Trends in Substance Use in Connecticut and the Impacts of COVID-19

Alcohol and Drug Policy Council October 20, 2020

Jane A. Ungemack, DrPH DMHAS Center for Prevention Evaluation and Statistics (CPES) at UConn Health

1 Percent of Persons Reporting Use by Substance, Ages 12 and Older: CT vs. US, 2017-2018 100

70 CT US 62.1 60 51.4 50

Percent 40 29.2 30 24.5 22.0 19.7 18.5 20 15.5

10 3.7 3.9 2.1 2.1 0.4 0.3 0 Past Month Alcohol Past Month Binge Past Month Past Year Past Year Pain Past Year Cocaine Past Year Heroin Drinking Tobacco Product Marijuana Reliever Misuse

2 Source: NSDUH, 2018 Note: Tobacco products include cigarettes, smokeless tobacco (i.e., snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco Percent of Youth and Adults Reporting Past Month Alcohol Use 100 and Binge Drinking: Connecticut, 2008-2018

80 70.9 68.0 68.8 68.9 67.4 68.4 70 66.5 65.6 67.2 67.0

66.7 65.3 66.1 65.6 64.8 60 63.1 63.0 64.7 63.3 64.7 48.8 47.3 48.0 46.9 47.0 47.0 50 44.5 46.1 42.2 40

28.9 26.4 27.8 30 26.2 24.6 24.8 24.6 22.7 22.6 18.6 20 17.8 16.8 17.6 14.2 13.6 12.8 11.2 11.4 12.6 10 13.3 11.2 10.2 8.1 7.5 6.3 6.4 0 6.1 6.2 2008-09 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18 12-17 Alcohol Use 18-25 Alcohol Use 26+ Alcohol Use 12-17 Binge Drinking 18-25 Binge Drinking 26+ Binge Drinking

3 Source: NSDUH Note: The 2015 NSDUH underwent significant redesigns. In 2015 the threshold for binge drinking changed for women from 5 to 4 Percent of High School Students Reporting Past 30-Day Alcohol Use and Binge Drinking: Connecticut, 2005-2019 100

50 45.3 44.7 43.5 41.5 40 36.7 30.2 30.4 27.8 30 26.2 24.2 25.9 22.3 20.8 20 14.2 14.9 12.9 10

0 2005 2007 2009 2011 2013 2015 2017 2019 Alcohol Use Binge Drinking Source: CSHS (CT YRBS) Past Month Tobacco Product Use by Age Group, Connecticut, 2008-2018

45 41.5 41.3 41.8 40 37.7 35.6 35.7 34.1 35 33.9 31.7

30 27.3 24.6 24.2 24.8 24.6 25 21.6 21.5 22.3 21.5 20.6 20.3 20

15 11 10.8 10.1 10 8.4 6.9 6.8 6.4 5.4 4.1 5 3.5

0 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 CT 12-17 CT 18-25 CT 26+

Note: Tobacco product use includes cigarettes, smokeless tobacco (i.e., snuff, dip, chewing tobacco, or snus), cigars, or pipe tobacco. Source: NSDUH 5 Tobacco Sales to Youth in Connecticut:

25 SYNAR, CDC & DMHAS, 2008-2018

14.8 15 14.0 13.7 13.3 13.3 12.1 11.3 10.7 9.7

10 9.0 8.8 Reported Retailer Rate Violation Retailer Reported 5

0 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Percent of High School Students Reporting Past 30-Day Use of Electronic Vapor Products vs. Cigarettes:

50 Connecticut, 2011-2019

30 27

25 Percent 20 14 14.7 15 8.9 10 7.2 5.3 3.5 3.7 5 2.4 5.6 0 2011 2013 2015 2017 2019 Electronic Vapor Products Cigarettes Source: CSHS (CT YRBS) Note: The language around electronic vapor products has changed over the years. In 2017 and earlier, the survey asked about current “e-cigarette” use rather than vapor products. Substances Used by E-cigarette Users in Vaping Devices Reported by Young Adults 18-25: Connecticut, 2020 100% N = 452 90%

