Prescription Drug Abuse is on the Rise in Florida

Trends of Nonmedical Prescription Drug Misuse in Miami-Dade,Broward, Palm Beach Counties, and the State of Florida: 2009

Number of Drugs Considered by a Medical Examinerto be a Cause of Death in Florida: 2005-2009

0

500

1000

1500

2000

2500Cocaine

Benzodiazepines

5 Rx Opioids

Cocaine 732 829 843 648 529

Benzodiazepines 678 722 878 1090 1324

5 Rx Opioids 1528 1748 2094 2284 2,531

2005 2006 2007 2008 2009

Number ofLethal DrugOccurrences(Greater thanNumber of deaths)

Source: FDLE: Florida Medical Examiners Commission

Between 2005 and 2009 an epidemic of deaths caused by nonmedical use ofprescription drugs has spread across Florida. Broward and Palm Beach areamong the heaviest impacted counties in the State. At the same time there hasbeen a decline in the number of deaths in which cocaine was considered a cause ofdeath since 2007. The 66-percent increase in fatal occurrences for 5 differentopioids were propelled by oxycodone with a 249-percent increase over the fiveyear period. Likewise, alprazolam led the fatal overdoses for benzodiazepines.

EPIDEMIOLOGIC TRENDSIN Prescription DRUG Misuse

2

Trends of Nonmedical Prescription Drug Misuse in Miami-Dade,Broward, Palm Beach Counties, and the State of Florida: 2009

James N. Hall1

ABSTRACT

During 2009, more than 5,000 individuals died in Florida with one or more prescriptionmedications in their system of which almost half (or an average of nearly 7 persons per day) hadat least one prescription drug that was considered a “cause of death.” Broward County, as thesecond most populated county in Florida, had the highest number of deaths related toprescription drugs than any of the State’s 67 counties. Oxycodone (e.g., OxyContin®,Roxicodone®, Percocet®), is the most frequently reported opioid involved with nonmedical use inthe South Florida region and across the State. Rates of oxycodone emergency department (ED)reports in Broward and Palm Beach Counties among those 21-29 years of age are nearly doublethe national rates for the same age group. Most deaths linked to opioid misuse are among those intheir late thirties or forties. All but one of the top 50 dispensing practitioners of oxycodone in theUnited States were located in Florida during the six-month period from October 2008 to March2009. Half of these top 50 dispensers were in Broward County who sold directly from their “pillmill” clinics more than 5 million dose units of oxycodone during the same six-months. ABroward County Grand Jury reported a new pain clinic opened in South Florida on averageevery 3 days between August 2008 and November 2009, reaching a total of 176 at that time with115 in Broward County. Prescription opioids account for most opiate ED reports and deaths inBroward and Palm Beach Counties while heroin represents the majority of opiate ED reports inMiami-Dade County. Prescription opioid misuse is occurring among heroin users. In 2008, 45percent of heroin-related deaths in Florida also had at least one prescription opioid detected.The region is poised for an emerging “Opiate Epidemic” involving the use of both illicit heroinand prescription opioids and a potential escalation of injecting drug use. After ethyl alcohol, thebenzodiazepine, alprazolam (i.e., Xanax®) is the most frequently occurring drug found indeceased persons in Florida with 94 percent of the cases also involving at least one othersubstance-in-combination reflecting the polysubstance abuse patterns associated withnonmedical prescription drug misuse. Muscle-relaxants are frequently found in combinationwith other prescription medications dispensed from “pill mills” and among deceased person inFlorida.

INTRODUCTION

This report reviews data from 2008 and 2009 about nonmedical use of prescription drug-relateddeaths, medical emergencies, addiction treatment admissions, law enforcement intelligence,crime laboratory analysis, and prevalence of use. Information is presented about nonmedical use

1The author is the director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University, and is

executive director of Up Front Drug Information Center in Miami, Florida.

Miami-Dade, Broward and Palm Beach Count ies, Flor ida

3

of prescription opioids, benzodiazepines, and muscle relaxants. While the information isclassified by a single drug or category, the reader should note an underlying problem of polysub-stance abuse as mentioned throughout this report. Exhibits for the report follow the narrative text.

Area Description

Located in the extreme southern portion of the Florida peninsula, Miami-Dade County has the

State’s largest population, with 2,398,245 residents, according to 2008 U.S. Census estimates. Sixty-

two percent are Hispanic; 17 percent are Black non-Hispanic; 18 percent are White non-His-

panic; and 1.5 percent are Asian/Pacific Islanders. Miami is Dade County’s largest city, with 360,000

residents. More than 100,000 immigrants arrive in Florida each year; one-half establish

residency in Miami-Dade County. More than one-half of the county’s population is foreign

born.

