Drugs - Florida's Center for Child...

Florida's Flakka & Opiate Epidemics

Jim Hall [email protected] 1

Novel Psychoactive

Substances (NPS)

Emerging Issues in Substance Abuse

James N. Hall

Epidemiologist, Nova Southeastern University Davie, Florida

Designer Drugs

From

MDA to

3,4 MDMA

“ecstasy”



DRUGS

• Not “spice,” “bath salts,” nor “incense”

• Psychoactive Substances

• Change the Brain’s Functions

• Complex Chemistry

• Complicated Neuropharmacology

• The Menu:

Classes of Novel Psychoactive Substances (NPS)

• Phenethylamines – includes Methamphetamine

• Cathinones – Stimulants & Hallucinogens

• Cannabinoids

• Tryptamines

• Piperazines

• Opiates- Fentanyl Analogues et al

• Benzodiazepine Analogues



Cathinone Stimulants often have trendy names and slick packaging

• White lightening

• Zoom

• Cloud 9

• Cloud 10

• Red Dove

• Blue silk

• Moon dust

• NRG (4-MEC)

• Head trip

• Radiance

• Ivory Wave

• Power surge

• Sextasy

• Vanilla Sky

MAJOR Synthetic Cathinones 2014-2015

• Cathinones – Synthetic Khat

• MDPV

• 4 MEC

• Methylone

• Alpha-PVP

• Ethylone

• Butylone

• Others



The Changing Face of Ecstasy, Molly, Flakka, et al

in Florida Crime Lab Reports 2010-2015

2010 2011 2012 2013 2014 2015

Ethylone 0 1 5 4 1,426 1,827

Methylone 1 123 739 2,813 1,042 29

Alpha-PVP 0 1 82 46 781 2,012

Other Cathinones 19 248 484 241 281 7

MDMA 1071 674 182 115 136 158

0

500

1000

1500

2000

2500

3000

3500

4000

4500

Ethylone

Methylone

Alpha-PVP

Other Cathinones

MDMA

Nu

mb

er o

f C

rim

e L

ab R

epo

rts

Source: US DEA - National Forensic Laboratory System Data Queried Jan 19, 2016

Florida Ecstasy, Molly, & Flakka Crime Lab Cases January-June 2016

Dibutylone, 186

Alpha-PVP, 122

Ethylone, 103

MDMA, 70

Dibutylone

Alpha-PVP

Ethylone

MDMA

Source: US DEA - National Forensic Laboratory System Data Queried July 25, 2016



She Makes Me Want to Dance

Looking for Molly

First, Methylone beta-ketone MDMA

Then, Ethylone 3,4-methylenedioxy-N-ethylcathinone

(MDEC, bk-MDEA)

Molly



“Flakka”

alpha-PVP

• Flaca – Skinny

• Flaka – Beautiful, elegant woman

who charms all

• Elsewhere called

“Gravel”

a-pyrrolidinopentiophenone

Toxic

Effects: • Tachycardia,

• Agitation,

• Psychosis,

• Violent behavior,

• Excited Delirium • Hyperthermia

• Kidney failure • Death

South Florida

Crime a-PVP Lab

Cases: • 2012 - 2

• 2013 - 6

• 2014 - 576

• 2015 - 1,661

• Jan-Jun 2016 57



Flakka Frenzy

Flakka Hospital Cases: Broward Health June 1 – December 27, 2015

Male 1,516

Female 356

Flakka Cases by Gender

Flakka Cases by Ethnicity

White NH 751

Black NH 996

White Hisp 110 Asian 6

Black Hisp 7

American Indian 2

19 %

81 %

n = 1,872 Flakka Cases



63 Flakka Related Deaths

Broward County, Florida

September 2014 – December 11, 2015

Clinical Issues for Flakka Clients • Cognitive Impairment

• “I can’t think”

