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The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 1
Mayors’ Opioid Summit PATTERNS AND TRENDS OF THE OPIOID EPIDEMIC
IN BROWARD COUNTY
Jim HallSenior EpidemiologistCenter for Applied Research on Substance Use and Health DisparitiesNova Southeastern University
DEFINITION OF OPIOID
“Similar to opium”
Morphine and similar drugs derived from opium
All substances, both natural and synthetic, that bind to opioid
receptors in the brain and body
TYPES OF OPIOIDS• Illegal Heroin
• Legal Prescription Opioid Pain Relivers
(e.g., Oxycodone, Hydrocodone, Methadone, Morphine, Rx Fentanyl, et al)
• Illicitly manufactured Opioid Analogues(e.g., Fentanyl, U-4700, et al sold as Heroin or adulterants to Heroin, Cocaine or other drugs,
and counterfeit prescription medications)
Counterfeit Xanax with
Fentanyl
Real
Fake
PinellasCounty Florida
Pill Press from China
Source: Royal Canadian Mounted Police
The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 2
AN EPIDEMIC OF DEATHS
Plus 6,186
Rx Opioid
Occurrences
In 2016
AN EPIDEMIC OF DEATHS
•USA – 91 deaths a day in 2015
• Florida – 14 + deaths a day in 2016
plus 27 non-fatal Overdoses
•Broward County – 10 deaths a week
plus 17 non-fatal Overdoses
• Jan– Aug 2017 Death Rate still increasing
Ft. Lauderdale Pill Mill
…….The doctor is in
ARCOS
October2008 – March 2009
Top 50
9,201,731
Dose Units
49 in Florida 25 in Broward County
1371.0
407.6
1427.6
782.0
519.3
230.2
647.8 640.0
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
1400.0
1600.0
BROWARD, FL MIAMI-DADE,FL
PALM BEACH,FL
USA
MME_PerCap_2010
MME_PerCap_2015
Rx Morphine Milligram Equivalent Rates per 100,000 in Southeast Florida Counties and USA: 2010 vs. 2015
Source: Centers for Disease Control and Prevention July 2017
MM
E R
ate
Pe
r 1
00
,00
0 P
op
ula
tio
n
USA Up From 180 MME in 1999
The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 3
Number of Nonmedical Rx OpioidsOccurrences Detected among Decedents
in Florida 2005 – 2016*
# o
f O
pio
ids
De
tect
ed
Am
on
g D
ece
de
nts
4,0354,416
5,0595,454
6,0066,608 6,333
5,489
5,085
5,624
6,514
8,162*
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2X1H2016
Opioids
House Bill 7095Takes effect
CS-II Dispensing Limits and OxyContin Tamper Resistant
Strike Force
Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2005 - June 2016 Reports
*2016 projection based on 2 x 1H2016
Number of Heroin Related-Deaths in Broward County Florida: 2010-2016
53 9 11
28
80
144
0
20
40
60
80
100
120
140
160
2010 2011 2012 2013 2014 2015 2x1stH 2016
Source: 2016 FL Medical Examiner Interim Report
1st H of 2016 Heroin Cases96 % Cause of Death92 % w/Other Drugs
Nu
mb
er
of
He
roin
Occ
urr
en
ces
Nu
mb
er
of
Fen
tan
yl O
ccu
rre
nce
s
Fentanyl Occurrences Among Deceased Persons in Broward County FL: Jan 2014-Jun 2016
Fentanyl
Source: FDLE - Florida Medical Examiners Commission
21
3242 40
94
0
10
20
30
40
50
60
70
80
90
100
1H 2014 2H 2014 1H 2015 2H 2015 1H 2016
1st H of 2016 Heroin Cases97 % Cause of Death86 % w/Other Drugs
Nu
mb
er
of
Occ
urr
en
ces
Heroin, Morphine, Fentanyl, and 3 Other Rx Opioid Occurrences Among Deceased Persons in Broward County FL: Jan 2015-Jun 2016
Morphine
Fentanyl
Heroin
Source: FDLE - Florida Medical Examiners Commission
40
56
73
4240
94
34
46
72
49 48 50
0
10
20
30
40
50
60
70
80
90
100
1st H 2015 2nd H 2015 1st H 2016
Oxycodone
Hydrocodone
Methadone
Source: FDLE - Florida Medical Examiners Commission
3229
38
11 10
6
69
60
5
10
15
20
25
30
35
40
1st H 2015 2nd H 2015 1st H 2016
Occurrences of 3 Selected Rx Opioids among Deceased Persons in Broward County: Jan 2015 -June 2016
Source: FDLE - Florida Medical Examiners Commission
Opioid 1st H 2015 2nd H 2015 1st H 2016
Fentanyl 42 40 94
Morphine 40 56 73
Heroin 64 46 72
Oxycodone 32 29 38
Hydrocodone 11 10 6
Methadone 6 9 6
Number of Selected Opioid Occurrences among Deceased Persons in Broward County: Jan 2015 – June 2016
The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 4
Nu
mb
er
of
Occ
urr
en
ces %
as Cau
se of D
eath
Opioid Occurrences and Number and Percent as Cause of Death Among Deceased Persons in Broward County FL : Jan 2016-Jun 2016
