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Heroin, Meth, and Poly-Substance Abuse: Where We Are Now

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Heroin, Meth, and Poly-Substance Abuse: Where We Are Now Heroin, Meth, and Poly-Substance Abuse: Where We Are Now Jane C. Maxwell, Ph.D. Research Professor The University of Texas at Austin No Relevant Financial Conflicts: Relevant to the content of this educational activity, I do not have any relevant financial conflicts with commercial interest companies to disclose. Heroin Overdose Deaths: 2017 CDC Wonder & Kaiser Family Foundation Synthetic Opioid Deaths (fentanyl, tramadol) CDC Wonder & Kaiser Family Foundation Opioid Overdoses Natural and Semisynthetic (oxycodone, hydrocodone): 2017 CDC Wonder & Kaiser Family Foundation Number of Drug Overdose Deaths Involving Opioids and Other Drug Types, Iowa Vital Statistics, 2010-2017 250 Other Opiates* Methamphetamine Heroin Cocaine 200 Other Opiates* 150 100 Methamphetamine Heroin 50 Cocaine 0 2010 2011 2012 2013 2014 2015 2016 2017 *Includes oxycodone, hydrocodone, synthetic narcotics (fentanyl) and other narcotics Mexican Black Tar Heroin SWA Brown Heroin or “Cheese” Heroin South American Heroin or “new” Mexican White Heroin Black Tar Heroin and Packaging Heroin Sources and Supply Routes 100 10 20 30 40 50 60 70 80 90 0 1977 1978 1979 1980 ( 1981 Distribution Area Source Heroin 1982 TRANSITION IN HEROIN SOURCE AREAS SOURCE IN HEROIN TRANSITION 1983 1984 1985 1986 Source:Heroin DEA Signature Program 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 1977 2008 2009 2010 2011 - 2012 2016) 2013 2014 2015 2016 Mexico Asia Southeast Asia Southwest America South Inconclusive Top Drugs Seized and Identified in Iowa • July-Oct, 2019., 48% of all drugs seized were meth, 28% cannabis, 7% cocaine, 3% fentanyl 2.4% heroin. • Iowa DEA reports bi-weekly loads of 20# to 50# meth. • Increase in availability and demand for heroin and fentanyl. Heroin Is still more popular and most comes from Chicago. • Seeing meth coming up I-35 and merging with drugs on I-29 out of Kansas City. • Fentanyl not as popular as heroin but seeing fentanyl mixed with other drugs. Heroin and Fentanyl Deaths in Iowa: 2015-2019 (Death with heroin & fentanyl is counted in each drug category) 800 660 600 563 535 400 263 200 238 37 82 66 29 59 0 2015 2016 2017 2018 2019 Fentanyl Heroin Items Identified and Reported to DEA by Iowa Division of Criminal Investigation: 2010-2018 800 730 700 660 600 563 535 500 400 345 294 304 286 300 242 238 200 179 100 38 62 6 5 2 7 5 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 Fentanyl Heroin Powdered Heroin and Fentanyl Test Strips Fentanyl Items, Fentanyl Citrate, Fentanyl Hydrochloride, Fentanyl Salt Undetermined: US NFLIS 2008-2018 62067 54990 32898 13644 4233 569 623 668 661 693 938 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 Fentanyl or Not? Kilogram seizure of suspected black tar heroin that was fentanyl with no heroin present. Fentanyl pills pressed to look like OxyContin Fentanyl pills pressed to look like alprazolam ? BLACK FENTANYL ? • Fentanyl source? China and Mexico • Nationally 21% of fentanyl exhibits were mixed with heroin. • Since 2017, 37% of samples submitted to Utah DOR contained a form of counterfeit prescription pills. • Since September 2018, 15 submissions resembling black tar heroin but also contained fentanyl. • Jan. 2019, Arizona seized 12# fentanyl packaged like cocaine. • May 2019, Idaho submitted sample of black tar that contained heroin/fentanyl mix. • October 2019, black powder tested positive for fentanyl and methamphetamine. • Nov. 2019 Denver seized kilo for suspected black tar that was only fentanyl • Cross-country trafficking—identical fentanyl compounds found on east and west borders. Fentanyl Exposure Calls to Texas Poison Centers Identifying Patches, Sprays, or Sublingual Tablets (Medical Products) or Form Unspecified: 2016-2018 34% 43% 73% 66% 57% 27% 2016 2017 2018 % Medical Product Not Specified DSHS Poison Centers The Iowa Prescription Monitoring Program Schedule CII or CIII Drugs 6000000 5000000 4000000 3000000 2000000 1000000 0 Total Prescriptions2013 2014 Dispensed 2015 Total Prescriptions2016 filled2017 2018 # Patients Filling CII or CIII ll includes OxyContin, Percocet, Dexedrine, Adderall, desoxyn; lll includes ketamine, Vicodin, steroids. Category of Drug Deaths and Mentions of Tramadol or Fentanyl on Death Certificates: Texas 2018 715 Psychostimulants 7 13 502 Benzodiazepines 29 32 706 Cocaine 8 12 547 Heroin 3 5 524 Other Opiates 105 176 Total Deaths Tramadol Fentanyl Tramadol Items Seized and Identified in U.S. Tox Labs: 1998-2018 8000 7000 6000 5000 4000 3000 2000 1000 0 1998 2000 2002 2004 2006 2008 2010 2012 2014 2016 2018 Medication Safety for Persons on Other Opioids: Taking strong pain pills safely • Do we need a prevention campaign to decrease deaths due to Other Opiates (oxycodone, hydrocodone, etc.)