San Francisco Bay Area Drug Trends and Effective

Intervention Strategies

Alice Gleghorn, Ph.D

County Alcohol and Drug Program Administrator

San Francisco Department Of Public Health

HEROIN PRICE* AND PURITY*Price unit = per milligram pure

2001 $1.40 10%

2002 $0.99 12%

2003 $0.98 11%

2004 $0.98 11%

2005 $0.89 12%

2006 $0.69 10%

2007 $1.28 8%

2008 $1.07 7.8%

2009 $2.09 5.8%

2010 $2.32 5.7%

2011 $1.40 3.9%

Source: DEA 2011 Heroin DMP, March 2011

Lab analysis of “Gunpowder” sample in 2012 found heroin, lidocaine, codeine, and morphine

San Francisco ED Reports 2004-2011 Source: DAWN 2011(weighted data)

Drugs 2004 2005 2006 2007 2008 2009 2010 2011

Heroin 2,424 3,138 1,994 1,993 1,616 1,224 1,242 731

Opiates/opioids 1,055 2,172 1,703 1,369 1,784 2,043 2,474 2,614

-Opiates,unspec 243 475 446 255 317 433 659 723

-NarcoticAnalges 839 1,804 1,332 1,152 1,504 1,649 1,863 1,953

---Buprenorphine/ * * * * * * * *

---Codeine/combo 69 * * * * * * *

---Fentanyl/combo * * * * * 124 * 171

---Hydrocodone/co 239 440 335 299 434 351 546 529

---Hydromorphone * * * * * 141 * 180

---Methadone 311 805 560 496 514 508 521 421

---Morphine/comb 107 180 131 121 155 188 270 283

---Oxycodone/co 104 251 246 217 315 449 504 543

San Francisco ED Reports 2004-2011, % changeSource: DAWN 2011

Percent Change (p < 0.05)

2004 2010 20112011 vs.

20042011 vs.

20092011 vs.

2010

Heroin 2,424 1,242 731 -70 -40 -41

Opiates 1,055 2,474 2,614 148  

-Opiates, unspec 243 659 723 197  

-Narcotic analges 839 1,863 1,953 133  

--Fentanyl/comb * * 171    

--Hydrocodone/co 239 546 529 122  

--Hydromorphone/ * * 180    

--Methadone 311 521 421   -17  

--Morphine/comb 107 270 283 164 51  

--Oxycodone/comb 104 504 543 424  

Drug Abuse Warning Network, 2011: Selected Tables of National Estimates of Drug-Related Emergency Department Visits. Rockville, MD: Center for Behavioral Health Statistics and Quality, SAMHSA, 2013

0

200000

400000

600000

800000

1000000

1200000

1400000

1600000

1800000

Hydro

codone

Zolpid

em

Loraze

pam

Oxyco

done/al

l

Clonaz

epam

Alpra

zola

m

Diaze

pam

Codeine

Temaz

epam

Caris

oprodol

Met

hadone

Adderal

l

Hydro

morp

hone

Ritalin

5 Bay Area Counties: 2012 Prescription Quantities By Drug Name

5 Bay Area Counties: Prescription QuantitiesHydrocodone/APAP

1550000

1600000

1650000

1700000

1750000

1800000

1850000

Hydrocodone/APAP

2011

2012

CURES Data provided by Mike Small, CA DOJ

Primary Drug Treatment Problem: Percent of total admissions

5 Bay Area Counties; FY2012-13

0 10 20 30 40

Alcohol

Methamphet.

Heroin

Cocaine

Marijuana

Other Opiates

Oxycodone

Other

FY2012/13

Source: DHCS 12-19-13 CalOMS Data System, Craig Chaffee

San Francisco Treatment Service Episode by Primary Drug Problem : FY0607 through FY1112

(Source: CBHS BIS Admission Data)

0

50

100

150

200

250

FY0607 FY0708 FY0809 FY0910 FY1011 FY1112

Non-Prescription Methadone Other Opiates OxyCodone/OxyContin

SAN FRANCISCO COUNTY PRIMARY DRUG AT TREATMENT ADMISSION PERCENTAGE BY AGE, 2011-12[I]

[i] Source: CalOMS Tx Data, Department of Alcohol and Drug Programs

1997: Treatment On Demand• Treatment Expansion: Significant,

sustained local funding increase• Commitment to Harm Reduction

approach: Reaching people wherever they are to reduce death and drug-related harm

• “Heroin Issues” subcommittee: – 1. Hep C Prevention– 2. Alternative Treatment modalities– 3. Soft-Tissue Infection – 4. OVERDOSE DEATH PREVENTION

TOD Heroin Issues Committee Actions:

• 1) Train Community Outreach & Syringe Exchange on overdose prevention education

• 2) Conduct broad public education campaign to increase overdose awareness

• 3) Target overdose response training for people at-risk of heroin overdose in jails, probation, and drug treatment programs

• 4) Test the feasibility and effectiveness of training heroin users to administer naloxone as an overdose death prevention tool

Drug Overdose Prevention Education (DOPE) Focus• Overdose Risk Factors • Recognizing Overdose signs• Overdose response:

– Call 911, Rescue Breathing, Recovery Position,& Follow Up Medical care

• Naloxone Pilot Program– 2003- Naloxone distribution and refills

• 2010 – Intra-Nasal device• Target populations

– SROs, Jail, SEPs, – Residential and Opiate Treatment Programs– AB 109 (Prisoners released to communities)– Pharmacy/Primary Care, Pain medication

Deaths Involving Drug Abuse – DAWN SF Metropolitan Area -1994-2002

343

378 388

317 322

362

286274

212

21 23 29 216 15 26 19 24

255

291 297

228253

288

217 206

143

67 64 62 68 63 5943 49 45

050

100150200250300350400450

1994

1995

1996

1997

1998

1999

2000

2001

2002

TotalMetro

MarinCounty

SanFranciscoCounty

San MateoCounty

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2002 (092003 update)

Heroin deaths: 1997= 297; 2010= 8