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Synthetic Cannabinoid Epidemiology among Florida High School Youth

Synthetic Cannabinoid Epidemiology among Florida High School Youth. June 10, 2013 Council of State and Territorial Epidemiologists Pasadena, California. Hal Johnson, MPH Florida Dept. of Children & Families Substance Abuse and Mental Health Program & Florida State University

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Synthetic Cannabinoid Epidemiology among Florida High School Youth

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  1. Synthetic Cannabinoid Epidemiology among Florida High School Youth June 10, 2013 Council of State and Territorial Epidemiologists Pasadena, California Hal Johnson, MPH Florida Dept. of Children & Families Substance Abuse and Mental Health Program & Florida State University Florida Center for Prevention Research

  2. Background • What are synthetic cannabinoids (SC)? • … psychoactive substances chemically similar to the active ingredient in marijuana that are applied to plant material and smoked (CESAR FAX, Vol. 22, Issue 7). • Originally developed to study cannabinoid receptors • Who is using it? • Teenagers and young adults (DAWN report, Dec, 2012) • Males, whites and Hispanics (Stogner & Miller, J Sub Use, early only online, 2013) • Members of the LGBT community (Stogner & Miller, J Sub Use, early only online, 2013)

  3. Background • Why is it popular? • Marketed as “safe,” legal alternative • Relatively easy access – internet, convenience stores, head shops … • Perceived as “natural” and harmless • Not detected in standard drug tests (NIDA DrugFacts, December, 2012) • No age restrictions (DAWN Report, Dec, 2012)

  4. Background • What are the effects/harm • Tachycardia and hypertension (2-3 times more likely than THC) • Hallucinations (5 times more likely than THC) • Seizures • Acute kidney injury (MMWR, Feb 15, 2013) • Convulsions (Schneir & Baumbacher, 2012)

  5. Background • At least 41 states have banned SC • Synthetic Drug Abuse Prevention Act • Signed by president July 9, 2012 • Placed 26 substances in Schedule I • 15 Cannaboids • 2 cathinone derivatives (bath salts) • 9 2C phenethylamines

  6. Background • SDAPA introduced “cannabimimetic agents” • “… any substance that is a cannabinoid receptor type 1 agonist as demonstrated by binding studies and functional assays within [five specified] structural classes.” • Helpful in scheduling future synthetic cannabinoids (NFLIS 2011 Annual Report)

  7. Background • DEA rule (4/12/13) places methylone in Schedule I • New SCs are used by sellers when current SC products are banned

  8. Background • 2010 Emergency Department visits (DAWN Report, Dec, 2012) – SC versus marijuana

  9. Background • 2011 and 2012 Poison Control Center data

  10. Background • 2011 and 2012 Crime lab data – 10 fold increase • More labs with ability to identify these substances

  11. On-line websites retrieved 6/5/13

  12. Methods • Florida Youth Substance Abuse Survey • Annual school-based survey – grades 6-12 • Question added to HS version in 2011 • On how many occasions (if any) have you smoked synthetic or “fake” marijuana such as spice or K2… …in your lifetime? …in the past 30 days? • 2011: N=5,732 (statewide sample) • 2012: N=33,798 (county-level sample)

  13. Results

  14. 2011 versus 2012 Prevalence of SC use among Florida high school youth by grade level and year, 2011-2012 + 48% + 78%

  15. Gender Differences - 2012 Prevalence of SC use among Florida high school youth by gender, 2012 + 39% + 61%

  16. Race/Ethnic Differences - 2012 Prevalence of SC use among Florida high school youth by race/ ethnicity, 2012 + 207% + 141%

  17. Florida Compared to National Data FYSAS compared to PATS – prevalence of various substance use among high school youth, 2012 PATS: Partnership Attitude Tracking Survey (Partnership for a Drug-Free America)

  18. Florida Compared to National Data FYSAS compared to MTF - prevalence of various substance use among 10th grade youth, 2012 MTF: Monitoring the Future (NIDA; University of Michigan)

  19. Florida Compared to National Data FYSAS compared to MTF - prevalence of various substance use among 12th grade youth, 2012 MTF: Monitoring the Future (NIDA; University of Michigan)

  20. SC versus Marijuana Use • Lifetime use • Of those that used SC 94.6% used marijuana • Of those that use Marijuana 35.8% used SC • Past-30-day use • Of those that used SC 85.2% used marijuana • Of those that used marijuana 23.3% used SC

  21. SC versus Marijuana Use Prevalence of SC and marijuana use among Florida high school youth by gender, 2012 + 13% + 35% + 39% + 61%

  22. SC versus Marijuana Use Prevalence of SC and marijuana use among Florida high school youth by race/ethnicity, 2012 + 24% + 207% + 26% + 141%

  23. SC vs Marijuana Odds Ratios Age, and parental education level controlled for in all analyses. Race/ethnicity controlled for in gender analyses & gender controlled for in race/ethnicity analyses.