Broward County, situated due north of Miami-Dade, is composed of Ft. Lauderdale, plus 28

other municipalities and an unincorporated area. The County covers 1,197 square miles, including

25 miles of coastline. According to 2008 Census estimates, the population was 1,751,234. The

population is roughly 48 percent White non-Hispanic; 25 percent Black non-Hispanic; 23

percent Hispanic; and 3 percent Asian/Pacific Islanders. One-fourth of the county’s population

is foreign born. Broward County is the second most populated county in Florida after Miami-

Dade, and accounts for almost 10 percent of Florida’s population.

Palm Beach County (population 1,265,293) is located due north of Broward County and is the

third most populated county in the State. The population is 64 percent White non-Hispanic;

17percent Hispanic; 15 percent Black non-Hispanic; and 2 percent Asian/Pacific Islanders.

Seventeen percent of the county’s population is foreign born. Together, the 5.4 million people of

these three counties constitute 30 percent of the State’s 18.3 million population.

Starting in 2003, these three counties constitute the federally designated Metropolitan Statistical

Area (MSA) for South Florida, making it the sixth largest MSA in the Nation. Previously, the

MSA included only Miami-Dade County. This means that the three counties are included in

more national data sets tracking health-related conditions and criminal justice information.

Approximately 25 million tourists visit South Florida annually. The region is a hub of international

transportation and the gateway to commerce between the Americas, accounting for sizable

proportions of the Nation’s trade. South Florida’s airports and seaports remain among the busiest in

the Nation for both cargo and international passenger traffic. These ports of entry make this region

a major gateway for illicit drugs.

Several factors impact the potential for drug abuse problems in South Florida, including the lack

of a prescription monitoring system in the State during the time periods covered by this report


4

made the State, and particularly Broward County, a source for diverted medications in the

eastern United States. A prescription monitoring system was enacted in July 2009 and is

expected to be operational by December 2010. As well, South Florida and particularly Broward

County has the most visible “pill mill” problem in the nation with an estimated 176 clinics in the

three-county area.

Data Sources

This report describes current drug abuse trends in South Florida, using the data sourcessummarized below:

Drug-related mortality data were provided by the Florida Department of Law Enforcement(FDLE) Medical Examiners Commission’s 2009 Report of Drugs Identified in DeceasedPersons between January and December 2009. The number of drug occurrences exceeds thenumber of decedents because of multiple drugs and/or alcohol identified in the same person.

Emergency Department (ED) data were derived for Miami-Dade as well as Broward and PalmBeach Counties from the Drug Abuse Warning Network (DAWN), Substance Abuse and MentalHealth Services Administration (SAMHSA). The data represent drug reports involved in drug-related visits the nonmedical use of selected prescription drugs (derived from the category of“other substances”). Drug reports exceed the number of ED visits because a patient may reportuse of multiple drugs (up to six drugs plus alcohol). Weighted DAWN data for calendar years2004- 2008 are included in this report and provide estimates of the total number of drug-related ED visits for selected substances for all of Miami-Dade County in those five yearsand the DAWN Ft. Lauderdale Division (Broward and Palm Beach Counties) only for 2008,the first year for which DAWN weighted estimates are provided in that Division.Unweighted, preliminary Miami-Dade ED data for the first half of 2009 are from the DAWNLive! restricted-access online query system administered by the Office of Applied Studies(OAS), SAMHSA. Eligible hospitals in only the Miami-Dade County Division totaled 21;hospitals in the DAWN sample numbered 19, with the number of EDs in the sample also totaling19. (Some hospitals have more than one emergency department.) During January to June 2009,nine EDs reported data each month. The completeness of data reported by participating EDsvaried by month (exhibit 1). Exhibits in this paper for the first half of 2009 Miami-Dade Countydata reflect cases that were received by DAWN as of December 22, 2009. Unweighted BrowardCounty ED data for the first half of 2009 are also from the DAWN Live! restricted-accessonline query system. Eligible hospitals in the Ft. Lauderdale Division only (that includesBroward and Palm Beach Counties) totaled 27; there were 21 hospitals in the DAWN sample,and the number of EDs in the sample also totaled 21. During January to June 2009, nine EDsreported data each month. The completeness of data reported by participating EDs varied bymonth (exhibit 2). DAWN Live! exhibits in this paper for Broward and Palm Beach Countiesreflect cases that were received by DAWN as of December 22, 2009. Based on the DAWN Live!reviews, cases may be corrected or deleted; thus, the unweighted data presented in this paper aresubject to change. Data derived from DAWN Live! represent drug reports in drug-related EDvisits. The DAWN Live! data are unweighted and, thus, are not estimates for the reporting area.DAWN Live! data cannot be compared to DAWN data from 2002 and before, nor canpreliminary data be used for comparison with future data. Only weighted DAWN data for 2004-2008 released by SAMHSA may be used for trend analysis as provided. A full description ofthe system can be found on the DAWN Web site <http://dawninfo.samhsa.gov>.