• 20 minute private sessions

• Decreased reading comprehension

– Use of pictures instead of paragraphs

• Continuous Paranoia

- Quiet, private room

- No bright lights

• The Matrix Model



China Bans alpha-PVP

Flakka Hospital Cases Broward Health Medical Centers: June 1 – December 27, 2015

n = 1,872 Flakka Cases

346 360 304 315 306

187

54

0

50

100

150

200

250

300

350

400

Source: Broward Health Medical Centers

Nu

mb

er

of

Flak

ka H

osp

ital

Cas

es

n = 1,872 Flakka Cases June 1 – December 27, 2015



Broward Addiction Recovery Center Flakka Treatment Admissions September 2014 – January 2016 n= 469

1

14 20 23 20

25 23

37

26

39

50

41 48

39

34

23

6 0

10

20

30

40

50

60Se

p-1

4

Oct

-14

No

v-1

4

De

c-1

4

Jan

-15

Feb

-15

Mar

-15

Ap

r-1

5

May

-15

Jun

-15

Jul-

15

Au

g-1

5

Sep

-15

Oct

-15

No

v-1

5

De

c-1

5

Jan

-16

# o

f Fl

akka

Tre

atm

en

t A

dm

issi

on

s

Source: Broward Addiction Recovery Center (BARC)



Frontline Florida: Emerging Drug Trends

The Opiate Epidemic

James N. Hall, Epidemiologist

Nova Southeastern University

Center for Applied Research on Substance Use

and Health Disparities

208 271 250 230

150 109

78 93 119 95 48 57

108

199

447

686*

0

100

200

300

400

500

600

700

800

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H2015

Number of Heroin Deaths in Florida: 2000 to 2015*

Nu

mb

er

of

He

roin

De

ath

s

Source: Florida Medical Examiners Commission 2015 Interim Report

* Projected Increase based on 2 X 1st Half of 2015

2015 Heroin Cases 93 % Cause of Death 95 % w/Other Drugs



Number of Nonmedical Rx Opioids Occurrences Detected among Decedents

in Florida 2005 – 2015* #

of

Op

ioid

s D

ete

cte

d A

mo

ng

De

ced

en

ts

4,035 4,416

5,059 5,454

6,006 6,608 6,333

5,489

5,085

5,624 6,174*

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Opioids

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2005 - June 2015 Reports

*2015 projection based on 2 x 1H2015

2015 Rx Opioid Cases 47 % Cause of Death 89 % w/Other Drugs

Number of Lethal Rx Opioid and Heroin Occurrences

Among Deceased Persons in Florida 2000 to 2015*

* Projected Increase based on 2 X 1st Half of 2015

# “C

ause

of

De

ath

” O

ccu

rre

nce

s


0

500

1000

1500

2000

2500

3000

3500

4000

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H

2015

Heroin

Fentanyl

Morphine

All Other Rx Opioids

3,529



Number of Hospital Cases for Non-Fatal Rx Opioid Poisonings in Florida: 2007-2014

Nu

mb

er

of

Rx

Op

ioid

Po

iso

nin

g P

atie

nts

Source: Analysis of data from the Florida Agency for Health Care Administration

CY2007

CY2008

CY2009

CY2010

CY2011

CY2012

CY2013

CY2014

Emergency Dept 2343 3069 3160 3285 3060 2534 2709 3990

Inpatient 4411 5084 5691 6286 6464 5909 5917 7915

0

2000

4000

6000

8000

10000

12000

14000

Emergency Dept

Inpatient

6,754

8,153 8,851

9,571 9,524 8,443 8,626

11,905

875

11,030

With

Without

Rx Opioid Poisoning Hospital Cases in Florida With and Without a Diagnosis of Opioid Abuse: 2014 n= 11,905

Source: Analysis of data from the Florida Agency for Health Care Administration 93 %

7 %



Number of Hospital Cases for Heroin Overdose Poisonings in Florida: 2014

Hospital Heroin Poisonings

561

1,364

0

500

1000

1500

2000

2500

Heroin

Emergency Dept.

