drug abuse in iowa · 2018-05-08 · iowa drug-impaired traffic fatalities drug & mixed...
TRANSCRIPT
Most Common Drugs Used: All Iowans Primary Substance of Choice by Iowans in Treatment
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0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
Alcohol
Marijuana
Meth
Other
Heroin
Cocaine
2
47.1%
25.1%
17.6%
6.3%
2.5%
1.4%
Iowa Department of Public Health, 2017
Iowa has the lowest rate of current illicit drug use &
5th highest rate of binge alcohol drinking in the U.S. National Survey on Drug Use & Health, 2015-2016 (12+)
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 2016
Alcohol
Tobacco
Other Drug
Marijuana
Rx
Meth
12%
9%
4%
4%
3%
3
Iowa Youth Survey, 2016
1%
Iowa Drug-Impaired Traffic Fatalities Drug & Mixed Drug/Alcohol-Related Traffic Deaths
0
10
20
30
40
50
60
70
80
90
4
Iowa Departments of Transportation & Public Safety, 2017
84
Rx opioids detected in
fatally-injured drivers:
7.2%-2015 vs. 1.0%-1995. 2017 American Journal of Public Health
U.S. drug-impaired fatal crashes now outnumber alcohol-
impaired fatalities (43% vs. 38%).
Marijuana is the most-cited drug involved in fatal crashes:
35.6% in U.S. & 51% in Iowa. 2015 NHTSA & 2016 IDOT
(41 of 84 also involved alcohol + 65 alcohol only fatalities)
Iowa “Drug-Related” Prison Admissions Primary Drug Involved
0
200
400
600
800
1,000
1,200
5
Iowa Justice Data Warehouse, 2017
Rx Heroin
All
Drugs
Meth
Marijuana
Cocaine/Crack
Other
586
902
58% of state prisoners & 63% of jail inmates in the U.S.
abused drugs vs. 5% of the general population. USDOJ, Bureau of Justice Statistics, 2017
Iowa Drug & Alcohol-Related ED Visits Monthly Averages
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0
500
1,000
1,500
2,000
2,500
3,000
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016
1,704/mo.
Iowa Department of Public Health, 2017
2,709/mo.
(*Caution advised interpreting trends due to reporting changes in 2015)
Marijuana
46% (62.8%)
Meth/
Amphetamines
29% (22.9%)
Opioids
12% (9.7%)
Iowa’s Workplace Small Sampling of Positive Drug Tests Reported 2017 (vs. 2002)
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In the general
U.S. workforce,
the rate of
amphetamine,
marijuana &
heroin detection
increased
annually over the
last 5 years in
urine testing.
2016 Quest Diagnostics
Benzodiazepines
7% (NA)
Cocaine
4% (9.7%)
Other
2% (NA)
Iowa Department of Public Health, 2018
Alcohol & Tobacco/Nicotine
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Current Alcohol Use Last 30-Days
0%
10%
20%
30%
40%
50%
60%
70%
12+ 12-17 18-25 26+
U.S.
Iowa
National Survey on Drug Use & Health, 2014/2015
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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
10
National Survey on Drug Use & Health, 2013/2014
Current Tobacco Use Last 30-Days
0%
5%
10%
15%
20%
25%
30%
35%
40%
12+ 12-17 18-25 26+
U.S.
Iowa
11
National Survey on Drug Use & Health, 2014/2015
Iowa Youth Cigarette vs. E-Cigarette Use Last 30-Days
0%
1%
2%
3%
4%
5%
6%
7%
8%
9%
10%
6th 8th 11th
Iowa Cigs
Iowa E-Cigs
Iowa Youth Survey 2016
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Marijuana Laws & Use by Teens
Law types by State, including DC
CNN/Money, 2018
Past Month Use by 12-17 Year Olds
NSDUH, 2015-2016
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Health Group Positions on Marijuana
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• Major public health organizations (American Cancer
Society, American Glaucoma Foundation, American
Medical Association, American Psychiatric Association,
National Pain Foundation, National Multiple Sclerosis
Society, National Association of School Nurses, et al.) do
not support smoked marijuana.
• The American Academy of Pediatrics “opposes marijuana
use by children & adolescents…the use of ‘medical’
marijuana outside the regulatory process of the
FDA…&…legalization of marijuana.”