5

Drug treatment data on primary admissions to all publicly-funded addiction treatmentprograms in Miami-Dade and Broward Counties during calendar year 2009 were provided by theFlorida Department of Children and Families.

Crime lab drug analyses data were derived from the Drug Enforcement Administration’s(DEA’s) National Forensic Laboratory Information System (NFLIS) Report for Miami-Dade,Broward, and Palm Beach Counties from January through December 2009. However, the NFLISdata combines some, but not all, pharmaceutical items into the category of “controlled substance.”This factor makes it difficult to track the role of illegally diverted medications, particularly inBroward County where other indicators of nonmedical prescription drug misuse areelevated.

Information on the Zip Code locations of the top 50 Dispensing Practitioners ofOxycodone in the United States is from the US Drug Enforcement Administration (DEA)Automation of Reports and Consolidated Orders System (ARCOS) October 2008 to March2009.

Data on the prevalence of substance use by high school students in Miami-Dade,Broward, and Palm Beach Counties as well as the State of Florida are from the 2008 FloridaYouth Substance Abuse Survey conducted by the Florida Department of Children andFamilies.

Data on the prevalence of nonmedical use of pain relievers by people aged 12 and aboveare from the SAMHSA National Survey on Drug Use Health Sub-State Data 2004-2006.

PATTERNS OF NONMEDICAL PRESCRIPTION DRUG MISUSE

Nonmedical Use of Prescription Opioids

During 2009, 5,275 individuals died in Florida with one or more prescription drugs in theirsystem. Nearly half, or 47 percent, (n=2,488) had at least one prescription medication that wasconsidered a cause of death for an average of 6.8 lethal prescription drug deaths per day. In totalthere were 11,109 prescription drugs detected (including 6,006 opioids - exhibit 3) and 4,376 or39 percent of the total medication occurrences were considered at a lethal dose and a cause ofdeath including 48 percent (n=2,897) of the opioids. The number of drug occurrences exceededthe number of deaths because many decedents had more than one substance detected includinganother prescription medication, illicit drug, or alcohol.

Between 2008 and 2009, reports in all of Florida related to the category of prescription opioidsdetected among deceased persons increased 10-percent, from 5,457 to 6,006, following a 8-percent rise between 2007 (n=5,059) and 2008. Reports of hydrocodone (Vicodin®, Lortab®),oxycodone (OxyContin®, Roxicodone®, Percocet®), and methadone (Dolophine®) identifiedamong decedents have been tracked in Florida since 2000. Beginning in 2003, morphine (MSContin®, Roxanol®), propoxyphene (Darvon®), fentanyl (Fentora®), hydromorphone(Dilaudid®, Palladone®), meperidine (Demerol HCl®), tramadol (Ultram®), Buprenorphine


6

(Buprenex®, Suboxone®) oxymorphone (Opana®, Numophan®) and other opioids wereincluded in the Florida Medical Examiners Commission’s surveillance monitoring program.Occurrences of 5 prescription opioids detected among deceased persons during 2009 totaled 415in Broward County, 158 in Miami-Dade County, and 342 in Palm Beach County.

Across Florida, the number of oxymorphone reports detected among deceased persons (n=236)increased 242-percent between 2008 and 2009 and those for oxycodone (n=1,948) increased 24-pecent while the number of occurrences for tramadol (n=268) increased 14-percent,hydromorphone reports (n=21) increased 6.5-percent and methadone reports (n=985) were up 5-percent.

The most lethal prescription opioids statewide were (1) methadone which was considered a causeof death for 73 percent (n=720) of the decedents in which it was detected, (2) oxycodone was acause of death for 61 percent (n=1,185) of the deaths related to it, (3) fentanyl was a cause ofdeath for 57 percent (n=122) of its occurrences, and (4) morphine had a 45 percent lethal rate(n=302). Most of the statewide prescription medical examiner opioid cases were polydrugepisodes, including 91 percent of the oxycodone reports, 90 percent of the methadone cases, 89percent of the hydrocodone reports, 78 percent of morphine cases, and 77 percent ofpropoxyphene-related deaths.

Miami-Dade County recorded 66 oxycodone occurrences among deceased persons in 2009, 38morphine reports, 27 for hydrocodone, 14 for methadone, and 13 for propoxyphene. These 158combined mentions represented a 27-percent increase from the 124 opioid occurrences in 2008.Among the total opioid reports in 2009, 42 percent were considered lethal doses and 82 percentwere found in combination with at least one other substance. Most of the deaths occurred amongthose over age 35 as illustrated with 35 percent of Maim-Dade oxycodone deaths in 2009 being35-50 and 47 percent over 50 years (exhibit 11).

Broward County recorded 225 oxycodone occurrences among deceased persons in 2009, 57morphine reports, 60 methadone reports, 46 for hydrocodone, and 27 for propoxyphene. These415 combined mentions represented a 21-percent increase from the 342 opioid occurrences in2008. Among the total opioid reports in 2009, 62 percent were considered lethal doses and 91percent were found in combination with at least one other substance. Most of the deathsoccurred among those aged 35-50 years as illustrated with 38 percent of Broward Countyoxycodone deaths in 2009 being in that age group (exhibit 11).

