current trends in substance abuse: in substance abuse: minnesota and nationally dept of corrections...
TRANSCRIPT
Current TrendsCurrent Trends in Substance Abusein Substance Abuse
Minnesota Minnesota andand nationally nationally
dept of correctionsdept of correctionsSt Paul Minnesota St Paul Minnesota
June 24 2011June 24 2011
Carol FalkowskiMinnesota Department of Human Services
carolfalkowskistatemnus
Past month use of selected illicit drugs among persons age 12 or older 2002-2009
87
Source National Surveys on Drug Use and Health SAMHSA + Difference between this estimate and the 2008 estimate is statistically significant at the 05 level
87
66
28
2009
0704
Specific drug used when initiating illicit drug use among past year initiates of illicit drugs aged 12 or older 2009
Source National Survey on Drug Use and Health SAMHSA 2009 Note The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day
Illicit Drug Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007 No differences across age groups
Marijuana Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Past month use of selected illicit drugs among persons age 12 or older 2002-2009
87
Source National Surveys on Drug Use and Health SAMHSA + Difference between this estimate and the 2008 estimate is statistically significant at the 05 level
87
66
28
2009
0704
Specific drug used when initiating illicit drug use among past year initiates of illicit drugs aged 12 or older 2009
Source National Survey on Drug Use and Health SAMHSA 2009 Note The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day
Illicit Drug Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007 No differences across age groups
Marijuana Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Specific drug used when initiating illicit drug use among past year initiates of illicit drugs aged 12 or older 2009
Source National Survey on Drug Use and Health SAMHSA 2009 Note The percentages do not add to 100 percent due to rounding or because a small number of respondents initiated multiple drugs on the same day
Illicit Drug Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007 No differences across age groups
Marijuana Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Illicit Drug Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007 No differences across age groups
Marijuana Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Marijuana Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Marijuana Use in Past Month among Persons Aged 12 -17 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Marijuana Use in Past Month among Persons Aged 18 -25 by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Illicit Drug Use Other Than Marijuana in Past Month among Persons Aged 12 and Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Nonmedical Use of Pain Relievers in Past Year among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Adults reporting at least one drink in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
DC = 681CT = 67 WI = 668NH = 647VT = 645RI = 64 MA = 63MN = 615ND = 605Nationwide = 539
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Adults reporting at binge drinking in past 30 days
Source Behavioral Risk Factor Surveillance System Centers for Disease Prevention and Control 2009
WI = 239 ND = 214MN = 202 Nationwide = 155
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Binge Alcohol Use in Past Month among Persons Aged 12 or Older by State
Source SAMHSA Office of Applied Studies National Survey on Drug Use and Health 2006 and 2007
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
1992 ndash 2010MINNESOTA STUDENT SURVEYMINNESOTA STUDENT SURVEY
The Minnesota Student Survey is conducted every three years among students in Minnesota public schools including charter schools and tribal schools in grades 6 9 and 12
bullOf the 335 public operating school districts 295 agreed to participate (88)
bullStudent participation was voluntary Pen and pencil surveys were anonymous
bullAcross the state approximately 79 of public school sixth graders 75 of public school ninth graders and 59 of public school twelfth graders participated in the 2010 Minnesota Student Survey
bullOverall participation across the three grades was approximately 71 of total enrollment
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Selected substance use in past year by 12th graders Nationally and in Minnesota - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student SurveyPain pills in MTF Survey refers to narcotics other than heroin
alcohol MJ pain pills cocaine MDMA inhalants meth heroin0
10
20
30
40
50
60
70 of 12th graders reporting
US Minnesota
US 652 348 87 29 45 36 1 09
Minnesota 553 306 63 47 32 24 14 14
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Methamphetamine use in past year by 12th graders Nationally and in Minnesota 2001 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
2001 2004 2007 20100
5
10
15
20 of 12th graders reporting