Iowans’ Current Marijuana Use Most Iowans are NOT current marijuana users (past 30 days)
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Use
5.38%
Do Not Use
94.62%
Use
5.47%
Do Not Use
94.53%
Iowa Youth 12-17 years old
currently using marijuana.
Iowans 12 & older
currently using marijuana.
National Survey on Drug Use & Health, 2015/2016
6th Lowest in U.S. 3rd Lowest in U.S.
Iowa Youth Marijuana Attitudes Among Iowa 11th Graders
0%
5%
10%
15%
20%
25%
30%
17
One in four Iowa High School Juniors Perceive No Risk
Smoking Marijuana Once or More a Week…
Iowa Youth Survey, 2016
12%
25%
…and 22% of Iowa 6th
Graders See No Risk.
Marijuana’s Increasing THC Potency Trends in Plant Material Seized in U.S. (<1% THC in 1972)
0%
2%
4%
6%
8%
10%
12%
14%
University of Mississippi Marijuana Project, 2016
3.75%
12.71%
Colorado THC levels averaged 17.1% for plant products
(62.1% for “concentrates”) 2015 Rocky Mountain HIDTA
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Concentrates Less is More
“Budder”
“Shatter”
“Ear Wax”
“Green Crack”
wax
Hash Oil Capsules
Butane Hash Oil
(BHO)
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New Marijuana in Iowa
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~1 of every 12 marijuana
samples sent to Iowa’s
crime lab in 2016
involved marijuana
“preparations” (high-THC
concentrates such as
hash oils, waxes &
marijuana-infused
edibles).
Iowa Department of Public Safety, 2016
8.5%
“Preparations”
90%
Plant Materials
1.5% Residue
Iowa Meth Labs
0
200
400
600
800
1000
1200
1400
1600
(Gold = “One Pot” Labs)
22
1,500
2 36
Iowa Department of Public Safety, 2018
Iowa Meth Purity Crime Lab Fiscal Year Averages
0%
20%
40%
60%
80%
100%
120%
2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
35%
23
97%
Iowa Department of Public Safety, 2017
Iowa Meth Treatment Admissions
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
10,000 9,193
24
4,062
Iowa Department of Public Health, 2017
Iowa’s meth treatment rate is the highest
in the U.S. (213/100,000 vs. 53/100,000) U.S. Treatment Episode Data System, 2014
Opioid OD Death Rates 2016
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CDC, 2017
2002 2014
2016 Iowa Drug OD Death Rate:
10.6 per 100,000, 47th in U.S.
Provisional
Report:
Iowa rate
increased
10.2%
during 12
months
ending July
2017 vs.
previous
year.
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Opioid Misuse: Top Line Trends in U.S.
Drug ODs claim 174 U.S. lives daily, 115 from opioids.
Surging synthetic opioids (e.g., fentanyl/analogs) are now
the leading cause of opioid OD deaths in the U.S.,
followed by heroin & Rx. CDC 2016
About 3 out of 4 new heroin users
report previous Rx opioid misuse. CDC 2016
The U.S. has <5% of the world’s population, but
consumes ~75% of its Rx, including 81% of its
oxycodone & >99% of its hydrocodone. UN 2010
Opioid OD Deaths: 1999-2016 By Type of Opioid (Rx, Heroin, Fentanyl, etc.)
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CDC, 2017
(Hydrocodone & Oxycodone, etc.)
(Fentanyl, Fentanyl
analogs, etc.)
U.S. deaths = 1 every 12.5 minutes
(42,249 in 2016).
