DRUG TRENDS IN IOWA...9.7%-8.9% Other NA-3.5% Opiates 9.7%-12.8% IDPH, 2014 Iowa’s Workplace...
Transcript of DRUG TRENDS IN IOWA...9.7%-8.9% Other NA-3.5% Opiates 9.7%-12.8% IDPH, 2014 Iowa’s Workplace...
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DRUG TRENDS IN IOWA
PROGRESS, PERIL & PERSEVERANCE
Governor’s Office of Drug Control Policy
March 2016
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Trending in Iowa: Drug Use at a Glance
• 2nd lowest rate of illicit drug use & 13th lowest rate of Rx abuse in US. (NSDUH, 2013-2014)
• Youth substance abuse declined steadily over last decade. (IYS, 2014)
• Meth labs down ~90% vs. peak of 12 years ago (135 vs. 1,500). (IDPS, 2015)
• Meth use treatment rate 11th highest in US. (TEDS, 2012)
• Underage & binge drinking exceed national average. (NSDUH, 2013-2014)
• OD deaths from Rx drugs (heroin too) near all time highs. Medicine
misuse/abuse fastest growing form of substance abuse. (ODCP, 2015)
• Marijuana “concentrates” are becoming more prevalent. (IDPS/ODCP, 2015)
• Synthetic drugs still evolving threat. (ODCP/IPCC 2015)
Most Recent Data Available
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Drugs of Choice: All Iowans Primary Substance of Choice by Iowans in Treatment
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Alcohol
Marijuana
Meth
Cocaine
Heroin
Other
6.3%
IDPH, 2014
3
50%
25.6%
14.8%
1.7% 1.6%
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Iowa Youth Substance Abuse 6th, 8th and 11th Grade Users, Last 30-Days
0%
5%
10%
15%
20%
25%
2002 2005 2008 2010 2012 2014
Alcohol
Tobacco
Other Drug
Rx
OTC
Meth
3%
23%
12%
14%
9% 10%
6%
4%
3%
4
4%
Iowa Youth Survey, 2014
1% 1%
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Iowa “Drug-Related” Prison Admissions Primary Drug Involved
0
200
400
600
800
1,000
1,200
827
5
Iowa Justice Data Warehouse, 2015
Rx Heroin
All Drugs
Meth
Marijuana
Cocaine/Crack
Other
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Alcohol
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Iowa Annual Distilled Spirits Sales Millions of Gallons Sold to Adults
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
5.16 m
3.26 m
7
IABD, 2015
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Current Alcohol Use Last 30-Days
0%
10%
20%
30%
40%
50%
60%
70%
80%
12+ 12-17 18-25 26+
U.S.
Iowa
NSDUH, 2013/2014
8
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Current Binge Drinking Last 30-Days
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
12+ 12-17 18-25 26+
U.S.
Iowa
NSDUH, 2013/2014
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Marijuana
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Marijuana Laws & Use by Teens by State
“Medical” & “Recreational” Marijuana Laws (2015 Governing.com)
Past Month Use by 12-17 Year Olds (2013-2014 NSDUH)
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• Dark Green = “Medical” marijuana (23 & DC).
• Light Green = “Medical” & “Recreational” marijuana (4).
• Not Shown: Low THC non-psychoactive “CBD” oils (16,
including Iowa, where the Pharmacy Board recommended
in 2015 the Legislature consider rescheduling CBD only).
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Marijuana
66.3%
Alcohol
21.9%
Other 6.5% Meth
4.1%
Cocaine 0.2%
Opiates/Synthetics 1.0%
Iowa Youth Drugs of Choice Primary Substance by Juvenile Clients Entering Treatment
IDPH, 2014
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Marijuana
62.8%-
59.0% Meth
22.9%-
15.8%
Cocaine
9.7%-8.9%
Other NA-3.5%
Opiates
9.7%-
12.8%
IDPH, 2014
Iowa’s Workplace Positive Drug Tests Reported 2002-2011
13
Positive drug tests
for marijuana
among employees
in the general U.S.
workforce increased
in 2014 for the 3rd
straight year.
Marijuana was
detected in 2.4% of
all drug tests, a
14.3% increase vs.
