and binds to opioid that are located in many areas of the brain (and in the body), especially those involved in the perception of pain and in reward. Opioid receptors are also located in the brain stem—important for automatic processes critical for life, such as breathing (respiration), blood pressure, and arousal. Heroin overdoses frequently involve a suppression of respiration With regular heroin use, tolerance develops, in which the user’s physiological (and psychological) response to the drug decreases, and more heroin is needed to achieve the same intensity of effect. Heroin users are at high risk for addiction—it is estimated that about 23 percent of individuals who use heroin become dependent on it. Heroin

  16. Prescription Drug Abuse • Ingesting another person’s prescription medication, or • taking it not as medically directed (dose, reasons).

  17. Commonly abused classes of prescription medications: -- Opioids (for pain), Opioids include hydrocodone (Vicodin®), oxycodone (OxyContin®), propoxyphene (Darvon®), hydromorphone (Dilaudid®), meperidine (Demerol®), and diphenoxylate (Lomotil®). -- Depressants (for anxiety and sleep disorders) Central nervous system depressants include barbiturates such as pentobarbitalsodium (Nembutal®), and benzodiazepines such as diazepam (Valium®) and alprazolam (Xanax®). -- Stimulants (for ADHD and narcolepsy). Stimulants include dextroamphetamine (Dexedrine®),methylphenidate (Ritalin® and Concerta®), and amphetamines (Adderall®).

  18. 30% SOURCE: Raofi S, Schappert SM, Medication therapy in ambulatory medical care: United States 2003– 2004, National Center for Health Statistics Vital Health Stat13 (163), 2006.

  19. Past year initiates of specific illicit drugs among persons aged 12 or older: 2009 SOURCE: National Survey on Drug Use and Health, SAMHSA, 2009

  20. Past Month Illicit Drug Use among persons age 12 or older: 2008 1 Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics

  21. Where pain relievers were obtained for most recent nonmedical use Sourcewhere respondent obtained Bought on Internet0.1% Drug Dealer/Stranger3.9% Other 14.9% Source where friend/relative obtained More than One Doctor 1.6% More than One Doctor3.3% Free from Friend/Relative7.3% Free from Friend/Relative55.7% One Doctor 19.1% One doctor 80.7% Bought/Took fromFriend/Relative4.9% Bought/Took from Friend/Relative14.8% Drug Dealer/Stranger1.6% Other 12.2% SOURCE: 2006 National Survey on Drug Use and Health, Substance Abuse and Mental Health Services Administration. Past year use among persons age 12 and older. Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown. 1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

  22. Among adolescents, prescription and over-the-counter medications account for most of the frequently abused drugs, following marijuana (excluding tobacco and alcohol).

  23. Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs, 2004 to 2009 Approximately one-half (48%) of these pharmaceutical misuse/abuse visits involved pain relievers, and more than one-third (35%) involved drugs to treat insomnia and anxiety. At the same time, ED visits involving illicit drug use were relatively stable. SOURCE: Drug Abuse Warning Network, SAMHSA

  24. US drug overdose deathsare at an all-time high 27,658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths. This increase in drug overdose death rates is largely because of prescription opioid painkillers. “Opioids” are synthetic versions of opium with the ability to reduce pain, but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContin® ), hydrocodone (Vicodin® ), and methadone]. SOURCE: CDC’s Issue Brief: Unintentional Drug Poisoning in the United States, Centers for Disease Control and Prevention, Available online at: http://www.cdc.gov/HomeandRecreationalSafety/Poisoning/brief_full_page.htm

  25. Substances for which treatment was received in the past year among persons aged 12 or older: 2009 SOURCE: National Survey on Drug Use and Health, SAMHSA, 2009.

  26. Patients receiving treatment for addiction to pain relievers among persons age 12 and older: 2002 - 2009 SOURCE: National Survey on Drug Use and Health, SAMHSA, 2009.

  27. If users addicted to pain medication can find a source of affordable quality heroin, many switch to heroin injection

  28. Mexican heroin price and purity: Minneapolis 2007 – 2009 SOURCE: US Drug Enforcement Administration, US Department of Justice, 2009 Heroin Domestic Monitor Program, DEA-NCW-RPT-013-10, November, 2010.