Palm Beach County recorded 184 oxycodone occurrences among deceased persons in 2009, 60reports for methadone, 45 for hydrocodone, 38 for morphine, and 15 for propoxyphene. These 342combined mentions represented a 5-percent decrease from the 361 opioid occurrences in 2008.Among the total opioid reports in 2009, 67 percent were considered lethal doses and 88 percentwere found in combination with at least one other substance. Most of the deaths occurred amongthose aged 35-50 years as illustrated with 38 percent of Palm Beach County oxycodone deaths in2009 being in that age group.

A 2008 study of 207 drug overdose deaths in Palm Beach County found that 85 percent hadmore than one drug present at the time of death. The study was conducted by Dr. Gary Martin ofLynn University and the Palm Beach County Sheriff’s Office. The average decedent was a 39year-old white, male with a high school diploma or a GED who died at home during sleep withothers present who were aware of the fatal drug use and had recognized distress. At least a third


7

of the decedents had a history of substance abuse as well as drug-related arrests, some substanceabuse and/or mental health treatment, and was under the care of a physician. Most hadexperienced a non-fatal drug overdose. The report identifies most drug overdose deaths arepreventable, particularly with early intervention and public education.

The DAWN weighted estimate of 711 ED reports for nonmedical use of prescription opioidsMiami-Dade County during 2008 (exhibit 4) accounted for 5 percent of all ED reports among 5substances (3 illicit drugs [cocaine, marijuana, MDMA] and nonmedical use of prescriptionopioids and benzodiazepines). Non-medical reports include those for overmedication, maliciouspoisoning, and “other case types.” Generally, “other case types” are considered intentionalsubstance abuse. Between 2007 and 2008 the number of prescription opioid ED reports decline 4-percent in Miami-Dade County (exhibit 5).

Unweighted DAWN Live! data for Miami-Dade show 165 opioid analgesic reports in the firsthalf of 2009 (exhibit 6) as compared to 452 reports for heroin. Among the narcotic analgesicreports, 64 (or 39 percent) were oxycodone ED reports. The total also includes 18 hydrocodonereports, 12 hydromorphone reports, 9 morphine reports, 6 methadone ED reports, 5 fentanylreports, 1 buprenorphine ED reports, and 36 unspecified opioid reports.

The DAWN weighted estimate of 2,364 ED reports for nonmedical use of prescription opioids inBroward and Palm Beach Counties during 2008 (exhibit 4) accounted for 17 percent of all EDreports among 6 substances (4 illicit drugs [cocaine, marijuana, heroin, MDMA] and nonmedicaluse of prescription opioids and benzodiazepines). The Broward and Palm Beach per capita rate of37.9 oxycodone ED reports per 100,000 population in 2008 was above the national rate of 34.6such reports per 100,000 population. The rates for those in their twenties were almost doubled inBroward and Palm Beach compared to the nation with 141.4 reports per 100,000 for those aged 21-24 compared to 69.8 across the country and 121.6 reports per 100,000 in Broward and Palm Beachfor those aged 24-29 compared to 64.8 nationally (exhibit 12). The rate for females of all ages inBroward and Palm Beach was 41.1 per 100,000 compared to 31.1 nationally while the rate formales was 34.5 in Broward and Palm Beach Counties, slightly below the national rate of 38.2

Unweighted DAWN Live! data for Broward and Palm Beach Counties show 752 opioidanalgesic reports in the first half of 2009 (exhibit 7) as compared to 143 reports for heroin.Among the narcotic analgesic reports, 399 (or 53 percent) were oxycodone ED reports. The totalalso includes 71 methadone ED reports, 37 hydrocodone reports, 27 morphine reports, 21hydromorphone reports, 10 fentanyl reports, 8 buprenorphine ED reports, and 170 unspecifiedopioid reports.

A comparison of opiate DAWN Live! ED reports for heroin and prescription opioids in Browardand Miami-Dade Counties during the first half of 2009 reflect different patterns of use. Heroinaccounts for 73 percent of opiate unweighted ED reports in Miami-Dade County while inBroward County prescription opioids accounted for 84 percent of opiate ED reports.

There were 113 primary admissions for opiates other than heroin, or 2 percent of the 5,542publicly funded primary treatment admissions in Miami-Dade County, as reported by the FloridaDepartment of Children and Families in 2009 (exhibit 8). Males accounted for 55 percent ofthe other opiate clients. Forty-one percent of the admissions were age 26-34 years, 37 percentwere age 35 or older, and 20 percent were ages 18-25.


