|Home Depot/Walmart Torch(no longer sold by Walmart)|
|Butane Gas - No longer carried by Walmart, Walgreens, or CVS, in Miami-Dade|
|Radio Shack Torch - No longer sold in Miami-Dade|
|Average Butane fired lighter - No longer carried by Walmart, Walgreens, CVS, or gas stations in Miami-Dade|
|Normal item now banned from big retailers for sale in high drug use counties|
Cocaine consequences as a proportion of all drug problems continue to be higher in South Florida than in most of the Nation. Yet, Miami-Dade County has been leading a decline in cocaine-related problems since 2007 which is now observed nationwide. Heroin remains at low and stable levels across Florida with wide scale availability of diverted prescription opioids. Primary treatment admissions for heroin increased locally between 2009 and 2010. More than half of the heroin deaths in recent years are found in combination with one or more prescription opioids at the time of death. Oxycodone remains the major opioid linked to nonmedical use, yet 93 percent of deaths attributed to it statewide are found in combination with other drugs including benzodiazepines, other opioids, and muscle relaxants. Deaths related to nonmedical use of opioids appear to have peaked in the second half of 2009 while other indicators are increasing. Oxymorphone is the fastest rising opioid in nonmedical use indicators. Injecting is increasingly reported among opioid treatment clients. Benzodiazepine related-deaths have stabilized while emergency department reports have increased. Muscle relaxant nonmedical use is stable at low levels. Indicators of methamphetamine abuse are low in Florida, yet seizures of small clandestine labs (mostly two-liter soda bottles) are on the rise in other parts of the State but not in South Florida. Such activity is associated with low-level yields for use by those involved in “cooking meth” and a small number of other users who often help acquire or “smurf” for the precursor, pseudoephedrine. Marijuana use is increasing among adolescents and ranks number one in addiction treatment admissions statewide as well as locally and number two behind cocaine in South Florida drug-related emergency department reports and crime lab cases. Ecstasy indicators decreased between 2008 and 2009 with many counterfeit pills detected often containing BZP at that time. More recently MDMA is the only drug detected in ecstasy tablets.
This report reviews data from 2009 and 2010 for drug-related deaths, medical emergencies, addiction treatment admissions, and crime laboratory analysis. Information is presented by primary substance of abuse, with topics including cocaine, heroin, nonmedical use of prescription opioids, benzodiazepines, methamphetamine/amphetamines, marijuana, GHB (gamma hydroxy- butyrate), MDMA (3,4-methylenedioxymethamphetamine) or ecstasy, and muscle relaxants. While the information is classified by a single drug or category, the reader should note an underlying problem of polysubstance abuse as mentioned throughout this report.
Located in the extreme southern portion of the Florida peninsula, Miami-Dade County has the State’s largest population, with 2,500,625 residents, according to 2009 U.S. Census estimates. Hispanic account for 62.5 percent of the population while 17.6 percent are White non- Hispanic, 16.6 percent are Black non-Hispanic and 1.6 percent are Asian. Miami is the County’s largest city, with 404,048 residents. More than 100,000 immigrants arrive in Florida each year;
1The author is the Director of the Center for the Study and Prevention of Substance Abuse at Nova Southeastern University, and is Executive Director of Up Front Drug Information Center in Miami, Florida.
The Miami Coalition For A Healthy, Safe and Drug-Free Community
Since 2003, Miami-Dade along with Broward and Palm Beach Counties to the north have consti- tuted the federally designated Metropolitan Statistical Area (MSA) for South Florida, making it the sixth largest MSA in the Nation. Previously, the MSA included only Miami-Dade County. This means that the three counties are included in more national data sets tracking health- related conditions and criminal justice information.
South Florida is a hub of international transportation and the gateway to commerce between the Americas, accounting for sizable proportions of the Nation’s trade. South Florida’s airports and seaports remain among the busiest in the Nation for both cargo and international passenger traffic. These ports of entry make this region a major gateway for illicit drugs.
Several factors impact the potential for drug abuse problems in South Florida, including the following:
The area's proximity to the Caribbean and Latin America exposes South Florida to the
entry and distribution of illicit foreign drugs destined for all regions of the United States.
South Florida is a designated High Intensity Drug Trafficking Area and one of the Nation’s
leading cocaine importation centers. It has also been a gateway for Colombian heroin since
Lack of a prescription monitoring system in Florida in the time periods covered by this
report made the State a source for diverted medications in the eastern United States. A
prescription monitoring system was enacted in July 2009 and is expected to be
operational by October 2011.
