substance use disorder trends in minnesota “the song ...€¦ · from the dark side…. seizures...

Substance Use Disorder trends in Minnesota “The Song Remains the Same”

Rick Moldenhauer, MS, LADC, ICADC, LPCC |Human Services Rep. 2 State Opioid Treatment Authority Representative | Alcohol and

Drug Abuse Division, DHS

10/20/2017 | Minnesota Department of Human Services | mn.gov/dhs

• Presented by Rick Moldenhauer, MS,

LADC, ICADC, LPCC

Human Services Representative 2/State

Opioid Treatment Authority

P: (651) 431 2474

F: (651) 431 7449

Alcohol and Drug Abuse Division, DHS

PO Box 64977

St Paul, Minnesota 55164-0977

[email protected] 2

Source: Minnesota Department of Human Services, ADAD, DAANES (5/31/2016)

Male64.60%

Female35.40%

Gender

White

70.70%

Black11.00%

American Indian9.20%

Hispanic4.70%

Asian/Pacific

Islander1.40%Other

3.00%

Race/Ethnicity

CY2016 Adult SUD Treatment Admissions

Total Admissions 54,222


Disability benefits

9.2%

Job30.4%

Retirement/

pension1.5%

Spouse/parents

7.6%

Relatives/

friends2.7%

Savings1.3%

Public

assistance11.6%

Other

5.1%None

23.3%

Source of Income

CCDTF Client41.6%

MHCP -

MCO Client25.3%

All Other

Sources33.1%

Funding Source

Total Admissions 54,222

CY2016 Adult SUD Treatment

Admissions


From the dark side….

11 SOURCE: 2016 Statewide VCET Statistics report

Arrests by Drug Type

Cocaine 309

Crack 52

GHB 5

Hashish 192

Heroin 392

Khat 5

LSD 26

Marijuana 989

MDMA (ecstasy) 31

MDMA (mali) 11

Meth 2,365

Morphine 9

Mushrooms 33

Opium 6

PCP 0

Prescription Drugs 755

Synthetic - Cathinone 11

Synthetic - Cannabinoid 21

Unkown 40

From the dark side….

Seizures

Drugs Seized & Purchased Seized Purchased Methamphetamine

Cocaine 17,112.03 772.14 Meth Lab Seizures 13

Crack 587.83 53.91 Meth Labs w/minors 4

GHB 709.00 0.00 Number of Children 33

Hashish 15,688.22 65.18

Heroin 4,950.23 1,029.78 Guns Seized

Khat 5,095.50 198.10 # Seized (Drug) 846

LSD 1,783.70 275.00 # Seized (Non-Drug) 262

Marijuana 994,535.59 4,634.92

MDMA (ecstacy) 2,259.10 28.00

MDMA (mali) 589.41 4.00

Meth 222,032.77 15,582.05

Morphine 29.00 0.00

Mushrooms 758.92 66.50

Opium 4.50 0.00

PCP 81.00 0.00

Prescription Drugs 58,603.60 2,121.50

Synthetic- Cathinone 280.50 10.00

Synthetic- Cannabinoid 2,573.41 108.50

Unknown Drug 6,142.28 150.38

12 SOURCE: 2016 Statewide VCET Statistics report

Expressed in grams

Who are we, Minnesota?

18 SOURCE: https://mn.gov/admin/demography/data-by-topic/age-race-ethnicity/

SUD Treatment Admissions for Females

Primary Substance of Abuse by Race/Ethnicity in CY2016

r

a

w

#

’s

SOURCE: MN DHS, ADAD,

DAANES, 3/15/2017 19

SUD Treatment Admissions for Females

Primary Substance of Abuse by Race/Ethnicity in CY2016 w/o White

r

a

w

#

’s


DAANES, 3/15/2017 20

SUD Treatment Admissions for Pregnant Females

Primary Substance of Abuse by Race/Ethnicity in CY2016

r

a

w

#

’s


DAANES, 3/15/2017 21

SUD Treatment Admissions for Pregnant Females

Primary Substance of Abuse by Race/Ethnicity in CY2016 w/o White

r

a

w

#

’s


DAANES, 3/15/2017 22

SUD Treatment Admissions for America Indian Females

Primary Substance of Abuse by CD Planning Regions in CY2016

r

a

w

#

’s


DAANES, 3/15/2017 23

Principles of Epidemiology in Public Health Practice, Third Edition

An Introduction to Applied Epidemiology and Biostatistics, Lession, 1, Section

11:

“Epidemic refers to an increase, often sudden,

in the number of cases of a disease above

what is normally expected in that population

in that area.”