8

In Broward County, there were 336 primary admissions for opiates other than heroin in 2009(exhibit 8), accounting for 5.9 percent of the 5,678 publicly funded primary treatmentadmissions. Males accounted for 55 percent of the other opiate clients. Thirty-seven percent ofthese clients were age 18–25; 32 percent were age 26–34; and 31 percent were 35 or older.

NFLIS reported 339 oxycodone crime laboratory cases; 65 hydrocodone items; 14 methadonecases; and 6 propoxyphene cases. Combined together these 424 reports represented 1.7 percentof all drug items analyzed in the three-county South Florida MSA (exhibit 9). There were also1,044 “controlled substance” cases in the 2009 NFLIS report, many of which were prescriptionopioids.

Broward County was the location for half of the top 50 dispensing practitioners of oxycodone inthe United States during the six month period from October 2008 through March 2009. All butone of the top 50 was located in State of Florida. These 25 Broward “pill mill” pain clinicsdispensed 5,233,785 dose units of oxycodone in the same six months. However the number ofBroward clinics declined from 33 of the top 50 in the previous six months and the number ofpills dispensed declined by 1,250,415 dose units. An additional 18 of the top 50 dispensingpractitioners were located in Palm Beach and Miami-Dade Counties, up from 12 during theprevious six months. The number of oxycodone pills dispensed by these 18 clinics in the twocounties increased by 755,530 dose units during October 2008 to March 2009 compared to theprevious six-month period reaching a total of 3,014,930.

Any lifetime nonmedical use of prescription pain relievers among high school students wasreported on the 2008 Florida Youth Substance Abuse Survey (FYSAS) by 5.4 percent in Miami-Dade County, 6.2 percent in Broward County, 8.2 percent in Palm Beach County, and 10.4percent in all of Florida. Results from the same survey for any current nonmedical use ofprescription pain relievers among high school students in the past 30 days was 1.9 percent inMiami-Dade, 2.3 percent in Broward, 3.2 percent in Palm Beach County, and 3.9 percentStatewide.

The most recent county-level data on prevalence of nonmedical use of pain relievers across thelifespan (aged 12 and above) are from the 2004-2006 National Survey on Drug Use and Healthin which 5 percent of all Floridians reported such use in the past year. The South Floridacounties’ rates were 3.6 percent for Miami-Dade County, 3.8 percent for Broward County, and4.5 percent for Palm Beach County.

Nonmedical Use of Prescription Benzodiazepines

Benzodiazepines in general, and alprazolam (i.e., Xanax®) in particular, were a substantialproblem in South Florida in this reporting period. There were 4,340 reports of abenzodiazepine present in deceased persons across Florida in 2009, representing a 4-percentincrease over the 4,167 cases in the previous year. Of the benzodiazepine occurrences in 2009, abenzodiazepine was identified as causing 1,099 deaths with a total of 1,324 lethal benzodiazepineoccurrences. Among the benzodiazepine ME reports statewide, 1,963 were attributed toalprazolam, and 892 were attributed to diazepam (i.e., Valium®); 42 percent of the alprazolamoccurrences, and 28 percent of the diazepam reports, were considered to be lethal doses.


9

In Miami-Dade County, there were 97 reports of alprazolam detected in deceased personsduring 2009, of which 43 percent were considered a lethal dose. Eighty percent of the reportsinvolved at least one other drug. There were also 27 reports of diazepam detected in deceasedpersons in Miami-Dade County; and 26 percent were considered to be the cause of death; 74percent of these deaths involved at least one other drug. These 124 combined mentions foralprazolam and diazepam represented a 17-percent decrease over the 145 reports in 2008, andfollowed a 10-percent increase from 2007 to 2008. One of the combined mentions in 2009involved a person younger than 18; 6 percent of the decedents were between the ages of 18 and 25;12 percent were age 26–34; 33 percent were age 35–50; and 48 percent were older than 50 (exhibit13).

In Broward County, there were 245 reports of alprazolam detected in deceased persons during2009, of which 60 percent were considered a lethal dose. Ninety-two percent of the reportsinvolved at least one other drug. There were also 131 reports of diazepam detected in deceasedpersons in Broward County; 45 percent were considered to be the cause of death; 92 percentof these deaths involved at least one other drug. These 376 combined mentions for alprazolamand diazepam represented an 11-percent increase over the 339 reports in 2008, and followed a 53-percent increase from 2007 to 2008. Broward County ranked first among all Florida counties orME’s district in the number of the two benzodiazepines detected among deceased persons. Twoof the Broward County combined mentions in 2009 involved a person younger than 18; 6 percentof the decedents were between the ages of 18 and 25; 17 percent were age 26–34; 40 percent wereage 35–50; and 36 percent were older than 50 (exhibit 13).