2013, when a 5%
increase was
recorded vs. 2012. 2015 Quest Diagnostics
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0
2
4
6
8
10
12
14
16
Marijuana Meth Rx Synthetic Opium Other
Iowa Drug-Related Traffic Fatalities Number Killed in 2014 Who Tested Positive for Illicit Drugs
14
Source: IDOT, 2014
15
Does not include alcohol-related fatalities.
Alcohol & poly-drug combinations were detected in some crashes.
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0
50
100
150
200
250
300
350
400
450
500
Iowa Drug-Impaired Driving 2015 Non-Alcohol Evaluation Findings by Drug Recognition Experts
15
IDPS, 2015
429
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Source of Marijuana Seized in Iowa 2015 Iowa State Patrol Significant Highway Interdictions
16
California
53.3% Colorado
40%
Wyoming
6.7%
Iowa was the 6th most
frequent state destination
for Colorado marijuana
seized in highway
interdictions. 2014 El Paso Intelligence Center
Iowa Department of Public Safety, 2015
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Iowa Marijuana ER Visits Cannabis Use as Causal or Contributing Factor
17
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2006 2007 2008 2009 2010 2011 2012 2013 2014
1,633
455
Iowa Department of Public Health, 2014
Marijuana impairs/worsens respiratory systems,
heart rate, coordination, judgment, memory,
problem-solving & mood. It contributes to auto
crashes & can cause severe anxiety & psychosis.
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Current Youth Marijuana Use Past 30 Days: U.S. vs. Iowa
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
37.1%
18
11.9%
21.3%
17%
11%
2015 Monitoring the Future Survey & 2014 Iowa Youth Survey
• 5.02% of all Iowans 12+ & 5.17% of Iowa teens are current marijuana users.
• 54% of Iowa 11th graders say marijuana would be easy or very easy for
peers to get in their neighborhood or community.
• 24% of Iowa 11th graders see no risk smoking marijuana once or more a
week, about twice as many as 15 years ago.
US 12th
Graders
Iowa 11th
Graders
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Youth Marijuana Attitudes Among Iowa 11th Graders
0%
5%
10%
15%
20%
25%
30%
19
Iowa Teens Perceiving
No Risk Smoking Marijuana
Once or More a Week
Iowa Youth Survey, 2014
12%
24%
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Youth Marijuana Attitudes vs. Use Among U.S. 12th Graders
0%
10%
20%
30%
40%
50%
60%
20
Perceived Risk of
Occasional Marijuana Use
Past Year Marijuana Use
Monitoring the Future Survey, 2014
College students daily marijuana use surpassed
cigarette smoking for the 1st time in 2014.
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Marijuana’s Increasing THC Potency Marijuana Seized in U.S.
0%
2%
4%
6%
8%
10%
12%
14%
University of Mississippi Marijuana Project, through 12-22-15
3.75%
11.16% U.S. THC levels averaged less than 1% in 1972.
2014 University of Mississippi Marijuana Project
21
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Marijuana’s Increasing Potency U.S. Seizures, Concentration of THC by % of Weight
0.74% 3.75%
11.8%
*50+%
0%
10%
20%
30%
40%
50%
60%
1975 1995 2014 *Recent
Co
ncen
trate
s
Source: NIDA & DEA
*Concentrates contain THC levels of 50-90%. (Examples: Hash Oil, Marijuana Wax, Marijuana-Infused Edibles)
DEA
22
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New Marijuana Examples of High THC Concentrates Found in Iowa
23
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Meth
24
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Iowa Meth Labs
0
200
400
600
800
1000
1200
1400
1600
(Gold = “One Pot” Labs)
Iowa Meth Labs Down 90% vs. Peak of 10 Years Ago. Source: IDPS, 2015
25
1,500
2
151
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Iowa Meth Purity Crime Lab Fiscal Year Averages
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2008 2009 2010 2011 2012 2013 2014
Source: IDPS, 2014
35%
26
93%
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Iowa Meth Treatment Admissions
0
1000
2000
3000
4000
5000
6000
7000
8000
Source: IDPH, 2014
7,196
27
4,062
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Rate of Meth Treatment % of 12+ Substance Abuse Treatment Admissions Primarily for Meth
0%
5%
10%
15%
20%
25%
30%
U.S.
