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

EMERGING DRUG TRENDS

IN BROWARD COUNTY AND FLORIDA

James N. Hall, Epidemiologist Nova Southeastern University

HEADLINES

• 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

MAJOR 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

2010 2011 2012 2013 2014 2015 Ethylone 1 5 4 1,426 1,827 Methylone 1 123 739 2,813 1,042 29 Alpha-PVP 1 82 46 781 2,012 Other Cathinones 19 248 484 241 281 7 MDMA 1071 674 182 115 136 158 500 1000 1500 2000 2500 3000 3500 4000 4500

Ethylone Methylone Alpha-PVP Other Cathinones MDMA

Number of Crime Lab Reports

Source: US DEA - National Forensic Laboratory System Data Queried Jan 19, 2016

Flakka Hospital Cases: Broward Health

June 1 – December 27, 2015

Number of Flakka Cases Mean Age = 34 years Average Age = 35.57 years

Flakka Cases by Age

1 9 34 232 335 372 277 206 199 128 49 21 3 2 4

50 100 150 200 250 300 350 400

n = 1,872 Flakka Cases

Synthetic Cathinone Deaths in Florida

14 17 19 17 25 28 73 53 45 64

20 40 60 80 100 1 H 2013 2H2013 1 H 2014 2 H 2014 1 h2015 Present Caused

42 90 72 62 89

Source: Florida Medical Examiners Commission 2015 Interim Report Number of Cathinone-Related Deaths

63 Flakka Related Deaths Broward County, Florida

September 2014 – December 2015

Click on: Initiatives Facing Flakka

China Bans production and exportation

• f 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

346 360 304 315 306 187 54

50 100 150 200 250 300 350 400 Source: Broward Health Medical Centers Number of Flakka Hospital Cases

n = 1,872 Flakka Cases

June 1 – December 27, 2015

Broward Addiction Recovery Center Flakka Treatment Admissions

September 2014 – January 2016 n= 469 1 14 20 23 20 25 23 37 26 39 50 41 48 39 34 23 6

10 20 30 40 50 60 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

# of Flakka Treatment Admissions

Source: Broward Addiction Recovery Center (BARC)

Number of Hospital Cases for Heroin Overdose Poisonings in Broward County: 2014

Hospital Heroin Overdoses 69 164

50 100 150 200 250 Heroin Emergency Dept. Inpatient

With or Without Abuse Diagnosis

167 66

Without Abuse Diagnosis With Abuse Diagnosis

28% 72 % 233

Source: Florida Agency for Health Care Administration

n = 233

Number of Heroin Deaths in Broward County Florida: 2010-2015

5 3 9 11 28 68

10 20 30 40 50 60 70 80 2010 2011 2012 2013 2014 2X1H 2015

Heroin

Source: 2015 FL Medical Examiner Interim Report

2015 Heroin Cases 97 % Cause of Death 85 % w/Other Drugs

208 271 250 230 150 109 78 93 119 95 48 57 108 199 447

686*

197 235 215 227 236 251 292 538

794*

100 200 300 400 500 600 700 800 900

Heroin Fentanyl

Number of Deaths

Source: Florida Medical Examiners Commission 2015 Interim Report

* Projected Increase based on 2 X 1st Half of 2015

Number of Heroin and Fentanyl Deaths in Florida: 2000 to 2015*

Number of Deaths Related to Fentanyl or Heroin in Broward County Florida: 2010-2015

3 11 14 21 53 79 5 3 9 11 28 68

10 20 30 40 50 60 70 80 90 2010 2011 2012 2013 2014 2015

Fentanyl Heroin

Sources: 2010-2013 FL Medical Examiner Commission Raw Data Tables , 2014 FL Medical Examiner Annual Report, 2015 Data from Broward Medical Examiner Office

2015 Fentanyl Cases 98 % Cause of Death 91 % w/Other Drugs 2015 Heroin Cases 97 % Cause of Death 85 % w/Other Drugs

Counterfeit Xanax with Fentanyl

Real Fake

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

2012

CHINA

2014

Non-Pharmaceutical Fentanyl (NPF) Trafficking

Reports of non-pharmaceutical fentanyl

Key

Powder alone or combined with heroin Sold as prescription medications (pills) No reports of NPF

Non-pharmaceutical fentanyl 4th Quarter 2014

Alaska Hawaii

Non-pharmaceutical fentanyl 4th Quart 2015

Alaska Hawaii

Non-pharmaceutical fentanyl 1st 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

• f the Public Health Service Act, and, if

requested by a Governor, under the Robert T. Stafford Disaster Relief and Emergency Assistance Act.

OTHER OPIATE ANALOGS

• 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

Source: Analysis of data from the Florida Agency for Health Care Administration

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

100 200 300 400 500 600 700 800 900 1000 Emergency Dept. Inpatient

695 849 909 833 731 585 652 826 Number of Rx Opioid Poisoning Patients

Rx Opioid Poisoning Hospital Cases in Broward County With and Without a Diagnosis of Opioid Abuse: 2007-2014 n= 6,080 724 5,356

With Without

12 % 88 %

Source: Analysis

• f data from the

Florida Agency for Health Care Administration

1034 1105 1307 16141702 1943 2052 2179 1791 1462 1402 1444 1318 1337 1508 1680

500 1000 1500 2000 2500 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20142X1H 2015

Number of Cocaine Deaths in Florida 2000-2015

# of Cocaine Deaths Source: Florida Medical Examiners Commission 2015 Interim Report

2015 Cocaine Cases 53 % Cause of Death 84 % w/Other Drugs

Number of Cocaine Deaths in Broward County 2000-2015

80 94 121 138 120 136 150 157 146 135 127 115 129 102 99 142

20 40 60 80 100 120 140 160 180 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H 2015

# of Cocaine Deaths

Source: Florida Medical Examiners Commission 2015 Interim Report

2015 Cocaine Cases 77 % Cause of Death 85 % w/Other Drugs

Number of Nonmedical Rx Benzodiazepine Reports Detected among Deceased Persons in Florida 2005 – 2015

# of Drugs Detected Among Decedents

2,608 2,973 3,339 4,167 4,340

6,188

5,947

5,184 4,304 4,282 4,364

1,000 2,000 3,000 4,000 5,000 6,000 7,000

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2X1H 2015

Benzodiazepines

House Bill 7095 Takes effect Pill Mill Strike Force

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