In Palm Beach County, there were 158 reports of alprazolam detected in deceased persons dur-ing 2009, of which 54 percent were considered a lethal dose. Ninety-seven percent of thereports involved at least one other drug. There were also 71 reports of diazepam detected indeceased persons in Palm Beach County; 25 percent were considered to be the cause ofdeath; 89 percent of these deaths involved at least one other drug. These 229 combined mentionsfor alprazolam and diazepam represented a 7-percent decrease over the 246 reports in 2008, andfollowed a 29-percent increase from 2007 to 2008. Two of the combined mentions in 2009involved a person younger than 18; 16 percent of the decedents were between the ages of 18 and25; 14 percent were age 26–34; 38 percent were age 35–50; and 30 percent were older than 50.

The DAWN weighted estimate of 1,524 ED reports for nonmedical use of prescriptionbenzodiazepine Miami-Dade County during 2008 (exhibit 4) accounted for 11 percent of all EDreports among 5 substances (3 illicit drugs [cocaine, marijuana, MDMA] and nonmedical use ofprescription opioids and benzodiazepines).

Unweighted DAWN Live! data for Miami-Dade show 309 nonmedical benzodiazepine reports(exhibit 6) in the first half of 2009. Among the nonmedical benzodiazepine reports, 137 (or 44percent) were alprazolam ED reports. The total also includes 52 clonazepam (Klonopin®)reports, 30 temazepam (Restoril®), 24 lorazepam (Ativan®), and 11 diazepam reports.

The DAWN weighted estimate of 2,274 ED reports for nonmedical use of prescriptionbenzodiazepine in Broward and Palm Beach Counties during 2008 (exhibit 4) accounted for 16percent of all ED reports among 6 substances (4 illicit drugs [cocaine, marijuana, heroin, MDMA]


10

and nonmedical use of prescription opioids and benzodiazepines) Per capita rates by age groups ofnonmedical alprazolam ED reports are shown in exhibit 14.

Unweighted DAWN Live! data for Broward and Palm Beach Counties show 693 nonmedicalbenzodiazepine reports (exhibit 5) in the first half of 2009. Of the total 693 reports, 29 percentdid not identify the specific benzodiazepine. Among the 489 reports where the drug was named,378 (or 77 percent) were alprazolam ED reports. The total also includes 40 clonazepam(i.e.,Klonopin®) reports, 32 lorazepam (i.e., Ativan®), 26 diazepam reports, and 12 temazepam(i.e., Restoril®).

There was only one primary admissions for benzodiazepines reported in Miami-Dade County

treatment admissions during 2009 (exhibits 8). In Broward County, there were 47 primary

admissions for benzodiazepines during 2009, or 0.8 percent of 5,678 primary admissions (includ-

ing alcohol).

NFLIS reported 568 alprazolam crime laboratory cases, 31 diazepam items, and 29 clonazepam cases

during 2009 in the three-county South Florida MSA. Combined they represented 2.5 percent of all

drug items analyzed (exhibit 9).

Any lifetime nonmedical use of depressants (with “Xanax®” use as an example in the question)among high school students was reported on the 2008 Florida Youth Substance Abuse Survey by5.5 percent in Miami-Dade County, 5.7 percent in Broward County, 7.8 percent in Palm BeachCounty, and 8.7 percent in all of Florida. Results from the same survey for any currentnonmedical use of prescription depressants among high school students in the past 30 days was 1percent in Miami-Dade, 2.1 percent in Broward, 2.2 percent in Palm Beach County, and 3percent Statewide.

Nonmedical Use of Prescription Muscle Relaxants

Muscle relaxants may be abused in combination with MDMA and other drugs. There were 455reports of carisoprodol (Soma®) or meprobamate (Miltown®, Equanil®) among deceasedpersons in Florida during 2009, of which 98 (or 22 percent) were considered to be caused bythe drug. The number of these deaths increased by 10-percent in 2009, as compared with the 415such deaths in 2008.

Unweighted DAWN Live! data for Miami-Dade County in the first half of 2009 show 10 reportson nonmedical use of muscle relaxants. Carisoprodol was specifically cited in half of the reports.

Unweighted DAWN Live! data for Broward and Palm Beach Counties in the first half of 2009show 92 reports on nonmedical use of muscle relaxants. Carisoprodol was specifically cited in85 percent of the reports.

NFLIS reported 19 carisoprodol crime laboratory cases for the South Florida MSA in 2009.

For inquiries regarding this report, contact James N. Hall, Center for the Study and Prevention of Substance

Abuse, Nova Southeastern University c/o Up Front, Inc., 13287 SW 124 Street, Miami, FL 33186,

Phone: 786-242-8222, Fax: 786-242- 8759, E-mail: [email protected].


11

Exhibit 1 DAWN ED Miami-Dade County Sample andReporting Information: January – June 2009

TotalEligibleHospital

s1

No. ofHospitalsin DAWNSample

TotalEDs inDAWN

Sample2

No. of EDs ReportingMonth: Completeness

of Data (%)No. of EDs

NotReporting

90–100%

50–89%

<50%

21 18 18 8 0 1 9

1 Short-term, general, non-Federal hospitals with 24-hour emergency departmentsbased on the American Hospital Association Annual Survey.