US Minnesota
US 39 34 17 1
Minnesota 58 48 22 14
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Alcohol use in the past year by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 768 737 743 733 706 664 652
Minnesota 799 688 695 676 624 625 553
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Cigarette smoking in past 30 days by 12th gradersNationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 278 335 351 295 25 216 192
Minnesota 313 392 419 345 264 228 192
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Marijuana use in past year by 12th graders Nationally and in Minnesota 1992 - 2010
SOURCE Monitoring the Future Study University of Michigan News Service Ann Arbor MI Retrieved 12142010 from httpwwwmonitoringthefutureorg and the Minnesota Student Survey
1992 1995 1998 2001 2004 2007 20100
20
40
60
80
100 of 12th graders reporting
US Minnesota
US 219 347 375 37 343 317 348
Minnesota 218 292 314 314 271 308 306
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
HeroinHeroinProcessed from morphine a naturally occurring substance extracted from the seed pod of poppy plants
West of Mississippi ndash Mexican heroin East of Mississippi - Columbian heroin
Heroin enters the brain is converted to morphine and binds to opioid that are located in many areas of the brain (and in the body) especially those involved in the perception of pain and in reward Opioid receptors are also located in the brain stemmdashimportant for automatic processes critical for life such as breathing (respiration) blood pressure and arousal Heroin overdoses frequently involve a suppression of respiration
With regular heroin use tolerance develops in which the userrsquos physiological (and psychological) response to the drug decreases and more heroin is needed to achieve the same intensity of effect Heroin users are at high risk for addictionmdashit is estimated that about 23 percent of individuals who use heroin become dependent on it
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Prescription Drug AbusePrescription Drug Abuse
Ingesting another personrsquos prescription medication or taking it not as medically directed (dose reasons)
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Commonly abused classes of prescription Commonly abused classes of prescription medicationsmedications
-- Opioids (for pain) Opioids include hydrocodone (Vicodinreg) oxycodone (OxyContinreg)
propoxyphene (Darvonreg) hydromorphone (Dilaudidreg) meperidine (Demerolreg) and diphenoxylate (Lomotilreg)
-- Depressants (for anxiety and sleep disorders)Central nervous system depressants include barbiturates such as
pentobarbitalsodium (Nembutalreg) and benzodiazepines such as diazepam (Valiumreg) and alprazolam (Xanaxreg)
-- Stimulants (for ADHD and narcolepsy) Stimulants (for ADHD and narcolepsy) Stimulants include dextroamphetamine (Dexedrinereg)methylphenidate
(Ritalinreg and Concertareg) and amphetamines (Adderallreg)
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
SOURCE Raofi S Schappert SM Medication therapy in ambulatory medical care United States 2003ndash 2004National Center for Health Statistics Vital Health Stat13 (163) 2006
30
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Past year initiates of specific illicit drugs among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Past Month Illicit Drug Use among persons age 12 or older 2008
1 Illicit Drugs include marijuanahashish cocaine (including crack) heroin hallucinogens inhalants or prescription-type psychotherapeutics
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Where pain relievers were obtained for most recent nonmedical use
BoughtTook from FriendRelative
148
Drug DealerStranger
39
Bought on Internet
01 Other 1
49
Free from FriendRelative
73
BoughtTook fromFriendRelative
49
One doctor807
Drug DealerStranger
16Other 1
22
Source where respondent obtained
Source where friendrelative obtained
One Doctor191
More than One Doctor
16
Free from FriendRelative
557
More than One Doctor33
SOURCE 2006 National Survey on Drug Use and Health Substance Abuse and Mental Health Services Administration Past year use among persons age 12 and older Note Totals may not sum to 100 because of rounding or because suppressed estimates are not shown 1 The Other category includes the sources ldquoWrote Fake Prescriptionrdquo ldquoStole from Doctorrsquos OfficeClinicHospitalPharmacyrdquo and ldquoSome Other Wayrdquo
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Among adolescents prescription and over-the-counter medications account for most of the frequently abused drugs following marijuana (excluding tobacco and alcohol)
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Past year use and availability of narcotics other than heroin by 12th graders nationally
SOURCE The Monitoring the Future Study University of Michigan
393 402 392 396
373349 351
542
93 95 9 9 92 91 92 87
2003 2004 2005 2006 2007 2008 2009 20100
10
20
30
40
50
60
70
80