24 https://www.cdc.gov/ophss/csels/dsepd/ss1978/lesson1/section11.html

25

71.18 74.59

82.84 80.55

76.40

82.07 84.76

87.10 88.12 84.94

8.38 8.28 8.57 8.49 8.56 8.68 8.66 8.68 9.03 8.56

0

10

20

30

40

50

60

70

80

90

100

2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Ra

te p

er 1

,00

0 P

op

ula

tio

n

Admission Year

Chemical Dependency Treatment Rates for Minnesota Residents

American Indian Non-American Indian

Minnesota Department of Human Services, ADAD, DAANES (4/3/2017)

26

0.91 1.23 1.50 2.18

2.95

4.00 4.60

7.82

8.79

11.29

13.34 14.00

14.64

13.36

11.46 11.88

7.70

0.09 0.11 0.13 0.16 0.19 0.21 0.25 0.36 0.45 0.57 0.66 0.71 0.69 0.68 0.60 0.59 0.51

0

2

4

6

8

10

12

14

16

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Ra

te p

er 1

,00

0 P

op

ula

tio

n

Admission Year

Chemical Dependency Treatment Rates, Other Opiates, for Minnesota Residents



27

0.40 0.40 0.49 0.45 0.54 0.59 0.86 1.00 1.36 1.97 2.08

3.95

8.06

10.74

12.89

18.63

21.34

0.17 0.19 0.19 0.22 0.21 0.26 0.29 0.35 0.35 0.40 0.41 0.59 0.76 0.84 0.88 1.03 1.03

0

5

10

15

20

25

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rat

e p

er

1,0

00

Po

pu

lati

on

Admission Year

Chemical Dependency Treatment Rates, Heroin, for Minnesota Residents



28

0.76 1.17 1.35 2.29

3.25 4.31

3.31 2.89 2.37 2.35 2.73 3.53

5.29

8.79

13.35 14.61

19.63

0.31 0.49 0.63 0.79 1.06 1.31 0.93 0.89 0.65 0.63 0.72 0.77 0.94 1.23 1.47 1.68 1.94

0

5

10

15

20

25

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rat

e p

er

1,0

00

Po

pu

lati

on

Admission Year

Chemical Dependency Treatment Rates Methamphetamine for Minnesota Residents



Admissions to Chemical Dependency Treatment by Primary Substance, by CY, by %, for Clients Residing on MN Reservations

SOURCE: HRQ, May 2017

%

MN Neonatal Abstinence

Syndrome Minnesota Health Care Program, State NAS Prevalence per 1,000 Live

Birth, by Race/Ethnicity for 2010-2016

2.03 5.3 4.58

70.88

6.96 8.8

0

10

20

30

40

50

60

70

80

asian PI black hispanic native unknown white

per 1000 live births

Minnesota Health Care Program, Hennepin and Ramsey County

Combined NAS Prevalence per 1,000 Live Birth, by Race/Ethnicity

for 2010-2016

2.09 5.39 5.33

84.12

5.01

14.05

0

10

20

30

40

50

60

70

80

90

asian black hispanic native unknown white

per 1000 live births

30 SOURCE: Claims data, 2010-2016 Minnesota Health Care Programs

Rank State Deaths Age-adjusted

Rate

(per 100,000)

… … … …

44 California 4,659 11.3

45 Hawaii 169 11.3

46 MINNESOTA 583 10.6

47 Iowa 309 10.3

48 Texas 2,588 9.4

49 North Dakota 61 8.6

50 South Dakota 65 8.4

51 Nebraska 126 6.9

Minnesota Ranks Among the Lowest for Drug Overdose Mortality Rates

SOURCE:Minnesota Death Certificates –

Minnesota Department of Health

Injury and Violence Prevention Section

State Rate Masks Significant Racial Disparities

SOURCE: Minnesota Death Certificates –



• The low-ranking (46th out of 51 states) drug overdose mortality rate,

however, masks significant racial disparities. In 2015, Minnesota

ranked first among all states when measuring the age-adjusted

disparity rate ratio (DRR) of deaths due to drug overdose among

American Indians/Alaska Natives relative to Whites (out of 16 states

for which data are available) and Blacks relative to Whites (out of 38

states for which data are available). The age-adjusted rate (AAR) of

death due to drug overdose was more than five times greater among

American Indians/Alaska Natives relative to Whites (DRR: 5.2; AAR:

53.4) and two times greater among African Americans/Blacks relative

to Whites (DRR: 2.1; AAR: 21.0). While the “traditional” ranking

indicates that Minnesota is “healthy” compared to other states, it masks

important racial disparities. For the purposes of this presentation, the

focus will be on American Indian drug overdose deaths in Minnesota.