2 Some hospitals have more than one emergency department.

SOURCE: DAWN Live!, OAS, SAMHSA, updated December 22, 2009

Exhibit 2 DAWN ED Ft.Lauderdale Division Sampleand Reporting Information: January – June 2009

1 Short-term, general, non-Federal hospitals with 24-hour emergency departmentsbased on the American Hospital Association Annual Survey.

2 Some hospitals have more than one emergency department.

SOURCE: DAWN Live!, OAS, SAMHSA, updated December 22, 2009

TotalEligibleHospital

s1

No. ofHospitalsin DAWNSample

TotalEDs inDAWN

Sample2

No. of EDs Reporting perMonth: Completeness of

Data (%)No. of EDs

NotReporting90–

100%

50–89%

<50%

27 21 21 6 1-2 1-2 12

EPIDEMIOLOGIC TRENDS IN DRUG ABUSE

12

Exhibit 3 Numbers of Substances Identified amongDecedents in Florida: 2009

45581111

6,006

4,340

1,462

4,046

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

Alcoho l

Cocaine

Benzos

Rx Op ioidHero

in

Methamphet

Musc

leRe laxant

All Rx = 11,109Alcohol +Illicit Drugs = 6,611

Fla gle r

Highlands

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Polk

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Indian River

PutnamAlachua

Bradfo

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Col

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Gilchrist

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Dixie

Suwanne e

Hamilton

S t.J ohnsCla y

Duval

Nas sau

Baker

Pinellas

Pas co

Manatee

Hillsborough

Bre va rd

Os ceola

Ora nge

Seminole

Collie r

HendryLee

Glades

De SotoSara sota

Palm Beach

LakeSumter

Hernando

Citrus

Marion

Taylor

Madis on

Jeffe

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Wakulla

Le on

Franklin

Liberty

Gads den

Jacks on

Calhoun

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BayW

ashing

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Escambia

Santa

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Walto n

Broward

Dade

Holmes

Monroe

Volusia

Lafayette

Charlotte

Source: Florida Department of Law Enforcement,Florida Medical Examiners Commission Interim Report 2009

Exhibit 4 Number of DAWN Estimate ED Reports byDrug in Miami-Dade & Ft. Lauderdale Divisions: 2008

7,4985,560

539

3,378

2,928

2,346

1,524 2,274

294

220

711

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

Miami-Dade Ft. Lauderdale

#o

fE

DR

ep

ort

Es

tim

ate

s

Benzodiazepine

Opioids

MDMA (Ecstasy)

Marijuana

Heroin

Cocaine

SOURCE: US Dept HHS-SAMHSA, OAS: DAWN Emergency Dept. 2008 Estimates .


13

7,498

9,8279,944

13,061

9,469

3,755

5,1924,333

3,5763,378

1,3721,788 1,497 1,362 1,524

464730 741654 711

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

2004 2005 2006 2007 2008

Cocaine

Marijuana

NMU Benzodiazepines

NMU Opioids

Exhibit 5 Number of Emergency Department Reportsby Drug Miami-Dade County: 2004-2008

Ra

tes

pe

r10

0,0

00

SOURCE: US Dept HHS-SAMHSA, OAS: DAWN Emergency Dept. Estimates.

Exhibit 6 Numbers of DAWN ED Unweighted1 Reports forSelected Drugs in Miami-Dade County, FL: Jan. – June 2009

1The unweighted data are from 8-9 Miami-Dade EDs reporting to DAWN in 2009. All DAWN cases are reviewed for quality

control. Based on this review, cases may be corrected or deleted, and, therefore, are subject to change.SOURCE: Miami – Dade County Division EDs DAWN Live!, OAS, SAMHSA, updated December 22, 2009

54

20

452

165

1,522

1,147

745

309

0 500 1,000 1,500 2,000

Alcohol in Combo

Cocaine

Marijuana

Rx Benzo's

Rx Opioids

Heroin

MDMA

Methamp

Number of DAWN Live! Reports


14

Exhibit 7 Numbers of DAWN ED Unweighted1 Reports forSelected Drugs in Broward County, FL: Jan. – June 2009

1 The unweighted data are from 9 Ft. Lauderdale EDs reporting to DAWN 2009. All DAWN cases are reviewed for quality control.