90
100 of 12th graders
PAST YEAR USE
SAYNG FAIRLY EASY OR VERY EASY TO GET
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
2004 2005 2006 2007 2008 20090
200000
400000
600000
800000
1000000
1200000
1400000
627291
1244679
991363 973591 Misuse or Abuse of Illicit Drugs
Misuse or Abuse of Pharmaceuticals
Approximately one-half (48) of these pharmaceutical misuseabuse visits involved pain relievers and more than one-third (35) involved drugs to treat insomnia and anxiety
At the same time ED visits involving illicit drug use were relatively stable
Estimated Number of Drug-Related Emergency Department Visits Related to the Misuse or Abuse of Pharmaceuticals and Illicit Drugs
2004 to 2009
SOURCE Drug Abuse Warning Network SAMHSA
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
US drug overdose deathsUS drug overdose deathsare at an all-time high are at an all-time high
27658 unintentional drug overdose deaths in 2007 in the US -- second only to motor vehicle crash deaths among leading causes of unintentional injury deaths
This increase in drug overdose death rates is largely because of prescription opioid painkillers
ldquoOpioidsrdquo are synthetic versions of opium with the ability to reduce pain but also suppress breathing to a fatal degree when taken in excess [oxycodone (OxyContinreg ) hydrocodone (Vicodinreg ) and methadone]
SOURCE CDCrsquos Issue Brief Unintentional Drug Poisoning in the United States Centers for Disease Control and Prevention Available online at httpwwwcdcgovHomeandRecreationalSafetyPoisoningbrief_full_pagehtm
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Substances for which treatment was received in the past year Substances for which treatment was received in the past year among persons aged 12 or older 2009among persons aged 12 or older 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Patients receiving treatment for addiction to pain relievers Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009among persons age 12 and older 2002 - 2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
If users addicted to pain medication can find a source of affordable quality heroin many
switch to heroin injection
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
2007 2008 2009
purity 599 5475 5335
$pure milligram
$029 $026 $025
qualified samples
16 13 4
Mexican heroin price and purity Minneapolis 2007 ndash 2009Mexican heroin price and purity Minneapolis 2007 ndash 2009
SOURCE US Drug Enforcement Administration US Department of Justice 2009 Heroin Domestic Monitor Program DEA-NCW-RPT-013-10 November 2010
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
The White Earth Reservation Tribal Council passed a Proclamation on Jan 31 2011 declaring a Public Health Emergency with respect to prescription medication and illegal drug abuse
We need to take down our fences and work together said Chairwoman Erma J Vizenor Business as usual isn t working - we need to step up our efforts
Vizenor stresses that prescription medication and illegal drug abuse is not unique to White Earth - it s a nationwide problem
A highlight of the Proclamation states The White Earth Reservation Tribal Council hereby directs all White Earth Tribal agencies departments and entities to make this proclamation their top priority and the Tribal Council further directs all White Earth Tribal agencies to collaboratively use their resources in developing solutions to the massive and complex problems caused by prescription drug abuse and the abuse of other illegal drugs which threatens our nation
According to the White Earth Police Department 70 to 75 percent of the drug problems on White Earth Reservation are the result of prescription medication abuse
Our families have all been affected by substance abuse the suicides and tragedies have impacted us all said White Earth Secretary-Treasurer Robert J Durant Now we need to need to get away from the blame game and stop letting it drag us down we need to step up and figure something out
To counteract the devastation caused by prescription drug abuse the Council has assembled a Substance Abuse Collaboration of tribal resources and programs including public health law enforcement child protection chemical dependency legal mental health and community councils to work creatively toward solutions to the problems caused by prescription drug abuse
The goal is not to be punitive but to be supportive and helpful said Vizenor
In addition to holding community forums in throughout the reservation the committee is currently putting together a resource manual that will list organizations on and off the reservation that individuals can refer with to seek immediate assistance Currently individuals in the White Earth areas can call the Becker County and White Earth Reservation Mental Health Hotline (24 hours) at 218-850-HELP (4357) or 1-877-380-3621 People experiencing thoughts of suicide can call the Native Alive Campaign Suicide Support Hotline at 1-888-261-8691