80%

70% 59% 60% 58% 51% 50%

40%

30% 23% 20%

10% 2% 0% Flavored Liquids Nicotine THC/Marijuana Oils CBD/hemp oil Other

Source: Young Adults Statewide Survey 8 Past Year Marijuana Use by Age Group: CT vs. US, 2008-2018 50 46.4 45.2 45 43.5 42.1 39.4 40 39.0 39.0 38.8 37.1 36.9 34.8 35.4 33.9 35 32.6 31.6 31.8 32.1 30.4 30.4 31.1 29.3 30

20 16.8 15.9 16.3 16.2 16.0 15.7 15.6 16.1 14.1 14.7 15.2 15 13.8 14.1 13.9 13.5 14.2 13.4 13.3 12.9 12.2 12.3 12.7 13.2 9.3 9.2 9.4 9.7 9.8 11.4 11.7 12.5 10 8.3 10.7 11.6 9.6 10.3 10.6 8.3 8.9 5 7.4 7.9 8.0

0 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018 2019 US 12-17 US 18-25 US 26+ Source: NSDUH, 2018 CT 12-17 CT 18-25 CT 26+ Percent of Persons Perceiving Great Risk from Smoking Marijuana Once a Month by Age Group: Connecticut, 2009-2018

40 34.9 35 32.7 30 28.3 28.1 26.9 25.7 23.9 22.1 25 23.5 24.7 23.1 23.0 22.4 20 18.3 21.8 20.6 15.4 13.3 15 12.4 12.3 11.7 11.3 10.4 9.3 10

0 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014 2014-2015 2015-2016 2016-2017 2017-2018

12-17 Years 18-25 Years 26 or Older

Note: The 2015 NSDUH underwent significant redesigns, including the order of perceived risk questions, affecting comparability. Source: NSDUH Percent Reporting Past Year Cocaine Use by Age Group: Connecticut, 2009-2018 25

Ages 12-17 Ages 18-25 Ages 26 or Older

10 9.1 8.4 7.6 6.7 6.3 6.7 5.7 6.2 5.1 5

1.8 2.1 1.2 1.4 1.3 1.5 1.6 1.6 1.6

1.1 0.7 0.6 0 1.0 0.9 0.6 0.6 0.6 0.4 2009-10 2010-11 2011-12 2012-13 2013-14 2014-15 2015-16 2016-17 2017-18

Source: NSDUH, 2018 Cocaine-involved Overdose Death Rate (per 100,000) by 5 CT Community Type, 2012-2019 25 24.3

20 18.8 16.9

11.5 11.2 10.7 9.6 9.4 10 8.7 8.8 7.0 7.6 7.2 7.0 7.0 5.2 5.8 5.5 5 3.8 4.2 3.0 3.4 3.5 4.0 4.0 2.4 2.1 2.4 1.7 1.6 2.0 1.4 1.0 1.5 1.0 0 0.0 0.0 0.5 0.5 0.5 2012 2013 2014 2015 2016 2017 2018 2019

Rural Suburban Urban Core Urban Periphery Wealthy

Source: Office of the Chief Medical Examiner Note: Death rate by town of residence 12 Percent of Persons Reporting Past Year Non-Medical Use of Pain Relievers, by Age Group: Connecticut, 2009-2018 25

Ages 12-17 Ages 18-25 Ages 26 or Older 20

11.1 10.7 9.2 10 8.5 8.6 7.2 7.5 7.0 5.0 4.7 4.5 5 3.9 4.1 4.1 3.8 3.4 2.9 3.5 3.4 3.3 3.0 2.9 3.2 2.3 0 2009-10 2010-11 2011-12 2012-13 2013-14 2015-16 2016-17 2017-18

Source: NSDUH, 2018 Percent of High School Students Reporting Ever Misusing Prescription Pain Medicine: CT vs. US, 2009-2019 50

