Transcript Prescription Drug Abuse EPI Profile Presentation

Trends in Alcohol, Tobacco, and
Other Drug Use in Indiana
Findings from the State Epidemiology and
Outcomes Workgroup
Weekend U: Sex, Drugs and Rock and Roll
March 8th, 2014
Marion Greene, MPH
SEOW Lead Epidemiologist
Public Health Research Analyst
PhD Student in Epidemiology
I have nothing to disclose.
SEOW
• Collaboration of members from various state
agencies
• Monitor substance abuse and its
consequences in Indiana
• Identify prevention priorities and ‘hot spots’
• Disseminate findings to legislators,
prevention planners, and community
organizations to encourage data-driven
decision-making
State Epidemiological Profiles
• Annual publications (2006-2012) – currently working on
2013 report
• Companion documents (fact sheets, related research
briefs)
• www.healthpolicy.iupui.edu
Supplement to the
2012 State Epi Report
• Returning veterans
• (Ex-)offenders/reentry population
• Individuals with co-occurring mental health
and substance use disorder (dual diagnosis)
• LGBT community
Epidemiological
Key Findings
ALCOHOL
• Continues to be the most widely used and
abused substance
• Over half of all Hoosiers 12+ years drank in the
past month and nearly 23% engaged in binge
drinking [1]
– Highest rates of use among population ages 18-25
(61% past month; 42% binge drinking)
• Underage drinking: 33% of high school
students drank in past month and 20% binged
[2]
Key Concern:
Underage Drinking
80%
70%
60%
50%
40%
30%
20%
10%
0%
Indiana
U.S.
8th Grade
Lifetime
36.8%
29.5%
8th Grade
Monthly
16.5%
11.0%
10th Grade
Lifetime
53.8%
54.0%
10th Grade
Monthly
27.4%
27.6%
12th Grade
Lifetime
65.1%
69.4%
Note: Lifetime and monthly alcohol use among 8th, 10th, and 12th graders
Source: ATOD and MTF Surveys, 2012 [3, 4]
12th Grade
Monthly
37.6%
41.5%
Key Concern:
Binge Drinking Among Young Adults
60%
50%
40%
30%
20%
10%
0%
Indiana
U.S.
1999
37.6%
37.8%
2000
37.8%
35.9%
2001
33.7%
38.1%
2002
46.8%
40.9%
2003
45.1%
41.3%
2004
43.5%
41.4%
2005
42.0%
41.5%
2006
41.1%
42.0%
2007
41.5%
42.0%
2008
40.3%
41.4%
2009
40.8%
41.4%
2010
40.8%
41.2%
Note: Estimates on binge drinking in the past month among 18- to 25-year-olds
Source: National Survey on Drug Use and Health, 1999-2011 [1]
2011
41.8%
40.2%
TOBACCO
• Cigarette smoking remains the leading cause
of preventable death in the U.S. [10]
• Nearly one-third of Hoosiers ages 12+
currently use a tobacco product [1]
• Adult smoking prevalence in Indiana is 26%
[5]
– Rates significantly higher among people with
lower educational attainment and income level
• 8% of MS and 26% of HS children reported
using tobacco in the past 30 days [6]
Key Concern: Mortality
• ~14-year reduction in adult life expectancy [10]
• Contributes to deaths from lung cancer, heart
disease, chronic lung diseases, and other
illnesses
• Over 9,700 Hoosiers die annually from
smoking-attributable causes.