In addition to the resource manual the White Earth Police Department is in the development stages of producing six short DVD videos that will deal with alcohol drug and prescription drug abuse and prevention within the White Earth Nation The videos will be culturally specific and will initially target young school-aged children
January 31 2011
White Earth Tribal Council declares public health White Earth Tribal Council declares public health emergencyemergency
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
February 26 2011
Prescription drug addiction called an emergency on Prescription drug addiction called an emergency on Red Lake ReservationRed Lake Reservation
Red Lake Tribal Chairman Buck Jourdain used his State of the Band address to highlight the problem of addiction to prescription drugs calling it a public health emergency Jourdain asked health officials to develop an action plan to fight such addiction
SOURCE wwwbemidjipioneercom
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Florida Pain ClinicsFlorida Pain Clinics aka ldquopill millsaka ldquopill millsrdquo
1048766 Treat on average 100+ ldquopatientsrdquo per day
1048766 $150 - $250 cash for doctorrsquos visit$200 - $400 cash for prescription
1048766 Dispensation directly from clinic or script is Iissued
1048766 Scripts are filled in numerous states
1048766 They do not accept insurance MedicareMedicaid or credit cards
1048766 ldquoPatientsrdquo from Kentucky Ohio Tennessee West Virginia
1048766 Travel to Florida individually by car airplane or in groups on buses or chartered planes
1048766 Receive coaching and drug dispensed 1048766 Oxycodone (avg 120 tablets per script)
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
February 24 2011
Florida raids target sellers of pain pillsFlorida raids target sellers of pain pillsBy Donna Leinwand USA TODAY Federal agents and police raided doctors offices across South Florida on Wednesday in a sweep aimed at what authorities say are operations that illegally deal prescription pain pills
The raids and tough new state laws that can result in criminal charges for doctors who overprescribe narcotics are part of a nationwide crackdown on an explosion of pain management clinics that have sprung up in storefronts and office buildings to supply the USAs growing appetite for prescription drugs
Often the cash-only clinics require just a cursory exam mdash if any mdash before a doctor will prescribe large amounts of narcotic pain medication such as oxycodone and hydrocodone which can be highly addictive Some of the clinics have in-house pharmacies to fill the prescriptions says Rusty Payne a spokesman for the Drug Enforcement Administration (DEA)
The DEA and local police call them pill mills
In South Florida on Wednesday authorities arrested 22 people including four doctors and seized dozens of exotic cars including Dodge Vipers Lamborghinis and a Mercedes-Benz SLR McLaren
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Treating opioid addictionTreating opioid addictionEffective medication-assisted treatments are available for opiate addiction
MethadoneMethadone is a synthetic opiate that blocks the effects of heroin and eliminates withdrawal symptoms and has a proven record of success for people addicted to heroin Methadones effects last four to six times as long as those of heroin so people in treatment need to take it only once a day Methadone is medically safe even when used continuously for 10 years or more Combined with behavioral therapies or counseling and other supportive services methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives
BuprenorphineBuprenorphine approved by the Food and Drug Administration (FDA) in 2002 provides a less addictive alternative to methadone maintenance reduces cravings with only mild withdrawal symptoms and can be prescribed in the privacy of a doctors office
Naloxone and naltrexone Naloxone and naltrexone block the effects of morphine heroin and other opiates As antagonists they are especially useful as antidotes Naltrexone has long-lasting effects ranging from 1 to 3 days depending on the dose and blocks the pleasurable effects of heroin It is useful in treating some highly motivated individuals and is found to be successful in preventing relapse by former opiate addicts released from prison on probation
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What you can doWhat you can doThe White House Office of National Drug Control Policy Federal blueprint for reducing prescription drug abuse
GOAL GOAL To reduce the nonmedical abuse of Rx drugs and ensure access to Rx medication used legitimately
Requires community collaboration and cooperation across multiple tribes and levels of government
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What you can doWhat you can doEDUCATIONEDUCATION
- Of parents peers patients dispensers and health care providers Scope Appropriate prescribing adverse events signs of abuseabuse risk signs of addiction
