Transcript Update on Latest Drug Trends - University of Texas – School of

Prescription Drug Epidemic in the
United States and Texas: A Look at the
Numbers
Jane Maxwell, Ph.D.
Center for Social Work Research
The University of Texas at Austin
Age-adjusted Rate of Drug Overdose Deaths
by State: 2010 vs 2015
MMWR / December 30, 2016 / Vol. 65 / Nos. 50 & 51 1445
Opioid Death Rates in States: 2010-2015
Increases in Drug and Opioid Involved Overdose Deaths-United States, 2010-2015. MMWR Dec. 2016
Number of Drug Poisoning Deaths: United
States: 1999—2015
16000
12000
Heroin
Other Opiates
8000
Methadone
Other Synthetics (fentanyl)
Benzodiazepines
4000
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
Number of Drug Poisoning Deaths: Texas:
1999—2015
700
600
500
400
Other Opioids
300
Synthetic Narcotics
(fentanyl)
Methadone
200
Heroin
Benzos
100
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
US and Texas Drug Deaths
Texas
U,.S.
14000
Heroin
12000
700
600
Other
Opiates
10000
8000
Methadone
6000
500
400
300
Other
Synthetics
(fentanyl)
4000
2000
Benzodiaz
epines
0
1999 2001 2003 2005 2007 2009 2011 2013 2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
200
100
0
6
Heroin Sources and Supply Routes
Mexican Black Tar Heroin
Mexican Brown (“Cheese”)
South American Heroin
& “new” Mexican White
Heroin
Fentanyl and Alprazolam (Xanax)
Opioids of Concern
•
•
•
•
•
•
•
•
•
•
•
Hydrocodone (Vicotin, Lortab)
Oxycodone (OxyContin)
Methadone (for pain)
Hydromorphone
Percodan
Dilaudid
Tramadol
Fentanyl (Acetyl & Butryl)
U-47700
MT-45
W-18
Abused Pharmaceutical Drugs Identified by
Forensic Labs by US Region: NFLIS 2016
35000
30000
25000
Hydrocodone
20000
Oxycodone
Heroin
15000
Fentanyl
Alprazolam
10000
5000
0
NEast
DEA NFLIS
MWest
South
West
Indicators of Heroin Trends in Texas:
1998-2015
10000
1000
100
10
1
# PCC Calls
% Treatment
# Tox Items
# Deaths
1998
1999
2000
2001
2002
2003
2004
2005
2006
2008
2009
2010
2011
2012
2013
2014
2015
2016
Source: Texas Drug Trends:
2007
Other Opiates
•Cost difference? Heroin cap in Texas is $10-$20 vs. $5-$80 for
old crushable OxyContin, $1-$10 for newer hard to crush, and
$5 for counterfeit Oxy containing fentanyl.
•Still problem with pain pill mills: Houston Cocktail “Holy
Trinity”: oxycodone, soma, alprazolam (Xanax). Fentanyl now
being pressed into these pain pills.
•Evidence in Florida of decreasing pain pill problems due to
Prescription Monitoring Programs but heroin is up.
•Reports of difficulty in using “hardened” extended release
pills so they prefer immediate release pills or shift to heroin.
Rates per 100,000 of Drug Poisoning Deaths
Involving Heroin in the US: 1999-2015
11
9.7
10
9
Rate per 100,000
8
7.4
7
5.6
6
5
3.8
4
3.4
3
1.8
2
1
0.5
1.0
1.3
0.3
0
15-24 years 25-34 years 35-44 years 45-54 years 55-64 years
1999
2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File
Rate per100,000
8
Rates per 100,000 of Deaths Involving Other
Opiates, Other Synthetics, Methadone, &
Other Unspecified Narcotics in the US: :
1999-2015
5.6
6
4.2
4.3
4.2
2
6.5
5.0
5.0
60-64
65-69
3.9
4
3.0
2.9
35-39
40-44
2.6
2.3
2.2
6.1
1.3
0
15-19
20-24
25-29
30-34
1999
45-49
2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File,
50-54
55-59
Source For Pain Relievers Obtained for Most
Recent Misuse for People Ages 12 or Older Who
Misused Them by Past Year Initiation Status, and
Disorder Status: NSDUH 2015
Past Year Initiate without
Disorder
60
Past Year Misuser without
Disorder and Not Past Year
Initiate
Past Year Misuser
(Including Initiates) with
Disorder
40
20
0
Got through
Given by, Bought from,
Prescription or Stole or Took from a Friend
from a Health Provider
or Relative
Bought from Drug
Dealer or Other
Stranger
Some Other Way
Results from the Texas School Surveys 20062016: Grades 7-12
Percent
2006
2008
2010
2012
2014
2016
Ever Used in Lifetime?
