Prescription Drug Abuse/Misuse in Florida

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 • FDLE – Medical Examiner data • Agency for Health Care Administration Emergency Department data • DOH/AHCA Pain Clinic Registrants • Florida Youth Substance Abuse Survey Data

3. 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

5. Source: DEA ARCOS System

6. 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

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

8. 78% higher than benzodiazepines 94% higher than benzodiazepines +45.8% Source: Drugs Identified in Deceased Person by Florida Medical Examiners, 2005 through 2009 Reports.

9. 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)

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

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

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

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

15. 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

16. Florida counties with high rates of opiate overdoses

17. Florida counties with high rates of benzodiazepine overdoses

18. “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

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 • Amphetamine trends • Depressant trends • Steroid trends

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. Xanax added to list On how many occasions in the past (30 days/year) have you used depressants or “downers” like quaaludes, Xanax, barbiturates or tranquilizers?

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. 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 • 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

26. Summary • 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

27. 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

28. 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

29. Summary • 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

30. Contact Information Hal Johnson DCF – Substance Abuse Program Office 850-413-6768 hal_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