storage of medications and disposal of medications
- Working with physicians to achieve consensus standards on opiate painkiller prescribing
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What you can doWhat you can do
PRESCRIPTION DRUG MONITORING PROGRAMSPRESCRIPTION DRUG MONITORING PROGRAMS
To help identify individuals who inappropriately obtain excessive amounts of controlled substances from multiple prescribers and pharmacies
Minnesota PMP since 2010as of March 1 2011Controlled substance prescriptions collected = 6875346Approved users for the PMP database = 4031
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What you can doWhat you can doDISPOSALDISPOSAL
-The goal is easy to use environmentally friendly disposal options to reduce amount and availability
-Initiate or participate in Drug Take Back Days In 2010 over 4000 sites across the country took back 121 tons - April 30 2011 April 30 2011 is the next one
- In your home follow guidelines on disposal
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What you can doWhat you can doLAW ENFORCEMENTLAW ENFORCEMENT
Increase training of law enforcement to bullHeighten interdictionbullDisrupt and dismantle drug trafficking organizationsbullShare intelligence and investigative information across departments and jurisdictions Take legislative steps to prohibit ldquopill millsrdquo (rogue pain clinics)
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Synthetic marijuana products
bullRick will cover
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Phenylethylamines ldquoResearch chemicalsrdquo
bullDepicted as research chemicals not for human consumption to be used by fellow researchersbullPhenylethylamines ndash long-acting hallucinogensbullInclude 2-CB ldquoNexusrdquo 2C-E ldquoEuropardquo 2C-I2 C-T-7bullSeveral are Federally controlled under Schedule I Controlled Substances which means they can be prosecuted under the Federal Controlled Substances Analogue Actbull2C-B is Schedule I
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Phenylethylamines ldquoResearch chemicalsrdquo
bullTypically is used by teenagers and young adults and used at raves private parties nightclubs and other venues where the use of other drugs such as MDMA (34-methylenedioxymethamphetamine also known as ecstasy) is well-established bullPhenylethylamines produce negative physical and psychological effects in usersbull Physical effects include visual and auditory disturbances and distortions increased blood pressure blurred vision dehydration dilated pupils headaches irregular heartbeat jaw clenching nausea and vomiting bullPsychological effects include emotional distress hallucinations inability to sleep irritability loss of memory nervousness restlessness and tension bullRisks increase with coingestants
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
An arrest after a night of drinking drugs and deathArticle by PAUL LEVY DAVID CHANEN and ERIC ROPER Star Tribune staff writers March 18 2011 - 1127 PM
A 21-year-old Blaine man was arrested Friday on suspicion of murder for allegedly providing the substance used at a house party that killed one and left 10 hurt
Jake Kruse got to the party late and walked into a Blaine house strewn with beer bottles Then teens and young adults began taking a drug that few knew anything about
Two days later one of those teens is dead from an overdose of 2C-E a synthetic hallucinogen and 21-year-old Timothy Richard Lamere is jailed on suspicion of providing the substance used at the party The Anoka County Sheriffs Office said he reportedly purchased possessed and provided the 2C-E
The office said Lamere of Blaine was arrested Friday on suspicion of third-degree murder in the death of Trevor Robinson and could be charged MondayEleven partygoers including Kruse ended up in a hospital early Thursday after the party and an 18-year-old woman remained in critical condition Friday The others have been released
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
N-BENZYLPIPERAZINE aka BZP A2 Legal E or Legal X
bull BZP has stimulant effects produces euphoria and cardiovascular effects (increased heart rate and systolic blood pressure)
bull Studies demonstrate that the abuse dependence potential pharmacology and toxicology of BZP are similar to those of amphetamine Public health risks of BZP are similar to those of amphetamine
bull BZP is about 10 times less potent than amphetamine in producing these effects in subjects with histories of amphetamine dependence
bull BZP is often abused in combination with 1-[3-(trifluoro-methyl)phenylpiperazine (TFMPP) a noncontrolled substance
bull This combo is known among youthful users as a substitute for MDMA yet no scientific studies indicate this combination produces MDMA-like behavioral effects
bull In 2004 the DEA permanently placed BZP in Schedule I of the Controlled Substances Act (CSA) because of its high abuse potential and lack of accepted medical use
