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A Law Enforcement View of Increasing Abuse of Heroin Current Levels of Prescription Abuse Indicate Possible Increased Abuse of Heroin

Transcript of Rx15 vi sion_tues_800_ameritox

A Law Enforcement View of Increasing Abuse of Heroin

Current Levels of Prescription Abuse Indicate Possible Increased Abuse of

Heroin

Past Year Initiates of Specific Illicit Drugs among Persons Aged 12 or

Older: 2013

2

Marijuana

Pain Relievers

2,427

1,539

1,180

751

603 601 563824

169 12832

Tranquilizers

Ecstasy

Stimulants

Cocaine

Inhalants

LSD

Heroin

Sedatives

PCP

0

500

1,500

1,000

2,000

2,500

3,000

hthttp://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf

http://www.samhsa.gov/data/sites/default/files/NSDUHresultsPDFWHTML2013/Web/NSDUHresults2013.pdf

Opiate Abusers 19 Times More Likely to Abuse Heroin

A 2013 report by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that people aged 12 to 49 who had used prescription pain relievers non-medically were 19 times more likely to have initiated heroin use recently (within the past 12 months of being interviewed) than others in that age group (0.39 percent versus 0.02 percent). The report also shows that four out of five recent heroin initiates (79.5 percent) had previously used prescription pain relievers non-medically.

http://www.samhsa.gov/newsroom/advisories/1308215815.aspx

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DEA REPORTS INCREASE AVAILABILITY OF HEROIN

• DEA intelligence indicates that South American and Mexican drug trafficking organizations have exploited this increased demand by producing heroin with increased purity that is not only more readily available, but also cheaper. That product enters the United States primarily across our southwest border and, not surprisingly, the amount of heroin seized there has increased nearly 300 percent from 2008 to 2013. During roughly the same time period (2008 to 2010), heroin-related overdose deaths have increased by 45 percent. This disturbing increase may be attributable to increased purity and a younger, less experienced user population. As the Administration takes a multifaceted approach to curb the availability of prescription-based painkillers on the illicit market, those addicted to opioids who are not seeking medication-assisted therapy may increasingly turn to cheaper or more easily-obtained alternatives, such as heroin.

Centers for Disease Control and Prevention, National Center for Health Statistics (accessed February 11, 2013) http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5729a1.htm

http://www.justice.gov/dea/pr/speeches-testimony/2014t/043014t.pdf

DEA DEPUTY ASSISTANT ADMINISTRATORCongressional Testimony Indicates Increased Heroin

Use Linked to Prescription Medicine Abuse

According to the most recent National Survey on Drug Use and Health (NSDUH), there were 335,000 current heroin users in 2012, more than double the number in 2007 (161,000). The DEA believes the increased heroin use is driven by many factors, including an increase in the misuse (e.g., using more than medically indicated or using in a manner not medically indicated) and abuse (i.e., using in order to feel the psychoactive effects of the drug) of prescription psychotherapeutic drugs, specifically opioids. Increases in heroin purity and availability, the low street cost of heroin, expanded Mexican Drug Trafficking Organizations’ involvement in the distribution of heroin, and the lack of public awareness of the risks of heroin use are also important contributing factors.

http://www.dea.gov/pr/speechestestimony/2014t/042914t.pdf

CDC Reports Links Between Heroin Use and Prescription Drug Abuse Used in DEA Administrator’s

2014 Congressional TestimonyRecently, the Centers for Disease Control and Prevention (CDC) reported that 38,329 people died from a drug overdose in the United States in 2010, the most recent year for which information is available. Nearly 60 percent of those drug overdose deaths (22,134) involved prescription drugs. And of those deaths, 75 percent (16,651) involved an opioid analgesic, also known as prescription painkillers. These deaths represent not just a statistic, but our family members, friends, neighbors, and colleagues. Years of over prescribing prescription painkillers and decreased perception of risk associated with drug use, particularly opiate abuse, has created too many new addicts. The rates are alarming: in 2011, 2.1 million Americans abused or were dependent to opioid pain relievers and 438,000 were addicted to heroin.

Drug Overdose in the United States: Fact Sheet. www.cdc.gov/homeandrecreationalsafety/overdose/facts.html (accessed March. 18, 2014).