  24. Geographic Variations

  25. B r e v a r d Santa Rosa Holmes ngton J a c k s o n Walton Okaloosa i h Escambia n N a s s a u G a d s d e n s o a s W r H a m i l t o n C a l h o u n e L e o n f f M a d i s o n a e B a y i J b D u v a l B a k e r m u L i b e r t y W a k u l l a l S u w a n n e e o d C T a y l o r r o Lafayette U n i o n S t . f d C l a y F r a n k l i n a G u l f r J o h n s B G i l c h r i s t A l a c h u a P u t n a m D i x i e F l a g l e r L e v y M a r i o n Volusia C i t r u s L a k e S e m i n o l e S u m t e r Lifetime Synthetic Cannabinoid Use H e r n a n d o O r a n g e P a s c o O s c e o l a Hillsborough P o l k Highest Quartile (18.1%-24.4%) I n d i a n R i v e r P i n e l l a s O k ee H a r d e e M a n a t e e ee c h o S t . L u c i e H i g h l a n d s b e D e S o t o e S a r a s o t a M a r t i n Charlotte Second Quartile (14.5%-18.0%) G l a d e s Palm Beach H e n d r y L e e Broward C o l l i e r Dade Monroe

  26. B r e v a r d Santa Rosa Holmes ngton J a c k s o n Walton Okaloosa i h Escambia n N a s s a u G a d s d e n s o a s W r H a m i l t o n C a l h o u n e L e o n f f M a d i s o n a e B a y i J b D u v a l B a k e r m u L i b e r t y W a k u l l a l S u w a n n e e o d C T a y l o r r o Lafayette U n i o n S t . f d C l a y F r a n k l i n a G u l f r J o h n s B G i l c h r i s t A l a c h u a P u t n a m D i x i e F l a g l e r L e v y M a r i o n Volusia C i t r u s L a k e S e m i n o l e S u m t e r Past-30-day Synthetic Cannabinoid Use H e r n a n d o O r a n g e P a s c o O s c e o l a Hillsborough P o l k Highest Quartile (6.8%-10.9%) I n d i a n R i v e r P i n e l l a s O k ee H a r d e e M a n a t e e ee c h o S t . L u c i e H i g h l a n d s b e D e S o t o e S a r a s o t a M a r t i n Charlotte Second Quartile (4.8%-6.6%) G l a d e s Palm Beach H e n d r y L e e Broward C o l l i e r Dade Monroe

  27. B r e v a r d Santa Rosa Holmes ngton J a c k s o n Walton Okaloosa i h Escambia n N a s s a u G a d s d e n s o a s W r H a m i l t o n C a l h o u n e L e o n f f M a d i s o n a e B a y i J b D u v a l B a k e r m u L i b e r t y W a k u l l a l S u w a n n e e o d C T a y l o r r o Lafayette U n i o n S t . f d C l a y F r a n k l i n a G u l f r J o h n s B G i l c h r i s t A l a c h u a P u t n a m D i x i e F l a g l e r L e v y M a r i o n Volusia C i t r u s Population Density L a k e S e m i n o l e S u m t e r H e r n a n d o O r a n g e P a s c o Lowest Quartile (10-42 PSM) O s c e o l a Hillsborough P o l k I n d i a n R i v e r P i n e l l a s O k ee H a r d e e M a n a t e e ee c h o S t . L u c i e H i g h l a n d s b 2nd Lowest Quartile (43-140 PSM) e D e S o t o e S a r a s o t a M a r t i n Charlotte G l a d e s Palm Beach H e n d r y L e e Broward C o l l i e r Dade Monroe Note: Remaining counties range from 160-1,507 PSM

  28. Correlation Between Substance Use and Population Density

  29. Likelihood of Use by Population Density Quartile Race/ethnicity, age, gender and parental education level controlled for

  30. Summary • Lifetime use of SC increases with age/grade • Past-30-day use shows less increase with age/grade • Though the Florida ban on SC chemicals was implemented between the 2011 and 2012 surveys, use appears to have increased slightly among HS youth

  31. Summary • Use among 9th graders increased 78% from 2011-2012 • Use among 11th graders increased 48% • Males are more likely that females to use SC • NH White youth are more likely to use SC than NH Black or Hispanic youth • The gender and race/ethnicity differences are greater for SC than for marijuana use

  32. Summary • The vast majority of SC users are also marijuana users • SC use among Florida youth is comparable to youth nation wide • Youth in rural counties are more likely to use SC, but not marijuana, than youth in densely populated counties

  33. Discussion • Where are youth getting SC? • New question added to FYSAS in 2013: • If you have used synthetic or “fake” marijuana, where did you get it? • On the internet • Convenience store or gas station • Tobacco or head shop • Other

  34. Conclusion • Given the consequences of SC use as indicated by poison center calls and ED visits by this age group, it is important to develop targeted prevention programs, especially for white, male youth

  35. Hal Johnsonhal@dcf.state.fl.us850-717-4420

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