Iowa
TEDS, 2012
28
*Clients reporting
meth as primary,
secondary or tertiary
drug of choice
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Iowa Drug-Related Child Abuse Confirmed/Founded Cases: Illegal Drugs in a Child’s Body
0
200
400
600
800
1000
1200
1400
1600
1800
633
IDHS, 2015
921
1,713
29
(Differential Response initiative began in 2014)
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Opioid
& Rx
Abuse
30
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Types of Medicines Abused
• Opioids (*Pain Relievers) – OxyContin®, Vicodin®, Percocet®
• Stimulants – Ritalin®, Adderall®, Sudafed®
• Anti-Anxieties – Xanax®, Valium®
• Anti-Depressants –Prozac®, Zoloft®
• Sedatives – Rohypnol®, Nembutal®, Seconal®
• Etc.
31
*Synthetic Opioid Examples: Oxycodone, Morphine, Methadone, Codeine, Fentanyl & Hydrocodone.
Hydrocodone combination products became Schedule II Controlled Substances in October 2014.
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Rx Diversion/Abuse in Iowa: Summary
• Iowa’s Rx abuse rate is lower than the U.S. average (past year nonmedical use of Rx pain relievers = 3.65%...13th lowest)
• Opioid abuse is one of the fastest growing forms of
substance abuse in the U.S. & Iowa (OD deaths at or near all time highs)
• Prescription Monitoring Program (PMP) utilization rates
by health care professionals are slowly rising
• Cases of suspected “doctor shopping” detected by the
PMP may be decreasing
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National Rx Painkiller Trends
CDC, 2013
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Pain Reliever Prescriptions: By State
CDC, 2014
34
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Controlled Prescription Drug Seizures In Dosage Units by Iowa Division of Narcotics Enforcement Agents
0
500
1000
1500
2000
2500
3000
3500
2009 2010 2011 2012 2013 2014
2,851 du
35
IDPS, 2015
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Iowa Drug Treatment: Numbers Any Abuse of Non-Heroin Opiates & Synthetics Reported at Admission
0
500
1,000
1,500
2,000
2,500
3,000
2005 2006 2007 2008 2009 2010 2011 2012
2,506
764
TEDS, 2012
36
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Poison Center: Public “Help” Calls Exposure, ID & Info Calls re: Painkillers Hydrocodone & Oxycodone
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
*2,318
1,097
Iowa Poison Control Center, 2015
37
#1 Category of “Exposure” Calls:
Pain Medicines
(opioid & non-opioid).
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Iowa Opioid-Related ER Visits Opioid Use (including Opiates & Others) as Causal or Contributing Factor
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2006 2007 2008 2009 2010 2011 2012 2013 2014
IDPH, 2014
1,555
38
519
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Iowa Drug-Related OD Deaths: All Drugs
0
50
100
150
200
250227
46
IDPH, 2015
39
110
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Iowa Drug-Related OD Deaths: Pain Relievers Rx Methadone, Other Opioids & Other Synthetic Narcotics
0
10
20
30
40
50
60
70
80
90
77
5
IDPH, 2015
40
42
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Heroin
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42
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Hydrocodone
(Lorcet®)
= $5-$7/tab
Oxycodone Combinations (Percocet®) = $7-$10/tab
OxyContin®
= $80/tab
Heroin = $10/bag
Roxicodone®
Oxycodone IR
15mg, 30mg
= $30-$40/tab
Rx Pain Reliever-Heroin Connection
DEA, 2013
43
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44
Rx-Heroin Trends
NSDUH, 2013
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Heroin Seizures In Grams by Iowa Division of Narcotics Enforcement Agents
0
500
1000
1500
2000
2500
3000
3500
2009 2010 2011 2012 2013 2014
2,920 g
45
IDPS, 2015
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Iowa Drug-Related Overdose Deaths: Heroin
0
5
10
15
20
25
20
1
IDPH, 2015
46
19
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Drug-Related OD Incidents: Cedar Rapids
0
10
20
30
40
50
60
70
80
9080
CRPD, September 29, 2015
47
54
All Drugs
Heroin
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Iowa Drug-Related Prison Admissions Primary Drug Involved
0
5
10
15
20
25
30
35
40
45
33
48
8
Iowa Justice Warehouse, 2015
13
5
Prescription Pain Relievers/Opioids
Heroin/Opiates
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Ease of Access & Perceptions of Safety
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Attitudes Drive Behavior
• 56% say it’s easy to get prescription drugs from their
parent’s medicine cabinet.