? Emphasis by prescribing physician describing mortality risks to family and patient, need for each patient to receive a naloxone kit (“Naloxone in the home like Fire Extinguisher in the home”). • Pharmacist working with patient and family on safe medication practices: write down time of taking pill; keeping pill away from recliner or bed where patient sleeps so will be wide enough awake to be aware of the time of the dose? Other safe prescription management? • Lock up these meds to prevent diversion by others, including teenagers. Indicators of Methamphetamine Trends in Texas: 1998-2018 - when PSE was limited 1000 100 10 1 # PCC Calls % Tmt Admits # Deaths % Tox Lab Items 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 DEA Methamphetamine Profiling Program: National Data 2006-2018 Production Routes Purity and Potency 100% 100% 80% 80% 60% 60% 40% 40% 20% 20% 0% 0% 2007 2012 2017 P2P Purity Potency PSE (Pseudoephedrine) *http://www.justice.gov/dea/resource-center/meth-lab-maps.shtml Domestic seizure counts, 2002-2018 Meth seizures now exceed marijuana Major drugs: • Marijuana seizures declining, both along SWB and in legalization states. • Cocaine declined in 2006-07; remains suppressed since 2012 • Meth dramatically rising since 2009; now exceeds marijuana seizure counts Opioids: • Heroin peaked in 2015, now declining (correlated to Quest trend). • Oxycodone peaked in 2011, continues to decline • Fentanyl commenced rising in 2014, and continues to rise 12/5/2019 25 Source: National Forensic Laboratory Information system (NFLIS), DEA, semi-annual reports A Ten-Year Lookback from UNODC ATS ATS includes non-plant based drugs such as methamphetamine, amphetamine, and MDMA • The global quantity of ATS seizures increased more than four times, from 60 tons in 2008 to 261 tons in 2017 • ATS is the primary drug of concern, as quantities of the drug seized increased more than sevenfold and its global share of all ATS seizures increased from 41 per cent in 2008 to 71 per cent in 2017 • The global ATS seizures increased from 60 tons in 2008 to 261 tons in 2017. • North America and Asia are the 2 main trafficking hubs but trafficking is increasing in other subregions; crystal meth and its health risks are increasing. • Between 2008 and 2017, US price has dropped from $220/gram to $70 and purity has increased from 46% to 93% The Global SMART Update Vol. 22 - “The ATS market – 10 years after the 2009 Plan of Action” 2017 Iowa Treatment Admissions 10080 7705 6767 936 1231 152 Items Identified and Reported to DEA by Iowa Division of Criminal Investigation: 2010-2018 10000 Fentanyl Cocaine Heroin Methamphetamine 8000 6000 4000 2000 0 2010 2011 2012 2013 2014 2015 2016 2017 2018 Methamphetamine-Related Treatment Admissions, by Age and Gender, IDPH, 2014-2018 1000 800 600 400 200 0 15-24 25-44 45-64 Female Male 2012 2013 2014 2015 2016 2017 2018 Iowa Substance Abuse Brief: Methamphetamine use and trends in Iowa, October, 2019. Increasing Size of Methamphetamine Seizures 2018-2019 Meth seizures on border on routes north: Feb 6, 2019—Pharr—1,005 pounds-bell peppers Feb 20. 2019—Pharr—906 pounds-strawberries Iowa DEA reports bi-weekly loads of 20 to 50 pounds. Western Iowa trafficking linked to Kansas City & Omaha. More meth in central Source: DEA & western parts of state. Characteristics of Meth Clients in Treatment in Central Texas in 2014 • N=222; 83% White; 54% female. • 46% injected, 34% inhaled, 19% swallowed, 60% smoked. • More females completed high school (83% vs. 76%). • Females had more children living with them. • Females scored 8 on Severity of Dependence Scale vs. 7 for males • 63% had seen a mental health professional; 67% had been given meds for depression and 60% meds for anxiety. • Over 89% said a family member had drug problem, 94% said a family member had a drinking problem, 90% said family had psychological problem, and 87% had a family member who had been in jail. • 41% as youths had drunk with family members and 34% had done drugs with family members. Maxwell, JC. A New Survey of Methamphetamine Users in Treatment Biggest Risks of Meth Use: Mental % Paranoia 38 Depression 35 Anxiety/panic 35 Damage to brain function 28 Psychosis 17 Aggressive/violent behavior 16 Memory impairment 12 Cognitive impairment 4 Long-term physical problems 9 Lack of motivation 8 Maxwell, Substance Use and Misuse, 2014 Biggest Risks of Meth Use: Personal Problems & Drug Use Problems % Legal/police problems 29 Family & child social services 22 Financial problems 20 Social/relationship problems 20 Employment problems 18 Addiction/dependence 38 HIV/AIDS 16 Hepatitis 15 Overdose 11 Unknown strength/contents 8 Taking more than intended 5 Maxwell, Substance Use and Misuse, 2014 Biggest Benefits of Meth Use 0 10 20 30 40 50 60 70 80 Increased energy/stay awake Weight loss Do more housework/care of kids Enhanced sexual experience The high Fun/good time Female Feeling in control/focused Male More social To not be depressed Increased confidence Enhanced mood/euphoria Work more hours or jobs *p=.05 Enhanced closeness/bonding Relax/escape Maxwell, Substance Use and Misuse, 2014 Suggestions for Sobriety Counselors Women are more likely to have higher unemployment, lower education level, engage in sex trade or other professions as source income.
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