33

SOURCE:Minnesota Death Certificates –



10 adult MCF….

34

Nutt, D; King, LA; Saulsbury, W; Blakemore, C (2007). "Development of a rational scale to assess the harm of

drugs of potential misuse". Lancet 369 (9566): 1047–53

35

tachyphylaxis

36

ED50

LD50

TW

3x

2x

1x

T1/2

37

Intoxication/Withdrawal

0 2 4 6 8 10 12 14

Substance Use Disorder, DSM-5 pgs 483-590

Substance Induced Disorders:

1) intoxication

2) withdrawal

38


Criterion for intoxication:

A)Reversible substance specific syndrome due to

recent ingestion

B) Problematic behavioral/psychological changes

attributable to recent use of substance

C) Symptoms not explained by another mental

disorder

39


Criterion for withdrawal:

A)Substance specific problematic behavioral change

with physiological and cognitive concomitants due

to recent cessation or reduction of use

B) Cause distress and impairment in social

occupational, other important areas of life

C) Symptoms not explained by another mental

disorder

40


Symptoms are divided into four major

groupings:

1) Impaired control

2) Social Impairment

3) Risky use

4) Pharmacological criteria

41


Impaired control grouping

Criterion 1: taking larger amount of substance or

over a longer period than planned

Criterion 2: multiple, unsuccessful attempts to

reduce or stop use

Criterion 3: spend a great deal of time obtaining,

using, or recovering from the use

Criterion 4: craving

42


Social Impairment grouping

Criterion 5: redcurrant use result in failure with

obligations at work, school home

Criterion 6: continued use despite recurrent social

or interpersonal problems related to use

Criterion 7: important social, occupation or

recreational activates are reduced or given up

because of substance use

43


Risky use grouping

Criterion 8: recurrent used in situations that are

physically hazardous

Criterion 9: continued use despite knowledge of

physical or psychological problem caused or

exacerbated by use

44


Pharmacological grouping

Criterion 10: tolerance; markedly increased dose to

achieve desired effect or reduced effect when same

dose is used

Criterion 11: withdrawal; when blood/tissue

concentrations decline after prolonged use

45


Diagnosis:

Substance Use Disorder (SUD)

Mild: presence of 2-3 symptoms

Moderate: presence of 4-5 symptoms

Sever: presence of 6 or more symptoms

46

“Speedballing”

“Your livin' harder, yeah,

harder than you know

Tell me, how fast,

Can ya burn?,

And how far can ya go?”

-Zakk Wylde “What You’re

Look’n For”

47

Heroin

• ROA: Inhalation, transmucosal, IV, IM,

insufflation, rectal,

• Bioavailablility: 44-61% (inhaled)

• Metabolism: Hepatic

• T1/2: ,10 minutes; compared to morphine, 2-3

hours

• The mean excretion half-life for total morphine

(free and conjugated) in the urine after heroin is

smoked or administered intravenously is slightly

more than 3 hours.

48

• Inhalation of heated heroin vapor is associated

with the occurrence of a symmetric spongiform

degeneration of white matter

(leukoencephalopathy) in the CNS characterized

by neurobehavioral changes. It is not known

whether this is caused by heating adulterants in

heroin or by pyrolysis products of heroin

http://www.osha.gov/dts/chemicalsampling/data/CH_244675.html 49

black tar heroin

50

“China” white

51

Route of Administration-

injection

53

Needle and the damage done

Intravenous

Intramuscular “muscling”

54

Subcutaneous “skin

popping”

55


insufflation

56

Route of Administration-smoking

57


rectal/anal

58

Route of Administration-drinking

59

Papaver somniferum (opium

poppy)

60

Opiate intoxication

• Clinically significant maladaptive

behavioral or psychological changes (e.g.

initial euphoria followed by apathy,

dysphoria, psychomotor agitation or

retardation, impaired judgment, or impaired

social or occupational functioning) that

developed during, or shortly after, opoid

use.

61

62

Opiate intoxication

• Directly related to

volume and strength

consumed

miosis

• Constricting of the

pupil, 2-3mm

63

64

fatigue

• That state, following a

period of mental or bodily

activity, characterized by a

lessened capacity for work

and reduced efficiency of

accomplishment, usually

accompanied by a feeling

of weariness, sleepiness,

or irritability.