Iowa deaths = 1 every 2.1 days
(180 in 2016). CDC & IDPH
Most-Prescribed Iowa Controlled Substances CIIs-CIVs per Iowa’s Prescription Monitoring Program (PMP) in 2017
Hydrocodone-23% (opioid)
Iowa Pharmacy Board/PMP, 2017
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Tramadol-17% (opioid)
Oxycodone-5% (opioid)
Alprazolam-11% (anti-anxiety)
Clonazepam-7% (anti-anxiety)
Lorazepam-7% (anti-anxiety)
Methylphenidates-6% (stimulant)
Zolpidem-5% (sedative)
All Others-6% (various)
Morphine-2% (opioid)
Amphetamines-9% (stimulant)
Diazepam-2% (anti-anxiety)
2017 C2-4 Rx doses dropped
9.7% to 271,499,890 vs. 2016 Iowa Board of Pharmacy/PMP, 2017
Iowa Opioid Treatment Admissions Heroin + Non-Heroin Opiates/Synthetics Primary at Admission
0
200
400
600
800
1,000
1,200
1,400
1,600
1,368
467
U.S. Treatment Episode Data System, 2017
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Top 2017 “Exposure” Calls:
#1 Analgesics (Pain Meds)
#2 Sedatives
#3 Antidepressants Iowa Poison Control Center, 2018
239
897
Non-Heroin
Opiates/Synthetics
Heroin
2017 Iowa Opioid Treatment Admits:
3,261…up 436% vs. 608 in 2005. Iowa Department of Public Health, 2017
Iowa 12+ Pain Reliever Misuse (4.05%) 44th in U.S. National Survey on Drug Use & Health, 2015-2016
Iowa Opioid-Related Hospital ED Visits Opioid Use as Causal or Contributing Factor: Monthly Averages
0
50
100
150
200
250
300
2006 2007 2008 2009 2010 2011 2012 2013 2014 *2015 *2016
Iowa Department of Public Health, 2017
265/mo.
31
43/mo.
Iowa had lowest rate of opioid-related hospital ED admissions &
inpatient stays, but hospitalizations rose 11% from 2009-2014. Agency for Healthcare Research & Quality, 2014
Heroin exposure calls to Iowa’s Poison Hotline more than
tripled in 6 years, from 10 in 2011 to 36 in 2017. Iowa Poison Control Center, 2018
Cost of Iowa opioid abuse health
care: $121m ($39 per-capita). Matrix Global Advisors, LLC, 2015
(*Caution advised interpreting trends due to reporting changes in 2015)
2017 Midwest opioid OD ED visits rose 70%
(avg.) vs. 30% in most states vs. 2016. CDC, 2018
Iowa Opioid OD Deaths Primary Cause of Deaths vs. Contributing Factor (Related) Deaths
0
50
100
150
200
250
Iowa Department of Public Health, 2018
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Opioid-“Related” Deaths
Opioid-“Caused” Deaths
*205 (63 Heroin-
Related)
*99 (30 Heroin)
*2017 provisional year-end data. “Related” totals include “caused” deaths.
13 OD deaths were caused by heroin mixed
with other drugs (meth, cocaine, fentanyl). Iowa State Medical Examiner, 2017
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Iowa Department of Public Safety, 2018
Iowa Illicit Opioid Law Enforcement Seizures Cases Submitted to the DCI Lab in 2017
Naloxone Use by Iowa EMS Providers # Times Administered to Reverse Opioid-Related ODs
0
100
200
300
400
500
600
700
800
2010 2011 2012 2013 2014 2015 2016 2017
Iowa Department of Public Health, Emergency & Trauma Services, 2017
*732
161
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Some Iowa EMS crews carry 2x-3x doses
due to powerful illicit synthetic opioids (~1 naloxone “save”/month in Dubuque in 2017)
*2017 year-end data preliminary.
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Opioid Misuse: Precursors
(Marijuana use appears to increase—>2x—rather than decrease, the risk of developing nonmedical
prescription opioid use & opioid use disorder. Offson, Wall, Liu, Blanco/American Journal of Psychiatry, September 2017)
Heroin, Fentanyl & Illicit Synthetic Opioids Law Enforcement Seizure Cases/Month per Iowa’s Crime Lab (average)
0
10
20
30
40
50
60
70
2010 2011 2012 2013 2014 2015 2016 2017 2018*
Illicit Synthetic Opioids/Fentanyl Analogs Only
Mixed (Heroin + Illicit Synthetic Opioid, etc.)
Fentanyl Only
Heroin Only
Iowa Department of Public Safety, 2018
Iowa’s crime lab reports counterfeit
oxycodone tablets containing carfentanil &
cases of illicit opioids mixed with cocaine,
meth, ketamine, caffeine, etc.…
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7.8
64.6*
The DEA reports a 117% increase in U.S. illicit
synthetic opioid lab submissions in 2017 vs. 2016,
including 7 new fentanyl analog compounds.
