Synthetic Cathinones in Florida crime Lab Cases:2015 M AJOR Synthetic - PowerPoint PPT Presentation

E MERGING D RUG T RENDS IN B ROWARD C OUNTY AND F LORIDA James N. Hall, Epidemiologist Nova Southeastern University

H EADLINES • Flakka’s Fall • Fentanyl Fatalities • Poisonous Opiate Analogues • Deadly Counterfeit Pills • Other Nova Psychoactive Substances • Still the Ones: Cocaine, Benzodiazepines, Marijuana • Toxic Vapors • Kratom Conundrum

Synthetic Cathinones in Florida crime Lab Cases:2015

M AJOR Synthetic Cathinones 2014-2016 • Cathinones – Synthetic Khat • MDPV • 4 MEC • Methylone • Alpha -PVP • Ethylone • Dibutylone • Others

The Changing Face of Ecstasy, Molly, Flakka, et al in Florida Crime Lab Reports 2010-2015 4500 Ethylone 4000 Number of Crime Lab Reports Methylone 3500 Alpha-PVP 3000 Other Cathinones 2500 MDMA 2000 1500 1000 500 0 2010 2011 2012 2013 2014 2015 Ethylone 0 1 5 4 1,426 1,827 Methylone 1 123 739 2,813 1,042 29 Alpha-PVP 0 1 82 46 781 2,012 Other Cathinones 19 248 484 241 281 7 MDMA 1071 674 182 115 136 158 Source: US DEA - National Forensic Laboratory System Data Queried Jan 19, 2016

Flakka Hospital Cases: Broward Health June 1 – December 27, 2015 Flakka Cases by Age 400 372 335 Number of Flakka Cases 350 Mean Age = 34 years Average Age = 35.57 years 277 300 n = 1,872 Flakka Cases 232 250 206 199 200 128 150 100 49 34 50 9 21 3 1 2 4 0

Synthetic Cathinone Deaths in Florida 100 90 Number of Cathinone-Related Deaths 89 80 72 62 60 64 73 Present 42 53 40 Caused 45 28 20 25 19 17 17 14 0 1 H 2013 2H2013 1 H 2014 2 H 2014 1 h2015 Source: Florida Medical Examiners Commission 2015 Interim Report

63 Flakka Related Deaths Broward County, Florida September 2014 – December 2015

Click on: Initiatives Facing Flakka

China Bans production and exportation of 116 Synthetic Drugs October 1, 2015 Including alpha- PVP

Flakka Hospital Cases Broward Health Medical Centers: June 1 – December 27, 2015 n = 1,872 Flakka Cases 400 Number of Flakka Hospital Cases 360 346 315 350 306 304 300 250 187 200 150 n = 1,872 Flakka Cases 100 June 1 – December 27, 2015 54 50 0 Source: Broward Health Medical Centers

Broward Addiction Recovery Center Flakka Treatment Admissions September 2014 – January 2016 n= 469 60 # of Flakka Treatment Admissions 50 48 50 41 39 39 37 40 34 26 20 23 20 25 23 30 23 14 20 10 1 6 0 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Source: Broward Addiction Recovery Center (BARC)

Number of Hospital Cases for Heroin Overdose Poisonings in Broward County: 2014 Hospital Heroin Overdoses With or Without Abuse Diagnosis 250 233 Without Abuse Diagnosis With Abuse Diagnosis 200 28% 66 164 150 167 100 Emergency Dept. 50 Inpatient 69 72 % 0 n = 233 Heroin Source: Florida Agency for Health Care Administration

Number of Heroin Deaths in Broward County Florida: 2010-2015 80 68 2015 Heroin Cases 70 97 % Cause of Death 60 85 % w/Other Drugs 50 40 28 30 Heroin 20 10 11 5 9 3 0 2010 2011 2012 2013 2014 2X1H 2015 Source: 2015 FL Medical Examiner Interim Report

Number of Heroin and Fentanyl Deaths in Florida: 2000 to 2015* 900 794* 800 Number of Deaths Heroin 686* 700 600 Fentanyl 538 500 447 400 292 197 235 215 227 236 251 300 200 271 250 230 208 199 100 150 109 78 93 119 95 48 57 108 0 * Projected Increase based on 2 X 1 st Half of 2015 Source: Florida Medical Examiners Commission 2015 Interim Report

Number of Deaths Related to Fentanyl or Heroin in Broward County Florida: 2010-2015 2015 Fentanyl Cases 90 79 98 % Cause of Death 80 91 % w/Other Drugs 70 68 53 60 50 Fentanyl 40 28 Heroin 21 30 2015 Heroin Cases 14 20 11 97 % Cause of Death 10 11 85 % w/Other Drugs 5 9 3 0 3 2010 2011 2012 2013 2014 2015 Sources: 2010-2013 FL Medical Examiner Commission Raw Data Tables , 2014 FL Medical Examiner Annual Report, 2015 Data from Broward Medical Examiner Office