Source: FDLE - Florida Medical Examiners Commission
94
7372
38
6 6
91
53
69
22
2 4
97%
73%
96%
58%
33%
67%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
0
10
20
30
40
50
60
70
80
90
100 Total Occurrences
# Cause
% Cause
Source: 2016 FL Medical Examiners Commission Interim Report
2015 332 Opiate Overdose Deaths
2016 522 Opiate Overdose Deaths
Jan-Jun 2017 282 + Drug Deaths
Broward County Florida Opiate Overdose DeathsIncludes Heroin, Prescription Opioids, and Clandestine Opiate Analogues
Source: Broward County Medical Examiner’s Office
Overdose Poisoning Cases for Heroin and Opioids, in Broward County Hospitals: Jan-Jun 2016
0
50
100
150
200
250
Heroin Patients Opioid PatientsInpatient 80 102
ED 141 98
ED Inpatient
221200
Nu
mb
er
of
Pat
ien
ts
or
Ad
mis
sio
ns
Source: Florida Agency for Health Care Administration
2016 Opioid Crime Lab Reports for Broward CountyNumber and Percent of all Exhibits• Heroin 530 (8.3%)
• Oxycodone 238 (3.7%)
• Fentanyl 110 (1.7%)
• Hydromorphone 90 (1.4%)
• Buprenorphine 49 (0.8%)
• Hydrocodone 48 (0.8%)
• Morphine 46 (0.7%)
• Carfentanil 35 (0.6%)
• Methadone 22 (0.4%)
• Furanyl Fentanyl 20 (0.3%)
Total 1,188 (18.7%)
Source: US DEA – NFLIS Data Queried 05/22/2017
Heroin from Mexico shown in Green
Symptoms of Opium Withdrawal
• nausea
• sweating
• cramps
• vomiting
• diarrhea
• insomnia
• loss of appetite
• agitation
• irritability
•mood swings
•depression
•anxiety
•muscle soreness
•aching bones
•fever
•runny nose
•twitching
The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 5
“Dope Sick” Addiction is the Affliction
IMPACT ON CHILDREN
Photo Source: The Daily Beast, Data Source: Florida Behavioral Health Association
78 % of Children in Florida’s
Child Care System for Parent’s SUD
Number of Neonatal Abstinence Syndrome
Cases State of Florida: 2007-2015
536
6941,019
1,336 1,563
1,6301,772
1,903
2,487
0
500
1000
1500
2000
2500
3000
2007 2008 2009 2010 2011 2012 2013 2014 2015
Source: Florida Agency for Health
Care Administration
Broward2007 29 2012 692008 35 2013 752009 48 2014 712010 73 2015 962011 55
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2009 2010 2011 2012 2013 2014 2015 2016
Other/Unknown
Marijuana
Rx Opioids
Heroin
Cocaine/Crack
Alcohol
Percent of Treatment Admissions by Primary Drug Broward County: 2009 - 2016
n=5,679 n=5,069 n=5,998 n=5,811 n=5,439 n=6,382 n=6,171 n=7,737
Source: Florida Department of Children and Families and
Broward Behavioral
Health Coalition
36%
8%
14%
20%
36%
22%
10%
27%
1105
13071614
17021943
2052 21791791
14621402
14441318
1337
1508 1,834
2,228*
0
500
1000
1500
2000
2500
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2 x1st H2016
Number of Cocaine Deaths in Florida and Broward County 2000-2016*
80
94 121 138
120
136 150 157 146 135 127
115
129102
99142
230*
050
100150200250
Source: Florida Medical Examiners Commission 2016 Interim Report
* Projected Increase based on 2 X 1st Half of 2016
# o
f C
oca
ine
Dea
ths
# o
f C
oca
ine
Dea
ths
Sources: Florida Medical Examiners Commission 2015 Report and Florida drug-Related Outcomes Surveillance and Tracking (FROST) System
Top 10 Co-Occurring Substances Among Florida Cocaine-Caused Deaths in 2015
5.6%
7.8%
10.4%
12.6%
13.2%
21.8%
25.1%
28.6%
31.1%
32.3%
0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%
Nordiazepam
Hydromorphone
Oxycodone
Cannabinoids
Codeine
Alprazolam
Fentanyl
Heroin
Ethanol
Morphine
The Opioid Epidemic In Broward County 08/24/2017
Jim Hall [email protected] 6
Epidemic of Opioid Use Disorder and DeathsThe Perfect Storm
For Pain
Rx
Or ForPleasure
Pill MillsStreet
ToleranceNeed More
OUD“Dope Sick”
Mexican Heroin FentanylAnalogues
el al IM Opiates
Counterfeit Pills
AbstinenceRelapse
Overdose
Polysubstance AbuseXanax
CocaineMarijuana
AlcoholWhatever Emergency
Exit
Emergency Exit
• Naloxone Distribution• Appropriate Prescribing By:
• Doctor, Dentist, Physician Assistant, Nurse Practitioner
• Intervention Training for Families• Increased Treatment Availability• Medically Assisted Treatment• Intensive Outpatient Services• Recovery Support Systems
This Presentation and Annual Broward Drug Trends Report
Mayors’ Opioid Summit