This report describes current drug abuse trends in South Florida, using the data sources summarized below:
Drug-related mortality data were provided by the Florida Department of Law
Enforcement (FDLE) Medical Examiners Commission’s 2010 Interin Report of Drugs
Identified in Deceased Persons between January and June 2010. The report for all of
2010 should be released by July 2011.
- Emergency Department (ED) data were derived for Miami-Dade County from the Drug Abuse Warning Network (DAWN), Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Behavioral Health Statistics and Quality (CBHSQ). The data represent drug reports involved in drug-related visits for illicit drugs (derived from the category of ―major substances of abuse,‖ excluding alcohol) and the nonmedical use of selected prescription drugs (derived from the category of ―other substances‖). Drug reports exceed the number of ED visits because a patient may report use of multiple drugs (up to six drugs plus alcohol). Weighted DAWN data for calendar years 2004–2009 are included in this report and provide estimates of the total number
- The Miami Coalition For A Healthy, Safe and Drug-Free Community of drug-related ED visits and per capita rates for selected substances for all of Miami- Dade County in those 5. A full description of the system can be found on the DAWN Web site http://dawninfo.samhsa.gov.
- Drug treatment data on primary admissions to all publicly funded addiction treatment programs in Miami-Dade County during calendar year 2009 and 2010 were provided by the Florida Department of Children and Families. State of Florida admissions from 1999 to 2009 are from SAMHSA - Treatment Episode Data Sets (TEDS) submitted by the Florida Department of Children and Families as of January 6, 2011
- Crime laboratory drug analyses data were derived from the Drug Enforcement Administration’s (DEA’s) National Forensic Laboratory Information System (NFLIS) Report for Miami-Dade, Broward, and Palm Beach Counties from January through December 2010. However, the NFLIS data combines some, but not all, pharmaceutical items into the category of ―controlled substance.‖ This factor makes it difficult to track the role of illegally diverted medications.
Data on Distribution of Pharmaceuticals are from DEA Automation of
Reports & Consolidated Orders System (ARCOS) data from 2009 and 2010.
Data on prevalence of nonmedical use of pain relievers are from
SAMHSA’s National Survey on Drug Use and Health Sub-State Data.
- Data on injection drug use among acquired immune deficiency syndrome (AIDS) cases are from Miami-Dade County Departments of Health.
DRUG ABUSE PATTERNS AND TRENDS
Indicators of cocaine problems in South Florida continue to dominate consequences of drug abuse, yet are declining in recent years. The numbers of cocaine occurrences among deceased persons have been declining since 2007 in Miami-Dade County as well as for the State of Florida. The majority of cocaine deaths and addiction treatment reports were among those older than 35, while medical emergencies related to cocaine were highest among those age 25-29. Many of the indicators reflected cocaine use in combination with other drugs.
Throughout Florida, the number of cocaine-related deaths decreased 16-percent in the first half of 2010 as compared as compared to the last half of 2009 continuing declines since 2007 and reversing what had been an upward trend since 2000 (exhibit 1). A cocaine-related death is defined as a death in which cocaine is detected in the decedent but not necessarily considered the cause of death. There were 603 cocaine-related deaths across Florida in the first half of 2010, compared with 716 the previous six months. In all of 2009 there were 1,462 cocaine- related deaths compared with 1,791 in 2008. The 2007 total of 2,179 reports was the highest number since the drug has been tracked beginning in the late 1980s. The number of cocaine deaths increased 97 percent between 2001 and 2007; the key factor for that rise appears to be a corresponding 105-percent increase of deaths with cocaine-in-combination with other drugs,
The Miami Coalition For A Healthy, Safe and Drug-Free Community
Heroin consequences remain at low and stable levels across Florida. Primary treatment admissions for heroin increased in South Florida between 2009 and 2010. More than half of the heroin deaths in recent years are found in combination with one or more prescription opioids at the time of death. South American heroin has been entering the South Florida area over the past two decades. However, reports and seizures of Mexican heroin in South Florida have been made since 2008. Deaths caused by heroin declined in Florida from 2001 to 2006, then increased between 2006 and 2008 before declining again in 2009 and 2010. Substantial increases in abuse and consequences of narcotic analgesic use have occurred as heroin problems were waning. Most heroin ED patients and addiction treatment admissions continued to be among older, White males.
Throughout Florida, the number of heroin-related deaths decreased 40 percent during the first half of 2010 compared to the previous six months. There were 30 heroin-related deaths across Florida during the first half of 2010 down from 50 in the second half of 2009. Heroin continued to be the most lethal drug, with 83 percent (n=25) of heroin-related deaths in 2010 caused by the drug. Polysubstance abuse was noted in 93 percent of the 2010 heroin-related deaths statewide.