Real Fake Counterfeit Xanax with Fentanyl

Fake Oxycodone with Fentanyl Authentic Oxycodone A 215

Canada: Non-Pharmaceutical Fentanyl Market  High volume Chinese trade through Vancouver  No searches of parcels under 30 grams

Non-Pharmaceutical Fentanyl (NPF) Trafficking 2012 2014 CHINA

Reports of non-pharmaceutical fentanyl Key Powder alone or combined with heroin Sold as prescription medications (pills) No reports of NPF

Non-pharmaceutical fentanyl 4 th Quarter 2014 Alaska Hawaii

Non-pharmaceutical fentanyl 4 th Quart 2015 Alaska Hawaii

Non-pharmaceutical fentanyl 1 st Quarter 2016 Alaska Hawaii

Pill press plus 1K NPF = $100,000 Street value = $20,000,000 Source: RCMP

Fentanyl: A Public Health Emergency The federal government should declare the fentanyl overdose crisis to be a Public Health Emergency under the National Emergency Act, the Section 319 of the Public Health Service Act, and, if requested by a Governor, under the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

O THER O PIATE A NALOGS U-47700 ( Synthesized from AH-7921 ) • • Boston • Erie County, New York • New Jersey • Dallas, Texas (2 Deaths) • Brevard County, Florida • Pinellas County, Florida (3 Deaths) • The W series: W-18 • University of Alberta 1980’s • Broward County – 2015 First in the USA • Indianapolis • Maybe Pittsburgh

Number of Hospital Cases for Non-Fatal Rx Opioid Poisonings in Broward County: 2007-2014 1000 Number of Rx Opioid Poisoning Patients Emergency Dept. 909 900 849 833 826 Inpatient 800 731 695 700 652 585 600 500 400 300 200 100 0 2007 2008 2009 2010 2011 2012 2013 2014 Emergency Dept. 241 329 348 305 256 193 251 298 Inpatient 454 520 561 528 475 392 401 528 Source: Analysis of data from the Florida Agency for Health Care Administration

Rx Opioid Poisoning Hospital Cases in Broward County With and Without a Diagnosis of Opioid Abuse: 2007-2014 n= 6,080 With 12 % 724 Without Source: Analysis 5,356 of data from the Florida Agency for Health Care Administration 88 %

Number of Cocaine Deaths in Florida 2000-2015 2500 2179 2052 1943 2000 1791 16141702 1680 1508 # of Cocaine Deaths 1462 1444 1500 1307 1337 1402 1105 1318 1000 1034 2015 Cocaine Cases 53 % Cause of Death 500 84 % w/Other Drugs 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20142X1H 2015 Source: Florida Medical Examiners Commission 2015 Interim Report

Number of Cocaine Deaths in Broward County 2000-2015 180 157 146 160 150 142 138 135 127 # of Cocaine Deaths 136 129 140 121 115 120 102 120 94 100 99 80 2015 Cocaine Cases 80 60 77 % Cause of Death 40 85 % w/Other Drugs 20 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H 2015 Source: Florida Medical Examiners Commission 2015 Interim Report

Number of Nonmedical Rx Benzodiazepine Reports Detected among Deceased Persons in Florida 2005 – 2015 # of Drugs Detected Among Decedents 7,000 Benzodiazepines 6,188 5,947 6,000 5,184 5,000 4,167 4,340 4,364 4,304 4,282 4,000 2,973 3,339 3,000 2,608 House Bill 7095 2,000 Takes effect Pill Mill Strike Force 1,000 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H 2015 Source: FDLE – Drugs Identified In Deceased Persons by Florida Medical Examiners Jan 2005 - Jun 2015 Reports

22 Kinds of Synthetic Cannabinoids • JWH Series – (John W. Huffman) 8 types in Florida • AM 2201 • UR-144 • XLR-11 • PB-22 • AB-FUBINACA • AB-PINACA • AB-CHMINACA • And 7 Others in Florida

“Budder” Beware: Dangers of Marijuana Wax • Marijuana Wax • “Budder,” or • Butane hash oil, or even • “ear wax hash” Produced by soaking marijuana plant material in a solvent such as butane which extracts various cannabinoids of the plant.

DABBING

Kratom: To Ban or Not to Ban? Photo Source: FoxNews.com

 Large tree indigenous to Thailand and Malaysia  Leaves are usually chewed but it can be found in a dried form to create powder, tinctures and resins and is sold in the US in pill form.

Kratom Commercial Packaging