25 20.2 20.7 20 17.8 16.8 14 14.3 15 11.1 12 9.6 9.6 10.1 10.1 10

0 2009 2011 2013 2015 2017 2019 US Connecticut Note: The wording of this question has changed over the years. In 2015 the question asked about taking prescription drugs without a prescription, but didn’t specify pain medicine. In 2013 and earlier, it asked about taking drugs without a prescription to get high. Source: CSHS (YRBS) Number of Opioid Prescriptions per Year: Connecticut, 2014-2018

3,000,000

2,602,050 2,625,042 2,510,702 2,500,000

2,161,959 1,960,988 2,000,000

1,500,000

1,000,000

500,000

0 2014 2015 2016 2017 2018 Opioid Prescriptions per Year 15 Source: CPMRS, Department of Consumer Protection Percent of Persons Reporting Past Year Use of Heroin by Age Group: CT vs. US, 2014-2018 2

1.8

1.6

1.4 1.31 1.2 1.21 1.07 1 0.93

0.8 2019 US 12-17 wasn’t 0.69 0.7 0.68 reported out due to 0.64 0.64 0.6 0.61 low precision 0.54

0.4 0.4 0.3 0.29 0.31 0.32 0.3 0.3 0.2 0.1 0.06 0.05 0.1 0.07 0.04 0 0.05 2014-15 2015-16 2016-17 2017-18 2019 CT 12-17 CT 18-25 CT 26+ US 12-17 US 18-25 US 26+ Source: NSDUH 16 Number of Opioid-related Emergency Department Visits and Hospital Admissions: Connecticut, 2013-2018

4000 3534 3361 3500 3042 3000

2500 1781 2000 1294 1500 1126 883 686 709 765 709 1000 601 500

0 2013 2014 2015 2016 2017 2018 ED Visits Hospital Admissions

Source: CT DPH 17 Number of Overdose Deaths by Year: Connecticut, 2012-2019

1200 1200

1100 1038 1017 1000 979 900 917

800 760 700 723 677 600 558 500 490 504 479 474 463 415 391 400 387 355 347 325 330 345 342 300 290 290 273 267 257 242254 255 200 220 174 157 186173174 147 127130 128 139 144 133 105 126 122 100 86 8397 61 78 75 49 37 0 14 2012 2013 2014 2015 2016 2017 2018 2019

Total Deaths Heroin-involved deaths Fentanyl-involved deaths Prescription opioid-involved deaths Cocaine-involved deaths Benzodiazepine-involved deaths Alcohol-involved deaths

18 Source: Office of the Chief Medical Examiner Multiple Drugs Involved in Opioid Overdose Deaths: CT, 2019

Xylazine, 3% Benzodiazepines, 38% Alcohol , 27% Only 15% of Prescription Opioid- Cocaine, 20% Involved Deaths did not involve Prescription Opioid-Involved Deaths Prescription Opioids*, 15% other substances (n=133) Heroin, 20% Fentanyl, 54%

Xylazine, 8% Benzodiazepines, 10% Alcohol , 26% Only 3% of Heroin-Involved Deaths Heroin-Involved Deaths Cocaine, 37% did not involve other substances (n=387) Prescription Opioids*, 7% Heroin, 3% Fentanyl, 88%

Xylazine, 7% Benzodiazepines, 22% Fentanyl-Involved Deaths Alcohol , 27% Only 17% of Fentanyl-Involved (n=979) Cocaine, 40% Deaths did not involve other Prescription Opioids*, 7% substances Heroin, 35% Fentanyl, 17%

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% *Prescription opioids include oxycodone, oxymorphone, hydrocodone, hydromorphone and tramadol. Substances that are underlined indicate deaths that involved only that substance (e.g., fentanyl-involved deaths involving only fentanyl and no other substances listed). 19 Source: Office of the Chief Medical Examiner Opioid Overdose Mortality Rate by Age Group: Connecticut, 2012-2019