Among the 111 heroin-related deaths in Florida during 2009, 59 percent (or 65) had from one to four prescription opioids present at the time of death (exhibit 7). There were a total of 89 opioids detected among the 65 decedents.
Measures of MDMA (3,4-methylenedioxymethamphetamine) abuse have stabilized at relative low numbers in recent years. Ecstasy pills generally contain 75–125 milligrams of MDMA, although pills are often adulterated and may contain other drugs. The stimulant, BZP (1- benzylpiperazine), continues to be reported in ecstasy pills, with or without MDMA.
There were 22 MDMA-related deaths statewide in Florida in the first half of 2010, with the drug being cited as the cause of death in 8 of these cases. There were also 13 reports of MDA (3,4- methylenedioxyamphetamine)-related deaths statewide in Florida during the semi-annual period. During the previous six months, there were 19 MDMA-related deaths, and 8 MDA- related deaths. MDMA deaths decreased 27 percent between 2008 (n=44) and 2009 (n=32).
The DAWN weighted estimate of 192 MDMA-involved ED visits for Miami-Dade County during 2009 (exhibit 3 above) accounted for 1.5 percent of all ED visits among six substances (four illicit drugs —cocaine, marijuana, MDMA, and methamphetamine as well as nonmedical use of prescription opioids and benzodiazepines). The 192 MDMA-involved ED visits in 2009 represented a 35-percent decrease from the 294 visits in 2008 (exhibit 28). The per capita rate of 7.7 MDMA ED visits per 100,000 population was similar to the national rate of 7.4. There was not a weighted estimate of MDMA ED visits for those under 21 years of age in 2009. Among those aged 21 and over, there were 140 MDMA ED visits in 2009 with a per capita rate of 7.7 which was above the national rate of 5.4.
The number of methamphetamine clandestine laboratory seizures in all of Florida doubled between 2008 and 2009 and continued to increase in 2010 (exhibit 24). Yet, most of these labs have been 2-liter soda bottles used in the so called ―shake and bake‖ production method yielding a relative small amount of methamphetamine more for personal use and sharing with those who may have help supply the precursor, pseudoephedrine. Of the 445 such lab seizures statewide in 2010 there was one in Miami-Dade County and one in neighboring Broward County. Indicators of methamphetamine abuse remained at low levels. While methamphetamine was cited as the primary drug for addiction treatment among less than 1 percent of addiction treatment clients in South Florida during 2010, 86 percent of clients were older than 25 years of age.
The Miami Coalition For A Healthy, Safe and Drug-Free Community
Methamphetamine was detected among 49 deceased persons during the first half of 2010 statewide in Florida, compared to 39 in the previous six months. There were 81 methamphetamine medical examiner occurrences in all of 2009 and 114 in 2008. Methamphetamine was considered a cause of death in 20 (41 percent) of the 49 cases during the first half of 2010. There were also 66 reports of amphetamine detected among decedents across Florida in the first six months of 2010, the same number as in the previous semi- annual period. An amphetamine was considered the cause of death in 18 percent of the 66 cases in the first half of 2010.
The DAWN weighted estimate of 86 methamphetamine-involved ED visits for Miami-Dade County during 2009 accounted for less than 1 percent of all ED visits among six substances (four illicit drugs —cocaine, marijuana, MDMA, and methamphetamine as well as nonmedical use of prescription opioids and benzodiazepines). Between 2004 and 2009, the number of methamphetamine-involved ED visits increased 43-percent in Miami-Dade County, from 60 to 86. In 2009, the per capita rate of 3.4 methamphetamine ED visits per 100,000 people was well below the national rate of 20.9. There was not an estimate for the number of illicit amphetamine ED visits in Miami-Dade County for 2009 due to a low number from the DAWN sample.
There were 22 primary admission for methamphetamine, accounting for 0.5 percent of the 4,548 primary treatment admission drug mentions (including alcohol) in Miami-Dade County during 2010 (exhibit 19 above). This total represents a 60-percent decrease over the 55 methamphetamine admissions in 2009. Females accounted for 64 percent of the methamphetamine clients. No methamphetamine client was younger than 18; 14 percent (n=3) were age 18–25; 45 percent (n=10) were 26–34; and 41 percent (n=9) were 35 or older. There were also 5 primary admissions for other amphetamines.
Methamphetamine accounted for 102 cases, or 0.4 percent, of all items analyzed by crime laboratories in 2010 for the three-county South Florida MSA as reported by the NFLIS. It ranked tenth among all substances (exhibit 10 above). In 2009 there were 110 methamphetamine crime lab reports.
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