Muhuri, et al. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the US. Center for behavioral Health Statistics and QualityData Review. SAMHSA (2013). 2013.http://www.justice.gov/dea/pr/speeches-testimony/2014t/043014t.pdf

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Heroin Traffickers Adapting to Opiate Abusing Population

• DEA intelligence reveals that heroin trafficking organizations are relocating to areas where non-medical use of prescription drugs on the rise. Correspondingly, NFLIS shows an increase in the heroin cases and reports.

http://www.dea.gov/pr/speeches-testimony/2014t/042914t.pdf

NFLIS Estimates

2008 2009 2010 2011 2012 Jan-June 2013

Heroin Reports 95,879 112,153 110,393 119,765 131,624 74,049

Heroin Cases 73,562 83,535 82,385 88,924 99,830 55,744

Total Reports 1,711,763 1,758,505 1,713,360 1,660,216 1,622,435 770,851

Total Cases 1,290,363 1,297,735 1,274,383 1,218,161 1,189,089 578,034

% Heroin Reports 5.60% 6.38% 6.44% 7.21% 8.11% 9.61%

% Heroin Cases 6.92% 7.95% 8.04% 9.24% 10.72% 12.25%

http://www.dea.gov/pr/speeches-testimony/2014t/042914t.pdf

In NFLIS, a “case” is a law enforcement investigation; a “report’’ is an analysis of an

exhibit pertaining to an investigation. There are typically many reports in a single

case.

US Heroin Seizures 2009 - 2013

http://www.dea.gov/resource-center/dir-ndta-unclass.pdf

Source: National Seizure System

Heroin-related Emergency Department Visits 2007 - 2011

Source: Drug Abuse Warning Network

http://www.dea.gov/resource-center/dir-ndta-unclass.pdf

Heroin Use Among Pain Patients Prescribed Opioids

Methods

• Retrospective review of 171,061 urine

samples

• All patients prescribed opioids for pain

• Samples evaluated for the presence of

– Heroin metabolite (6-monoacetylmorphine)

– Other illicit drugs

– Non-prescribed medications

– Prescribed medication

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014

Overall Results

• 1.3% of samples tested positive for 6-MAM

• Why is this significant

– Detection time of 6-MAM in urine is up to 24

hours

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014Ameritox Data on file Qiao Y et al Reaction pathways and free energy profiles for cholinesterase-catalyzed hydrolysis of 6-monoacetylmorphine Org. Biomol. Chem., 2014,12, 2214-2227

Demographic Analysis

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014

Percentage of samples with other illicits found

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014

Percentage of samples with a non-prescribed medication found

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014

Percentage of samples with a non-prescribed medication found

Heroin Use Among Pain Patients Prescribed Opioids Pain Week 2014

Heroin mixed with other non-prescribed or illicit drugs

• 20.3% tested positive for non-prescribed sedative hypnotic

– 11.7% positive for heroin and sedative-hypnotic

– 4.4% positive for heroin, sedative hypnotic, synthetic opioid

– 3.1% positive for heroin, sedative hypnotic, and cocaine

– 1.1% positive for heroin, cocaine, sedative hypnotic, and synthetic opioid

Ameritox Data on File

Heroin mixed with other non-prescribed or illicit drugs

• 19.1% tested positive for cocaine

– 11.3% positive for heroin and cocaine

– 3.6% positive for heroin, cocaine, synthetic opioid

– 3.1% positive for heroin, cocaine, and sedative hypnotic

– 1.1% positive for heroin, cocaine, sedative hypnotic, and synthetic opioid

Ameritox Data on File

Conclusions

• Samples from patients prescribed opioids that tested positive for heroin were more likely to test positive for other illicit drugs, such as cocaine and marijuana.

• In addition, they were more likely to test positive for other non-prescribed medications and negative for medications that were prescribed.

• Clinicians should consider testing for heroin use when conducting urine drug screens in patients prescribed opioids.

Ameritox and PRIUM Hospitality SuiteLocated in Piedmont 3 on the 12th Floor

Tuesday, April 7: 9:00 AM– 12:00 PM

Meet with the presenters of the Ameritox Vision Session, “Gateway to Heroin: Opioids”, and continue the discussion:

– Richard Tucker, former DEA Diversion Control Agent– Toni Torsch, founder of the Perry Hall, Maryland chapter of GRASP (Grief Recovery After

Substance Passing), and the Daniel Carl Torsch Foundation

Meet the Ameritox Toxicology Specialists: discuss test results, additional Ameritox offerings, and see where your state ranks for illicit drug use, and the use of prescription and non-prescription medications from the Ameritox National Prescription Drug Report.

Wednesday, April 8: 11:30 AM– 1:30 PM

Michael Gavin, President of PRIUM, an Ameritox Solutions Provider.

Meet the Ameritox Toxicology Specialists: discuss test results, additional Ameritox offerings, and see where your state ranks for illicit drug use, and the use of prescription and non-prescription medications from the Ameritox National Prescription Drug Report.