80.0

72.3 70.0

60.0 60.8 58.3 58.9 55.4 50.0 50.9 51.1 48.3 45.2 44.3 41.8 41.0 40.0 39.5 36.5 32.0 30.0 30.3 30.0 29.0 27.4 28.6 24.9 26.2 23.4 20.3 20.0 18.719.0 16.8 15.6 14.7 14.0 12.4 12.1 12.8 10.7 11.7 10.0 9.2 7.99.0 7.4 6.3 5.3 4.6 2.3 3.2 2.4 2.7 0.0 1.1 0.5 2012 2013 2014 2015 2016 2017 2018 2019 15-24 25-34 35-44 45-54 55-64 >=65

Source: Office of the Chief Medical Examiner 20 Opioid-involved Overdose Death Rate (per 100,000) by 5 CT Community Type: Connecticut, 2012-2019 60.0

55.3

50.0 Rural Suburban Urban Core Urban Periphery Wealthy

44.1 40.0 36.1 34.8

30.0 29.0 28.4 26.9 26.4 27.2 23.2 23.3 24.0 20.0 18.1 17.518.0 18.4 16.4 16.5 15.8 16.0 15.1 16.1 12.9 11.1 10.0 10.09.9 10.7 10.7 8.7 9.0 7.5 5.9 5.4 6.4 4.7 4.0 4.9 4.4 3.0 0.0 1.0 2012 2013 2014 2015 2016 2017 2018 2019 Note: Death rate by town of residence Source: Office of the Chief Medical Examiner 21 Opioid Overdose Mortality Rate per 100,000 by Race/Ethnicity:

40.0 Connecticut, 2012-2019

35.0 33.8

31.2 31.3 30.0 29.4 29.0 26.6 25.0 23.8

21.1 19.0 21.7 20.0 16.7 18.7 16.4 16.5 15.0 12.8 12.6 10.7 10.7 10.0 10.2 9.9 9.1 8.7 7.6 5.1 5.9 6.4 5.0 4.4 4.5 3.1 3.6 3.3 2.3 0.0 2012 2013 2014 2015 2016 2017 2018 2019

White Black Hispanic Other

Source: Office of the Chief Medical Examiner 22 Drug Seizure Submissions by Year: Connecticut, 2014-2019

600 579 568 528 514 491 500 492 485 457 452 433 416 400 394 471 409 384 377 371 346 300

245 200 203

100 # of substances submitted to labs to submitted substances of # 59 50 39 32 25 36 25 28 0 4 2014 2015 2016 2017 2018 2019 All fentanyl-related substances* Fentanyl Heroin Cocaine Methamphetamine

Source: US DEA, Diversion Control Division, 2014-2019. Springfield, VA: US Drug Enforcement Administration. Retrieved from: https://www.nflis.deadiversion.usdoj.gov/Resources/NFLISPublicResourceLibrary.aspx *All fentanyl-related substances includes: fentanyl, 4-fluoroisobutyryl fentanyl, acetyl fentanyl, acryl fentanyl, carfentanil, cyclopropyl fentanyl, furanyl fentanyl, U-47700, ANPP, butyryl fentanyl, fluoroisobutyryl fentanyl, 23 methoxyacetyl fentanyl, o-fluoro acryl fentanyl, valeryl fentanyl, p-fluoroisobutyryl fentanyl, and p-fluorobutyryl fentanyl. Problem Substances of Greatest Concern for Age Groups, According to Key Informants: Connecticut, 2020 Problem Gambling

0.1 2.4 0.2 0.5 4.8 Prescription drugs 100 4.3 0.4 1.5 16.5 Heroin/Fentanyl 90 23.4 0.0 23.4 80 13.3 36.6 Cocaine/Crack 0.8 0.2 70 18.2 0.9 0.2 Marijuana/Hashish/ 60 24.5 THC 4.2 2.0 8.5 Vaping/ENDS 50 52.2 3.1 40 13.3 Tobacco/Cigarettes 1.9

Percent Reporting Percent 30 1.9 47.7 48.0 Alcohol 20 29.5 10 15.1

0 12-17 years old 18-25 years old 26-65 years old 66 or older Source: Community Readiness Survey 2020 COVID-19