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Bath SaltsBath Salts
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Bath Salts (mephedrone)Bath Salts (mephedrone)bullAlso marketed as plant food incense cleaner and incensebullUsed by snorting injection and smokingbullSold in convience stores gas stations tattoo parlors pawn shops truck stopsbullLabeled ldquonot for human consumptionrdquobullUsers range from teens to 40rsquosbullUser have extensive drug abuse historiesbullDateline NBC tracks Minneapolis-based manufacturer
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Bath Salts (mephedrone)Bath Salts (mephedrone)bullldquoBath SaltsrdquobullMimic effects of cocaine amp XTC bullHallucinationsbullParanoiabullRapid heart ratebullSuicidal thoughtsbullContains mephedrone (MDPV) an amphetamine
The bath salts are being snorted and smoked to produce a cocaine- and meth-like high and have sent dozens of users to emergency rooms after violent behavior and hallucinations Minnesota has banned the sale of the product
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Past year hallucinogen initiates among persons aged 12 or older 2002-2009
SOURCE National Survey on Drug Use and Health SAMHSA 2009
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What about MinnesotaWhat about Minnesota
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Exposures to selected drugs reported to Hennepin County Regional Poison Center 2009 - 2011
SOURCE AAPC Toxic Exposure Surveillance System (TESS) Hennepin County Regional Poison Center May 2011
2009 2010 1st Q 2011
Bath Salts 0 6 26
2C-I and analogs 4 7 12
MDMA 63 38 13
89Synthetic THC 49
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Twin Cities metropolitan area estimates of drug-related emergency department visits by drug category 2004 - 2009
SOURCE Drug Abuse Warning Network (DAWN) Center for Behavioral Health Statistics and Quality Substance Abuse and Mental Health Services Administration 2010 Analytic group = drug misuse and abuse visits Table ED visits by drug
2004 2005 2006 2007 2008 20090
1
2
3
4
5
6
7Thousands
MJ cocaine heroin meth MDMA inhalants narc analgesics
MJ 4455 4467 4302 5757 5617 5596
cocaine 6228 6076 6764 5189 539 3843
heroin 1189 1023 1309 1691 1651 1855
meth 1741 2209 112 1103 1001 097
MDMA 0204 0254 0252 0433 0485 0475
inhalants 0181 0128 008 01 0092
narc analgesics 194 1872 2491 3391 3905 389
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
Heroin 78Other opiates 84
Methamphetamine 64
Cocaine 57
Marijuana 183
Alcohol 513
Other 21
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Percent of admissions to MinneapolisSt Paul area addiction treatment programs by primary substance problem 2000 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
other
alcohol
marijuana
cocaine
meth
heroin
other opiates
other 17 16 12 15 17 15 17 1 2 17 21
alcohol 544 553 537 492 482 457 483 511 526 518 513
marijuana 223 214 213 219 194 177 183 183 166 181 183
cocaine 138 118 127 131 134 144 141 116 99 64 57
meth 31 48 52 75 10 12 8 67 6 57 64
heroin 33 34 38 43 42 53 58 64 67 8 78
other opiates 14 17 21 25 31 34 38 49 62 83 84
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Admissions to MinneapolisSt Paul area addiction treatment programs with cocaine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
26192697
2884
31663014
2213
1905
1317
1116
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Admissions to MinneapolisSt Paul area addiction treatment programs with methamphetamine as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1063
1537
2119
2641
1679
12831154 1169
1259
0
500
1000
1500
2000
2500
3000
3500
2002 2003 2004 2005 2006 2007 2008 2009 2010
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
0
20
40
60
80
100
120
140
2005 2006 2007 2008 2009 2010
100
5633
49
18 28
34
22
1710
129
year
dumpsites
labs
Methamphetamine labs and dumpsites dismantled by Methamphetamine labs and dumpsites dismantled by narcotics task forces Minnesota 2005 - 2010narcotics task forces Minnesota 2005 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
5491287076
415158
807743
32413
108386
484955
0
100000
200000
300000
400000
500000
600000
700000
800000
900000
2004 2005 2006 2007 2008 2009 2010
Khat seized by narcotics task forcesKhat seized by narcotics task forcesMinnesota 2004 - 2010Minnesota 2004 - 2010 grams
yearSOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime Task Forces 2011 Annual Report March 2011
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Admissions to MinneapolisSt Paul area addiction treatment programs with heroin and other opiates as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
1223
1422
1613
19482032
2157
2479
3366
3171
0
500
1000
1500
2000
2500
3000
3500 Other opiates Heroin
2002 2003 2004 2005 2006 2007 2008 2009 2010
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Drug-related deaths in Hennepin County and Ramsey County 2000 - 2010