• 42% who have misused or abused a prescription drug
obtained it from their parent’s medicine cabinet.
• 49% of teens who misuse or abuse prescription
medicines obtained them from a friend.
• 27% of teens mistakenly believe abusing prescription
drugs is safer than using street drugs.
• 16% of parents believe using prescription drugs to get
high is safer than using street drugs.
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PATS, 2013
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Response to Reduce Rx Abuse: Iowa Plan
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Education & Intervention
Secure Storage & Safe Disposal
Monitoring
Enforcement
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Rx Abuse Prevention = Heroin Prevention
IowaMedicineTLC.org
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Safe Medicine Disposal
National Take-Back Events: Special take-back events are a good way
to remove expired, unwanted, or unused medicines from the home.
Law Enforcement Collection: A growing number of law enforcement
agencies collect expired, unwanted, or unused pharmaceutical controlled
prescription drugs on an ongoing basis via secure drop-off boxes.
Disposal in Household Trash: You may carefully mix medicines with
substances such as kitty litter or used coffee grounds and place them in a
container such as a sealed plastic bag to throw in your household trash.
Disposal by Flushing: A few medicines have specific instructions to
flush them down the sink or toilet when they are no longer needed.
ODCP, 2015
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Pharmacy Collection: Some pharmacies collect expired, unwanted, or
unused pharmaceutical controlled prescription drugs from patients.
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U.S. “Take-Back” Initiative Amount (in Tons) of Rx Drugs Collected
0
50
100
150
200
250
300
350
400
450
DEA, 2015
10 Events, 5 Years = 2,783 Tons
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122
351
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Iowa “Take-Back” Initiative Amount (in Pounds) of Rx Drugs Collected
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000
DEA, 2015
10 Events, 5 Years = 59,935 Pounds
(~30 Tons)
55
1,569
8,643
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Iowa Permanent Rx “Take Back” Sites Controlled Prescription Drugs
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ODCP, 2016
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Iowa PMP: Total Prescriptions Dispensed
3,900,000
4,000,000
4,100,000
4,200,000
4,300,000
4,400,000
4,500,000
4,600,000
4,700,000
4,800,000
4,900,000
2009 2010 2011 2012 2013 2014
4,800,912
4,239,890
IDPH, 2014
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Iowa PMP: Prescription Doses Dispensed
200,000,000
210,000,000
220,000,000
230,000,000
240,000,000
250,000,000
260,000,000
270,000,000
280,000,000
2009 2010 2011 2012 2013 2014
269,466,402
228,149,732
IDPH, 2014
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Synthetic
Drugs
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Synthetic Cannabinoids & Cathinones Hallucinogens & Stimulants by State
2010 2012
DEA, 2013
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Signs & Symptoms Synthetic Cannabinoids
• Panic, Anxiety
• Hallucinations
• Hypertension
• Tachycardia
• Paranoia
• Aggressive Behavior
• Suicidal Tendencies
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• Nausea, Vomiting
• Drowsiness
• Agitation
• Dyspnea (shaking)
• Palpitations
• Headache, Dizziness
• Seizures
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Signs & Symptoms Synthetic Cathinones