  29. January 31, 2011 White Earth Tribal Council declares public health emergency The White Earth Reservation Tribal Council passed a Proclamation on Jan. 31, 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse. "We need to take down our fences and work together," said Chairwoman Erma J. Vizenor. "Business as usual isn' t working - we need to step up our efforts." Vizenor stresses that prescription medication and illegal drug abuse" is not unique to White Earth - it' s a nationwide problem." A highlight of the Proclamation states: The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies, departments, and entities to make this proclamation their top priority, and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs, which threatens our nation. According to the White Earth Police Department, 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse. "Our families have all been affected by substance abuse; the suicides and tragedies have impacted us all," said White Earth Secretary-Treasurer Robert J. Durant. "Now we need to need to get away from the blame game and stop letting it drag us down, we need to step up and figure something out. To counteract the devastation caused by prescription drug abuse, the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health, law enforcement, child protection, chemical dependency, legal, mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse. "The goal is not to be punitive, but to be supportive and helpful," said Vizenor. In addition to holding community forums in throughout the reservation, the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance. Currently, individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621. People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691. In addition to the resource manual, the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol, drug and prescription drug abuse and prevention within the White Earth Nation. The videos will be culturally specific and will initially target young school-aged children.

  30. February 26, 2011 Prescription drug addiction called an emergency on Red Lake Reservation Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs, calling it a public health emergency. Jourdain asked health officials to develop an action plan to fight such addiction. SOURCE: www.bemidjipioneer.com

  31. Florida Pain Clinics a.k.a. “pill mills” 􀂾 Treat on average 100+ “patients” per day 􀂾 $150 - $250 cash for doctor’s visit /$200 - $400 cash for prescription 􀂾 Dispensation directly from clinic or script is I issued 􀂾 Scripts are filled in numerous states 􀂾 They do not accept insurance, Medicare/Medicaid or credit cards 􀂾 “Patients” from Kentucky, Ohio, Tennessee, West Virginia 􀂾 Travel to Florida individually by car, airplane or in groups on buses or chartered planes 􀂾 Receive coaching and drug dispensed 􀂾 Oxycodone (avg. 120 tablets per script)

  32.  February 24, 2011 Florida raids target sellers of pain pills By Donna Leinwand, USA TODAY Federal agents and police raided doctors' offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills. The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USA's growing appetite for prescription drugs. Often the cash-only clinics require just a cursory exam — if any — before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone, which can be highly addictive. Some of the clinics have in-house pharmacies to fill the prescriptions, says Rusty Payne, a spokesman for the Drug Enforcement Administration (DEA). The DEA and local police call them pill mills. In South Florida on Wednesday, authorities arrested 22 people, including four doctors, and seized dozens of exotic cars including Dodge Vipers, Lamborghinis and a Mercedes-Benz SLR McLaren.

  33. Effective medication-assisted treatments are available for opiate addiction: Methadoneis a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin. Methadone's effects last four to six times as long as those of heroin, so people in treatment need to take it only once a day. Methadone is medically safe even when used continuously for 10 years or more. Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives. Buprenorphine,approved by the Food and Drug Administration (FDA) in 2002, provides a less addictive alternative to methadone maintenance, reduces cravings with only mild withdrawal symptoms, and can be prescribed in the privacy of a doctor's office. Naloxone and naltrexone block the effects of morphine, heroin, and other opiates. As antagonists, they are especially useful as antidotes. Naltrexone has long-lasting effects, ranging from 1 to 3 days, depending on the dose and blocks the pleasurable effects of heroin. It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation Treating opioid addiction

  34. What you can do: The White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse: GOAL: To reduce the nonmedical abuse of Rx drugs, and ensure access to Rx medication used legitimately Requires community collaboration and cooperation across multiple tribes and levels of government

  35. What you can do: EDUCATION - Of parents, peers, patients, dispensers, and health care providers Scope: Appropriate prescribing, adverse events, signs of abuse/abuse risk; signs of addiction; storage of medications, and disposal of medications - Working with physicians to achieve consensus standards on opiate painkiller prescribing.

  36. What you can do: PRESCRIPTION DRUG MONITORING PROGRAMS To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies. Minnesota PMP since 2010 as of March 1, 2011: Controlled substance prescriptions collected = 6,875,346 Approved users for the PMP database = 4,031

  37. What you can do: • DISPOSAL • The goal is easy to use, environmentally friendly • disposal options to reduce amount and availability. • Initiate or participate in Drug Take Back Days. In 2010 over 4,000 sites across the country took back 121 tons. • April 30, 2011 is the next one. • - In your home, follow guidelines on disposal.

  38. What you can do: • LAW ENFORCEMENT • Increase training of law enforcement to • Heighten interdiction • Disrupt and dismantle drug trafficking organizations, • Share intelligence and investigative information across departments and jurisdictions. • Take legislative steps to prohibit “pill mills” (rogue pain clinics).

  39. Synthetic Drugs

  40. Synthetic marijuana products • Rick will cover

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