Heroin
1.5
1.4
1.4
1.1
0.5
Oxy & Hydro
0.7
5.0
Hydrocodone
6.3
5.3
7.5
4.5
Oxycodone
3.5
1.1
3.6
2.2
Valium & Xanax
4.0
Valium
3
2.4
2
0.9
Xanax
5.2
4.5
3.9
2.8
Very easy to get
heroin?
8.5
8.5
5.7
4.9
3.1
2.8
Very dangerous
for kids to use
heroin?
86.6
86.7
86.1
86.7
87.6
89.6
Source: Texas DSHS
1999 vs. 2015 Overdose Death Rates per 100,000 in
Texas Counties Due to Heroin, Other Opiates,
Other Synthetic Opiates, Methadone, &
Benzodiazepines
2010
2015
Bexar County
6.8
6.1
Brazoria County
7.3
Unreliable
Collin County
4.2
4.2
Dallas County
4.5
6.4
Denton County
Unreliable
4.2
El Paso County
4.1
3.7
Fort Bend County
3.9
Unreliable
Galveston County
15.4
7.4
Harris County
6.8
6.2
Montgomery County
6.6
6.5
Nueces County
12.9
10.6
Tarrant County
2.0
4.4
Travis County
5.1
7.9
Statewide
4.7
5.0
Counties with fewer than 20 deaths were suppressed but termed "unreliable“ for Bell, Brazoria,
Brazos, Fort Bend, Hidalgo, Liberty, Lubbock, McLennan, Nacogdoches, Smith, Webb, Williamson
Medicare Part D Opioid Prescribing Mapping
Tool
CMS.gov/research Statistics Data Medicare {provider Charge Data
19
22
Pill Mill Pharmacy Shelves
23
Medications to Treat Opioid
Dependence
Buprenorphine
Methadone
Naltrexone
Naloxone
22
US Opioid and Heroin Patients Receiving
Methadone or Prescriptions for Buprenorphine or
Naltrexone vs. Abuse/Dependent or Past Month
Users of Pain Relievers Nonmedically or Heroin:
2012
5,197,000
1,462,069
Opioid and Heroin Patients
Receiving MAT*
Past Month Use of Pain Relievers
or Heroin NSDUH 2012
* Number of individuals receiving buprenorphine or naltrexone from IMS plus number of patients receiving
methadone from NSSATS. Source: IMS Total Patient Tracker, Sept 2014 and SAMHSA NSSATS.
Buprenorphine data exclude forms indicated for pain. Oral naltrexone factored for opioid dependence use.
Methadone patients from SAMHSA, N-SSATS 2012.
GOOD LINKS
http://socialwork.utexas.edu/site/ari/announcements
http://socialwork.utexas.edu/dl/ari/texas-drug-trends2016.pdf
https://www.cdc.gov/drugoverdose/data/statedeaths.html
https://www.cdc.gov/drugoverdose/data/statedeaths.html
https://www.cdc.gov/drugoverdose/data/analysis.html
https://www.cdc.gov/drugoverdose/data/analysis.html
https://www.cms.gov/Research-Statistic-Trends-andReports/Medicare-Provider-Charge-Data/OpioidMap.html
http://www.texasschoolsurvey.org/
24
Jane C. Maxwell, Ph.D.
Research Professor
Addiction Research Institute
Center for Social Work Research
The University of Texas at Austin
1717 West 6th, Suite 335
Austin, Texas 78703
512 656-3361