Stupor or coma

• The partial or nearly

complete

unconsciousness,

manifested by the

subject's responding

only to vigorous

stimulation

65

Slurred speech

• Inability to enunciate

words, broken

sentence structure and

vocabulary choice

66

67

Impairment in attention

• Inability to focus on

objections or

discussions, e.g. can’t

“track”

Impairment in memory

• Inability to recall short

or long term memory,

may also have

difficulty with

recognition

68

Opioid withdrawal

• A) Either of the

following:

1) cessation of (of

reduction in) opioid

use that has been

heavy and prolonged

(several weeks or

longer)

2) administration of an

opioid antagonist after

a period of opioid use

69

70

Opioid withdrawal

Rarely life threatening

• Looks like bad case

of the flu

madryiasis

• Widening of the pupil,

7-8mm, slow and

sluggish to respond

71

dysphoria

• Excessive pain,

anguish, agitation,

disquiet, restlessness,

malaise.

72

Nausea/emesis

• Upset stomach and

vomiting

73

diarrhea

• A frequent and profuse

discharge of loose or

fluid evacuations from

the intestines

74

Muscle aches

• Burning pain in the

muscle body

75

lacrimation

• Watering of the eyes,

shedding tears

76

rhinorrhea

• Flowing, nasal

discharge

77

78

Muscle aches

• Burning pain in the

muscle body

79

fever

• A rise in body

temperature above

normal usually as a

natural response to

infection. Typically an

oral temperature

greater than 100.4

degrees Fahrenheit

constitutes a fever.

diaphoresis

• Perspiration,

especially profuse

perspiration, e.g

“sweating”

80

piloerection

• Erection of the hair,

e.g. “hair standing on

end”

81

82

Thirty years later,

Speed still kills

83

What is methamphetamine?

84

An amine derivative of amphetamine,

C10H15N, used in the form of its

crystalline hydrochloride as a central

nervous system stimulant, both medically

and illicitly.

85

Methamphetamine, for our

discussion, means….

-amphetaines

-methamphetamine

-dextroamphetamine

-YABA

-methcathinone

-and so on……

87

Then….

• -speed

• -reds

• -white cross

• Deep Purple sang

about the “Speed

King” and it helped

you party faster,

longer, harder

88

Various medications

• -ritalin

• -dexedrine(d-MA sulfate)

• -adderall

• -metadate

• -concerta

• -focalin

• -Methedrine (methamphetamine)

89

now

• -glass

• -ice

• -crank

• The party’s over

90

The methamphetamine user

97

"Faster, faster, until the thrill of

speed overcomes the fear of death."

Hunter S. Thompson

Stimulant (methamphetamine)

intoxication

• Clinically significant maladaptive

behavioral or psychological change that

developed during, or shortly after, stimulant

use.

98

tachycardia

99

pupillary dilation

100

elevated blood pressure

101

perspiration or chills

102

nausea or vomiting

103

weight loss

104

psychomotor agitation

105

stimulant withdrawal

Cessation of (or reduction in) prolonged

amphetamine-type substance

106

dysphoric mood

107

vivid, unpleasant dreams

108

hypersomnia

109

increased appetite

110

psychomotor retardation

111

Tx options?

• Residential tx

• Out-pt tx

• MAT tx

112

Minnesota’s First Searchable Online Tool for Statewide Substance Use Disorder Services Fast-Tracker for SUD services will provide the ability to track and find available statewide substance use disorder services. The website will help YOU find

resources for the people you work with, and assist individuals affected by

substance use disorder to find YOU and your services. Individuals, family members, primary care clinics, emergency departments, mental health and substance use disorder providers, assessors, healthcare navigators, prevention specialist, Tribes and other stakeholders will want to know about this new tool! Its implementation will save lives.

In July, Fast-Tracker staff began calling licensed SUD treatment and detoxification programs to gather agency information and explain

how to easily update bed/slot/treatment availability. There is NO cost to have your program information and openings posted on the site. All that is required is that each site provide program/clinic information, and take a few minutes each day to update their treatment opening status to ensure accuracy of service availability. What can you do now? Share this article with colleagues. Inform pertinent staff that Fast-

Tracker will be calling your program this summer to gather current information about your organization and services provided

Decide who within your organization should speak with Fast-Tracker staff and can provide program information and learn details of how to update your bed/slot openings DAILY.

If you have any questions or would like to request a presentation from DHS on Fast-Tracker, please contact, Cindy Swan-Henderlite at [email protected] or 651-431-2463.

mailto:[email protected]



substance use disorder trends in minnesota “the song ...€¦ · from the dark side…. seizures...

Documents