(*2018 year-to-date data through March)
51.3
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Illicit Synthetic Opioids: Less is More
Drug Enforcement Administration, 2017
Often mixed with heroin,
illicit synthetic opioids (e.g.,
fentanyl analogs)—in tiny
amounts—can be much
more lethal vs. heroin.
Iowa’s 1st Carfentanil
OD death per SME:
February 2017
Response to Opioid Misuse “3 Rs” to Curb Supply & Demand
Rescue (Intervention)
-PMP: Enhancements ongoing & more proposed
-Naloxone: Access improving to reverse ODs
Recovery (Treatment & Aftercare)
-Substance Use Disorder & Medication Assisted Treatment: MAT
expansion continues
-Peer Recovery Mentors: Training underway for OD referrals
-Support: CRUSH & other groups forming
Reduction (Prevention & Enforcement)
-CDC Opioid Prescribing Guidelines: More prescribers adopting
-Patient Instruction: Take as directed & respect medicines
-Education: Information for youth & adults
-Safeguards: Secure storage & proper disposal
Get Help 24/7: Call 855-581-8111, Text 855-895-8398 or go to YourLifeIowa.org
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Iowa “Take-Back” Initiative Amount (in Pounds) of Rx Drugs Collected
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
43
1,569
12,257
Next National Prescription Drug Take Back Day:
Fall 2018!
DEA, 2018
Collected in first 15 one-day events:
56+ tons (30+ pounds per minute) in Iowa &
9+ million pounds (2+ tons per minute) in U.S.
Iowa Permanent Rx “Take Back” Sites Controlled Prescription Drug Disposal Locations
44
231 Sites in all 99 Counties (117 Law Enforcement Centers, 114 Pharmacies) vs. 47 in January 2016
ODCP, 2017
odcp.iowa.gov/
rxtakebacks Search: Iowa Rx Takebacks
Iowa Medication Assisted Treatment Provider Locations
45
84 Iowa MAT Providers in 2018 vs. 31 in 2015
Iowa Department of Public Health, 2018
Governor’s Priorities to Curb Opioid Misuse
1. Increase Prescriber Use of the Prescription Monitoring Program (e.g., faster, friendlier & more complete PMP database; proactive notices to
prescribers & dispensers of inappropriate patient use; integration)
2. Reduce Opioid Prescribing to Prevent Misuse (e.g., partial
prescriptions; CDC guidelines to reduce opioids for certain chronic pain;
electronic Rx; prescriber activity reports; education/prevention)
3. Strengthen Interventions for Iowans Misusing or Addicted to
Opioids (e.g., naloxone access & use; Good Samaritan incentive for reporting
ODs; peer coaches & mentors)
4. Enhance Medication Assisted Treatment for Opioid Addicted
Iowans (e.g., expand MAT providers & access; reduce insurance barriers)
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Iowa Opioid-Related Legislation & News
HF 2377: Comprehensive Opioid Response (Passed House & Senate, with *amendment)
1. Automatic PMP registration at time of professional licensure or license renewal.
2. Mandatory PMP queries on patients when prescribing opioids.
3. Proactive PMP notices of possible improper use of controlled substances.
4. Next business day controlled substance dispensing to PMP.
5. Reporting to PMP of non-pharmacy controlled substance dispensing (*veterinarians exempt).
6. Reporting to PMP of naloxone use by first responders.
7. Annual PMP prescriber “report cards.”
8. License surcharge of up to 25% to pay for PMP enhancements.
9. Continuing education requirements for all opioid prescribers re: CDC guidelines.
10. Penalties for inappropriate opioid prescribing.
11. Universal electronic prescribing of all prescriptions by January 2020.
12. Banning new illicit synthetic opioids, similar to emergency federal action.
13. Good Samaritan protection to encourage 911 calls to report overdoses.
Proposals Not in HF 2377:
• Monitoring Schedule V controlled substances.
• Opioid prescription limits.
• Needle exchanges.
• Rx opioid surcharge.
• Additional treatment resources.
Other News: ~50 Iowa counties join suit; state AGs probe; USDOJ targets...Rx opioid makers.
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STAY SAFE!
Iowa Governor’s Office of Drug Control Policy
Visit Our Website: https://odcp.iowa.gov
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Get Help 24/7: Call 855-581-8111, Text 855-895-8398 or go to YourLifeIowa.org