25 Prevalence of Increasing/Initiating Substance Use and Adverse Mental Health Outcomes Associated with COVID-19: 100% US, June 24-30, 2020 90%

80% 75%

70% 66%

60% 52% 52% 50% 44% 45% 41% 38% 40% 35% 35%

Prevalence 30% 30% 25% 22% 22% 20% 20% 18% 15% 15% 13% 13% 13% 11% 10% 8% 3% 0% Overall 18-24 yrs 25-44 yrs 45-64 yrs >=65 yrs White non- Black non- Hispanic, Less than Professional Income <25K Income Hispanic Hispanic any race high school degree >=200K Substance Use Initiation or Increase >=1 Adverse Mental or Behavioral Health Symptom

Czeisler MÉ, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, Weaver MD, Robbins R, Facer-Childs ER, Barger LK, Czeisler CA, Howard ME, Rajaratnam SMW. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Aug 14;69(32):1049-1057. doi: 10.15585/mmwr.mm6932a1. 26 PMID: 32790653; PMCID: PMC7440121. Young Adults Statewide Survey Health and behavior indicators that increased as a result of COVID-19

100

90 85.8% 83.2% 80.8% 80 75.7%

50 42.1% 39.3% 40

30 21.9% Percent of Young Adults ReportingAdults ofYoung Percent 20

0 Boredom Anxiety Sense of isolation Depression Interpersonal/family Alcohol and/or drug Gaming/gambling conflict use

Source: Young Adults Statewide Survey 27 Past Month Substance Use Among Young Adults 18-25: Connecticut, 2020 100% N = 777

90% 87%

80%

70%

60%

50%

40% 37%

30% 28% 21% 20% 12% 10% 3% 4% 2% 1% 0% alcohol (1+ heavy alcohol cigarettes/ vape/ e- Marijuana/ cocaine heroin/ fentanyl Prescription OTC meds (non- drinks) use* tobacco cigarettes hashish drugs (non- medical use) medical use) *heavy alcohol use: 5 or more drinks on one occasion

Source: Young Adults Statewide Survey 28 Suspected Overdoses Since Onset of COVID-19 Impact: Connecticut, 2020 (ODMAP Submissions)

http://www.odmap.org/Content/docs/news/2020/ODMAP-Report-June-2020.pdf

29 Overdose Deaths by Month: Connecticut, Jan 2018- July 2020* • From Jan-Jul 2020, there were 802 confirmed overdose deaths (with possible additional deaths 160 pending confirmation) COVID-19 • +20% compared to Jan-Jul 140 2019 (n=667) 135 133 126 120 123 120 121 121 114 105 104 105 106 100 98 98 92 92 93 89 89 87 90 83 86 83 80 81 78 79 78 73 74 60 63 There were 770 overdose deaths in 40 the 7-m period of 20 Jun-Dec 2019 (+15%) 0 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul

2018 2019 2020

*Mortality data for 2018 and 2019 from publicly available data from the CT Office of the Medical Examiner (available at https://portal.ct.gov/OCME/Statistics). Data for 2020 is provisional and subject to change, and was obtained from https://portal.ct.gov/-/media/DPH/Injury-Prevention/Opioid-Overdose-Data/August-2020-and- 2019-Drug-Overdose-Deaths-Monthly-Report_Updated-9-17-2020.pdf 30 Substance Use Treatment Admissions by Month: Connecticut, January 2018 - May 2020

7000 6474 6481 COVID-19 6343 6371 6413 6267 6205 6300 6198 6282 6089 5997 6023 6032 5968 6000 5852 5821 5798 5583 5661 5288 5184 5442 5444 5344 4931 5000 5087

4000 3517 3441

3000 Admissions 3019

2000

1000

2018 2019 2020 Source: DMHAS 31 For more information, contact Jane Ungemack: [email protected]

or visit the SEOW Prevention Data Portal at https://preventionportal.ctdata.org/