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 20100
20
40
60
80
100
120
cocaine 60 48 45 54 49 62 61 70 31 21 32
opiates 58 77 77 69 72 102 96 106 115 113 92
meth 17 10 14 25 28 17 14 13 14 13 13
cocaine
opiates
methamphetamine
SOURCE Hennepin County Medical Examiner and Ramsey County Medical Examiner May 2011
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Most frequently identified drugs of total analyzed drug items in MinneapolisSt Paul area 2010
SOURCE National Forensic Laboratory Information System(NFLIS) US Drug Enforcement Administration May 2011 Geographic metropolitan area includes the counties of Hennepin Ramsey Dakota Washington Anoka Scott and Carver
1404
1380
1298
252
227
133
104
68
61
61
828
CannabisTHC
methamphetamine
cocaine
MDMA
heroin
oxycodone
cathinonecathine
acetaminophen
N-benzylpiperazine (BZP)
hydrocodone
other
0 200 400 600 800 1000 1200 1400 of items
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Percent of male arrestees who tested positive for drugs in Hennepin County 2007 - 2010
SOURCE Data from 2007 - 2009 from the Arrestee Drug Abuse Monitoring (ADAM) II 2009 Annual Report White House Office of National Drug Control Policy (ONDCP) Table 34 and Table 35 2010 data from the Arrestee Drug Abuse Monitoring (ADAM) II 2010 Annual Report ONDCP May 2011 Appendix C Minneapolis Fact Sheet p 131 Sampled eligible arrestees in 2007 = 881 in 2008 = 854 in 2009 = 996 and in 2010 = 899
275
427
47 32
225
478
6124
187
469
5836
198
536
9
32
cocaine marijuana opiates meth0
20
40
60
80
100 of arrestees testing positive
2007 2008 2009 2010
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
If your looking for a Medical Marijuana Doctor please call 206-618-9091
These networks are here to help the community
They have programs to help low-income patients
Emerald City Compassion Center SeattleShorelineFree Meds to new patientsOpen from 1100 to 700Open 7 days a weekCall 206-319-5198
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Admissions to MinneapolisSt Paul area addiction treatment programs with marijuana as the primary substance problem 2002 - 2010
SOURCE Minnesota Department of Human Services Drug and Alcohol Abuse Normative Evaluation System (DAANES) May 2011
43874483
4134
3895 3868
30673199
37443578
2002 2003 2004 2005 2006 2007 2008 2009 20100
1
2
3
4
5
Thousands
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
010002000300040005000600070008000
2006 2007 2008 2009 2010
4564
70647538
7834 7618
plants
year
Cultivated marijuana plants seized Cultivated marijuana plants seized by narcotics task forces Minnesota 2006 - 2010by narcotics task forces Minnesota 2006 - 2010
SOURCE Office of Justice Programs Minnesota Department of Public Safety Drug and Violent Crime s Task Forces 2011 Annual Report March 2011
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What is addiction
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Addiction is NOT just a lot of substance abuse
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Addiction is a chronic relapsing brain disease characterized by compulsive drug seeking and use despite harmful consequences associated with use
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
DECREASED BRAIN METABOLISM IN A DRUG ABUSER
DECREASED HEART METABOLISM IN AHEART DISEASE PATIENT
Both addiction and heart disease disrupt the functioning of the underlying organ have serious consequences are treatable and last a lifetime
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
DSM-IV Substance Dependence Criteria DSM-IV Substance Dependence Criteria Substance dependence is defined as a maladaptive pattern of substance use leading to clinically significant impairment or distress as manifested by three (or more) of the following occurring any time in the same 12-month period
1Tolerance as defined by either of the following (a) A need for markedly increased amounts of the substance to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of the substance
2Withdrawal as manifested by either of the following (a) The characteristic withdrawal syndrome for the substance or (b) The same (or closely related) substance is taken to relieve or avoid withdrawal symptoms
3The substance is often taken in larger amounts or over a longer period than intended
4There is a persistent desire or unsuccessful efforts to cut down or control substance use
5A great deal of time is spent in activities necessary to obtain the substance use the substance or recover from its effects
6Important social occupational or recreational activities are given up or reduced because of substance use
7The substance use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated by the substance (for example current cocaine use despite recognition of cocaine-induced depression or continued drinking despite recognition that an ulcer was made worse by alcohol consumption)