Inpatient

With or Without Abuse Diagnosis

1,368

557

Without Abuse Diagnosis

With Abuse Diagnosis

29%

71 %

1,925

Source: Florida Agency for Health Care Administration

n = 1,925

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



“Dope Sick” Addiction is the Affliction

How Did Florida Get Here: The Nonmedical Rx Epidemic 2000 to 2010



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

Number of Nonmedical Rx Opioids Occurrences Detected among Decedents

in Florida 2005 – 2015*

# o

f O

pio

ids

Det

ect

ed

Am

on

g D

ece

de

nts

4,035 4,416

5,059 5,454

6,006 6,608 6,333

5,489

5,085

5,624 6,174*

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Opioids

House Bill 7095 Takes effect

CS-II Dispensing Limits and OxyContin Tamper Resistant

Strike Force


*2015 projection based on 2 x 1H2015



Number of Selected Lethal Rx Opioid Occurrences Among Deceased Persons in Florida 2008 to 2015

Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2008 - Jun 2015 Reports

# “C

ause

of

De

ath

” O

ccu

rre

nce

s

476 465

533

652 715

801

607 640

392

343 279

255 219 251 274

337 336 380

340 336 358

341

350 274

238 221 168 170 142 158 153 147 160 142

110 152

144 201 176

239 268

300 295

410 387

141 129 136 129

139 176

136 171

118 126 158

133

119 131 108 85 100

139

258 289

0

100

200

300

400

500

600

700

800

900

1H

'08

2H

'08

1H

'09

2H

'09

1H

'10

2H

'10

1H

'11

2H

'11

1H

'12

2H

'12

1H

'13

2H

'13

1H

'14

2H

'14

1H

'15

Oxycodone

Methadone

Morphine

Hydrocodone

Fentanyl

House Bill 7095 Takes effect

CS-II Dispensing Limits & OxyContin Tamper Resistant Strike Force

208 271 250 230

150 109 78 93 119 95

48 57 108

199

447

686*

197 235 215 227 236 251

292

538

794*

0

100

200

300

400

500

600

700

800

900

Heroin

Fentanyl

Nu

mb

er

of

De

ath

s

Source: Florida Medical Examiners Commission 2015 Interim Report * Projected Increase based on 2 X 1st Half of 2015

Number of Heroin and Fentanyl Deaths in Florida: 2000 to 2015*



2012

CHINA

2014

Non-Pharmaceutical Fentanyl (NPF)

2012: New NPF Trafficking

NPF Pill press businesses Pill press equipment and NPF supplied by

Chinese

Internet ordering and Canadian in-country pill pressing

Found in British Columbia, Alberta, Ontario and Quebec in Canada

In the US so far: Los Angeles, New York,

Ohio, Seattle



Pill press plus 1K NPF = $100,000 Street value = $20,000,000

Source: RCMP

Counterfeit Xanax with

Fentanyl

Real

Fake

Pinellas County Florida



Fake Oxycodone

with Fentanyl

Authentic Oxycodone

A 215

Pinellas County Florida

Non Pharmaceutical Fentanyl

• acetylfentanyl, •butyrfentanyl, • 3-methylfentanyl •Furanylfentanyl •Carfentanil



Number of Neonatal Abstinence Syndrome

Cases State of Florida: 2007-2014

536

694

1,019

1,336 1,563

1,630 1,771

1,914

0

200

400

600

800

1000

1200

1400

1600

1800

2000

2007 2008 2009 2010 2011 2012 2013 2014

Source: Florida Agency for Health

Care Administration



Branch of Community Organization Resources Available Activities Contact

Branches of Community Law Enforcement First Responders

Medical Community Non-Profits

Addiction Treatment Judicial

Faith-Based Education

County Government Media

Business Sector Youth/Parents

Federal Agencies

Sam Quinones

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