Based on this review, cases may be corrected or deleted, and, therefore, are subject to change.SOURCE: Miami – Ft. Lauderdale Division EDs DAWN Live!, OAS, SAMHSA, updated December 22, 2009

63

17

143

752

693

652

1,064

980

0 500 1,000 1,500 2,000

Alcohol in Combo

Cocaine

Marijuana

Rx Benzo's

Rx Opioids

Heroin

MDMA

Methamp

Number of DAWN Live! Reports

Exhibit 8 Number of Primary Treatment Admissions bySubstance in Miami-Dade and Broward Counties, FL: 2009

5,678TOTAL ADMISSIONS5,542

422Substance Unknown117

689All Other Drugs108

47Benzodiazepine1

0PCP29

0MDMA3

6Amphetamine2

20Methamphetamine55

2,030Marijuana2,118

336Rx Opioids113

105Heroin150

159Powder Cocaine690

610Crack Cocaine867

1,254Alcohol1,289

Broward CountyPrimary Treatment SubstanceMiami-Dade County

SOURCE: Florida Department of Children and Families


15

Exhibit 9 Number and Percent of Top 10 Most FrequentlyIdentified Drugs in South Florida Crime Labs: 2009

NOTES:

Data are for January-December2009 from the Miami/Ft. Lauderdale/Pompano Beach MSA and includeMiami-Dade, Broward, and PalmBeach Counties.

Unspecified Controlled Substancerepresents 1,044 cases and areincluded in “Other.”

Percentage may not sum to thetotal due to rounding.

Source: US Drug EnforcementAdministration - NationalLaboratory Information System(NFLIS) April 24, 2010

100%24,772Total

8.1%1,996Other

0.3%65Hydrocodone

0.4%110Methamphetamine

0.5%1361-Benzylpiperazine (BZP)

1.4%339Oxycodone

1.4%356MDMA

1.7%421Hallucinogen

2.3%568Alprazolam

3.1%773Heroin

19.0%4,699Cannabis/Marijuana

61.8%15,309Cocaine

PercentNumberDRUG

Exhibit 10 Percent of Heroin-Related Deathswith Rx Opioids Present in Florida: 2008

Total n= 132 Heroin Deaths(119 Cause of Death)

( 13 Present at Death)

SOURCE: Analysis of Florida Medical Examiners Commission data bythe Center for the Study and Prevention of Substance Abuse,Nova Southeastern University

45 % had 1 or more Rx Opioid Present

with a total of 80 Opioids detected

including 36 considered a lethal dose

Morphine 20 Propoxyphene 6Codeine 19 Hydrocodone 5Oxycodone 15 Hydromorphone 3Methadone 10 Other Opioids 2

n= 59

n= 73


16

Source: FDLE Florida Medical Examiners Commission Report 2009

Exhibit 11 Number of Oxycodone Reports Detected

Among Decedents by Age Groups in Florida: 2009#

of

Oxycod

on

eR

ep

orts

0 116

5 19

241

7

50

370

23

85

761

31

69

558

0

100

200

300

400

500

600

700

800

<18 yrs. 18-25 yrs. 26-34 yrs. 35-50 yrs. >50 yrs.

Miami-Dade 66

Broward 225

State of Florida 1,946

Exhibit 12 Rates per 100,000 of Oxycodone NonmedicalUse Emergency Department Reports by Age Groups

DAWN Ft. Lauderdale Division vs. USA: 2008

19.3

53.5

46.5

77.1

121.6

141.4

73.7

30.247.5

53.7

43

64.869.859.7

0

20

40

60

80

100

120

140

160

18-20

yrs.

21-24

yrs.

25-29

yrs.

30-34

yrs.

35-44

yrs.

45-54

yrs.

55-64

yrs.

Broward

USA

Rate

per

10

0,0

00

SOURCE: US Department HHS-SAMHSA, OAS: 2008 Drug Abuse WarningNetwork (DAWN) Emergency Department Estimates


17

Source: FDLE Florida Medical Examiners Commission Report 2008

Exhibit 13 Number of Alprazolam Reports Detected

Among Decedents by Age Groups in Florida: 2008#

of

Alp

razola

mR

ep

orts

2 023

11 23

324

1438

362

35

87

706

3955

458

0

100

200

300

400

500

600

700

800

<18 yrs. 18-25 yrs. 26-34 yrs. 35-50 yrs. >50 yrs.

Miami-Dade 101

Broward 203

State of Florida 1,873

Exhibit 14 Rates per 100,000 of Alprazolam Nonmedical UseEmergency Department DAWN Reportsby Age Groups South Florida and USA: 2008

35.4

87.4

106.9 102.2

62.7 58.4

40.7

16.323

61.7

88.376.3

55.242.9

41.9

21.4

13

57.7

73.8

30.436.4

0

20

40

60

80

100

120

12-17

yrs.

18-20

yrs.

21-24

yrs.

25-29

yrs.

30-34

yrs.

35-44

yrs.

45-54

yrs.

55-64

yrs.

65+

yrs.

Ft. Lauderdale Div

USA

Miami-Dade

Rate

per

10

0,0

00

SOURCE: US Department HHS-SAMHSA, OAS: 2008 Drug Abuse WarningNetwork (DAWN) Emergency Department Estimates

Documents

Prescription Drug Abuse is on the Rise in Florida