SOURCE American Psychiatric Association 1994 Diagnostic and Statistical Manual of Mental Disorders DSM-IV Washington DC American Psychiatric Association (pp 181-183)
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Why some people get addictedWhy some people get addicted and others do not and others do not
DRUG
BiologyGenes Environment
Brain Mechanisms
AddictionAddiction
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
How effective is How effective is addiction treatment addiction treatment
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
The outcomes of addiction treatment
are comparable to the outcomes
of other chronic diseases
with behavioral components
SOURCE McLellan T et al Journal of the American Medical Association 284 (2000)
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Comparison of Relapse Rates BetweenDrug Addiction and Other Chronic Illnesses
SOURCE McLellan et al JAMA 284 1698 - 1695 2000
Drug Addiction Type I Diabetes Hypertension Asthma0
10
20
30
40
50
60
70
80
90
100Percent of patients who relapse
40 - 60
30 - 50
50 - 70 50 - 70
Relapse rates for drug-addicted patients are compared with rates for those suffering from diabetes hypertension and asthma Relapse is common and similar across these illnesses (as is adherence to medication) Thus drug addiction should be treated like any other chronic illness with relapse servingas a trigger for renewed intervention
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
85
MinnesotaMinnesota treatment treatment outcomesoutcomesMinnesotaMinnesota treatment treatment outcomesoutcomes
Addiction treatment services in Minnesota help people remain alcohol and drug free obtain or regain employment stay out of the criminal justice system find stable housing and enter into recovery
Minnesota reports the following addiction treatment outcomes for public pay patients
A 694 decrease in alcohol use A 639 decrease in illicit drug use A 471 decrease in client homelessness A 594 decrease in arrests in the past 30 days
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
What about identifying What about identifying addictionaddiction
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Identification Rates for substance use disorders Identification Rates for substance use disorders and other common health conditionsand other common health conditions
Disorder of affected individuals who are ID-ed
AlcoholDrug use disorders 7 ndash 18
Depression 45
Diabetes 65
Hypertension 70
SOURCE Center for Integrated Behavioral Health Policy Dept of Health Policy George Washington University Medical Center
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
4 Most cost effective screening4 Most cost effective screening and brief interventionsand brief interventions
bullDiscuss daily aspirin use men over 40 women over 50
bullChildhood immunizations
bullSmoking cessationadvice to quit adults
bullAlcohol screening and brief intervention
SOURCE Solberg LI et al Primary care intervention to reduce alcohol misuse ranking its health impact and cost effectiveness Am J Prev Med 2008 34 (2)
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-
Screening Brief Intervention Screening Brief Intervention and Referral to Treatment (SBIRT) and Referral to Treatment (SBIRT) PLUSPLUS
Initiative of MN DHS to train primary care doctors in state Initiative of MN DHS to train primary care doctors in state contracted HMOs to screen evaluate and treat substance use contracted HMOs to screen evaluate and treat substance use disordersdisorders
NEW in 2011NEW in 2011
- PowerPoint Presentation
- Slide 2
- Slide 3
- Slide 4
- Slide 5
- Slide 6
- Slide 7
- Slide 8
- Slide 9
- Slide 10
- Slide 11
- Slide 12
- Slide 13
- 1992 ndash 2010 Minnesota Student Survey
- Slide 15
- Slide 16
- Slide 17
- Slide 18
- Slide 19
- Slide 20
- Slide 21
- Slide 22
- Slide 23
- Slide 24
- Slide 25
- Slide 26
- Where pain relievers were obtained for most recent nonmedical use
- Slide 28
- Slide 29
- Slide 30
- US drug overdose deaths are at an all-time high
- Slide 32
- Slide 33
- Substances for which treatment was received in the past year among persons aged 12 or older 2009
- Patients receiving treatment for addiction to pain relievers among persons age 12 and older 2002 - 2009
- If users addicted to pain medication can find a source of affordable quality heroin many switch to heroin injection
- Slide 37
- Slide 38
- Slide 39
- Slide 40
- Slide 41
- Slide 42
- Slide 43
- Slide 44
- Slide 45
- Slide 46
- Slide 47
- Slide 48
- Slide 49
- Slide 50
- Slide 51
- Slide 52
- Slide 53
- Slide 54
- Slide 55
- Slide 56
- Slide 57
- Slide 58
- Slide 59
- Slide 60
- Slide 61
- Slide 62
- Slide 63
- Slide 64
- Slide 65
- Slide 66
- Slide 67
- Slide 68
- Slide 69
- Slide 70
- Slide 71
- Slide 72
- Slide 73
- Slide 74
- Slide 75
- Slide 76
- Slide 77
- Slide 78
- Slide 79
- Slide 80
- Why some people get addicted and others do not
- Slide 82
- Slide 83
- Slide 84
- Minnesota treatment outcomes
- Slide 86
- Slide 87
- Slide 88
- Slide 89
-