• Panic, Anxiety
• Hallucinations, Delusions
• Hypertension
• Tachycardia
• Paranoia
• Violence
• Suicidal Tendencies
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• Nausea, Vomiting
• Sleeplessness
• Agitation
• Palpitations
• Shortness of Breath
• Headache, Dizziness
• Seizures
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Phenylalkylamines
Benzodiazepines
Piperazines
Arylcyclohexamines
Tryptamines
Synthetic Cannabinoids
Ecgonine Derivatives
Anabolic agents
Designer Drugs
phenazepam
Benzyl-
piperazines
BZP
MDBP
4-Bromo-2,5-
diMeO-BZP
MBZP
MDBZP
Phenyl-
piperazin
es:
mCPP
TFMPP
MeOPP
pFPP
Steroids:
THG
Many
examples
SARMs:
Andarine
LGD-2226
Mk-2866
2C Series –
2,5-dimethoxy-
ethanamine:
2C-B
2C-C
2C-D
2C-E
2C-H
2C-I
2C-N
2C-P
2C-T-2
2C-T-4
2C-T-7
2C-T-21
25I-NBOMe
D-Series-2,5-
dimethoxy-
phenyl-
propanamines:
2,5-DMA
3,4-DMA
DOB
DOC
DOET
DOF
DOI
DOM
DON
DOPR
MDOB
Dimethoxy derivatives:
Monomethoxy
derivatives
PMA
PMMA
N-ethyl-PMA
Trimethoxy
derivatives:
3,4,5-TMA
TMA-2
TMA-3
TMA-4
TMA-5
TMA-6
4-MTA
homologs
4-MTA
4-MTMA
4-MTEA
4-MTPA
4-MTBA
4-MTDMA
b-Keto-
phenethylamines
Mephedrone
MDPV
Methylone
Ethylone
Butylone
Flephedrone
Methcathinone
Ethcathinone
bk-MDDMA
Naphyrone
4-MEC
4-EMC
a-PVP
4-MePPP
a-PBP
buphedrone
Difurnanyl
compounds
Bromo-
dragonfly
2C-B-fly
Fluoro-
containing
compounds
4-FA
3-FA
2-FA
N-Methyl-4-FA
N-Ethyl-4-FA
3-F-4-MeO-A
Others
MDDMA
Ethyl-
amphetamine
N-OH-MDMA
MDDM
N,N-Dimethyl-1-
phenyl-2-
ethanamine
1-phenyl-2-
butylamine
MDA
AMT
DMT
DET
DPT
DBT
DiPT
MiPT
4-OH-DiPT
4-OH-MiPT
4-OH-MET
5-MeO-AMT
5-MeO-DMT
5-MeO-DiPT
5-MeO-MiPT
5-MeO-EiPT
5-AcO-DiPT
5-MeO-DPT
5-MeO-DALT
Classic
cannabinoi
ds
HU-210
IP-751
Parahexyl
and many
others
Cyclohexyl-
phenols
CP-47,497
CP-47,497-
C8
CP-55,950
Indoles/Pyrr
oles
JWH-018
AM2201
JWH-200
JWH-081
JWH-250
AM694
RCS-4
SR-18
UR-144
XLR11
Eicosanoids:
Anandamide
Oleamide
Others
AKB48
URB597
CB-13
4-Fluorotropa-
cocaine
b-CFT
p-FBT
Red = Controlled substance
Yellow = Positional isomer, controlled by definition
Green = Determined to be controlled substance analogue
PCPR
PCMPA
PCMEA
PCEEA
PCEPA
5-MeO-
PCP
MXE
4-Me-
PCP
3-MeO-
PCE
63 Modified from Wohlfarth and Weinmann, Bioanalysis, 2010
2/10/2016 63
The Chemistry
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Parents & Key Influencers
Make a Difference
• Drug use is a preventable behavior.
Drug addiction is a treatable disease.
• Teenagers who learn about the dangers of drugs through
ongoing dialogue at home are up to 50% less likely to
ever use drugs.
• Illegal means unsafe, but legal substances can also be
unsafe when not used as intended.
• One of the most frequent reasons cited by drug free
teenagers for their decision to not use drugs is the fear
of disappointing their parents.
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Drug Trends in Iowa: Summary
• Alcohol remains Iowa’s most abused addictive substance.
• Iowans’ appetite for meth remains strong, fed by cartels.
• Marijuana is Iowa’s most used illicit substance, & is
morphing into new more potent forms.
• Medicine/Opioid abuse is Iowa’s fastest growing form of
substance abuse…leading to more heroin use too.
• Synthetic drugs are a fast-changing threat to Iowa youth.
• With exceptions, Iowans generally abuse drugs at rates
below many other states…& Iowa youth substance abuse
is declining. Challenges remain, now & in the future.
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SHARE THE NEWS & STAY SAFE!
Iowa Governor’s Office of Drug Control Policy
www.iowa.gov/odcp
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