• Indiana’s smoking-attributable mortality rate
(309 per 100,000) higher than U.S. rate (263
per 100,000)
Key Concern: Smoking in
Vulnerable Populations
45%
40%
35%
30%
45%
25%
40%
35%
20%
30%
15%
25%
10%
20%
5%
0%
Less than High School
High School or GED
Some post-High School
College Graduate
15%
Smoking
41.6%
30.0%
24.3%
8.5%
10%
5%
0%
Income Less than $15,000
Income $15,000 – $24,999
Income $25,000 – $34,999
Income $35,000 – $49,999
Income $50,000 and above
Note: Adult smoking prevalence
Source: Behavioral Risk Factor Surveillance System, 2011 [5]
Smoking
40.6%
30.3%
31.2%
26.7%
16.4%
MARIJUANA
• Marijuana is the most commonly used illicit
substance in the United States
• Current use within Indiana’s population ages
12+ was 7% [1]
– Prevalence highest among young adults ages 1825 (18%)
• Percentage of Indiana treatment admissions with
marijuana use (46%) [7]
– Highest use among males, blacks, and those
under the age of 18
Key Concern: Marijuana Use among
Young Adults in Indiana
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
12-17
18-25
26 and older
2000
7.5%
12.3%
2.7%
2001
7.2%
11.4%
2.2%
2002
7.6%
18.3%
4.0%
2003
7.4%
17.2%
3.9%
2004
7.6%
14.7%
3.6%
2005
6.5%
14.4%
3.2%
2006
6.2%
15.6%
3.6%
2007
7.4%
16.2%
4.1%
2008
7.6%
16.9%
4.3%
Note: Estimates on current (past-month) marijuana use among 18- to 25-year-olds
Source: National Survey on Drug Use and Health, 2000-2011 [1]
2009
7.2%
16.5%
4.2%
2010
6.7%
17.5%
4.1%
2011
6.5%
18.2%
4.4%
Key Concern: Marijuana Use in
Indiana’s Treatment Population
100%
80%
60%
40%
20%
0%
under 18
18 to 24
25 to 34
35 to 44
45 to 54
55 and over
2000
86.0%
69.5%
52.4%
37.8%
24.9%
12.7%
2001
88.8%
72.7%
57.5%
41.0%
27.7%
11.3%
2002
89.1%
73.1%
57.1%
41.0%
29.9%
11.7%
2003
89.9%
72.2%
56.4%
41.5%
29.7%
10.9%
2004
86.7%
69.6%
55.3%
41.0%
31.0%
14.3%
2005
85.9%
68.9%
55.2%
40.8%
32.1%
13.5%
2006
83.8%
70.0%
56.2%
42.4%
34.1%
19.2%
2007
83.3%
69.7%
57.0%
44.0%
35.1%
18.3%
Note: Marijuana use reported at treatment admission in Indiana, by age group
Source: Treatment Episode Data System, 2000-2010 [7]
2008
85.8%
70.7%
57.3%
44.0%
34.2%
20.0%
2009
82.0%
66.3%
53.9%
41.5%
30.3%
18.3%
2010
62.4%
60.1%
48.9%
38.2%
29.3%
16.5%
COCAINE
• Approximately 1% of Hoosiers ages 12+
reported past-year cocaine use [1]
– Rates were highest among 18- to 25-year-olds
(3%)
• Percentage of Indiana treatment admissions with
cocaine use (15%) [7]
– Highest use among females, blacks, and people
ages 35-54
Key Concern: Cocaine Use in
Indiana’s Treatment Population
Gender
Race
Age Group
Total
Male
Female
White
Black
Other
Under 18
18-24
25-34
35-44
45-54
55 and over
Cocaine Use
13.3%
17.6%
11.3%
32.7%
16.3%
2.4%
7.0%
13.8%
23.0%
22.6%
15.9%
14.8%
Cocaine
Dependence
5.0%
8.1%
3.9%
17.4%
5.8%
0.2%
1.7%
4.9%
11.4%
10.4%
6.9%
6.1%
Note: Cocaine use reported at treatment admission in Indiana
Source: Treatment Episode Data System, 2010 [7]
HEROIN
• Heroin prevalence in the general population is
fairly low  makes it difficult to assess
• 2.1% of Indiana’s 12th grade students
reported having used heroin at least once in
their lifetime [3]
• Percentage of Indiana treatment admissions
with heroin use (7%) [7]
– More than doubled from 3% in 2001 to 7% in
2010
Key Concern: Heroin Use in
Indiana’s Treatment Population
12%
10%
8%
6%
4%
2%
0%
Under 18
18 to 24
25 to 34
35 to 44
45 to 54
55 and over
2001
0.1%
2.0%
1.8%
2.6%
7.6%
3.7%
2002
0.2%
1.6%
2.3%
2.5%
8.1%
5.1%
2003
0.3%
2.1%
2.5%
2.2%
5.7%
2.9%
2004
0.4%
2.1%
2.8%
2.6%
6.3%
7.1%
2005
0.3%
2.2%
2.9%
2.8%
6.2%
10.2%
Note: Heroin use reported at treatment admission
Source: Treatment Episode Data System, 2000-2010 [7]
2006
0.2%
2.4%
3.2%
2.4%
5.0%
9.3%
2007
0.1%
2.3%
3.6%
2.5%
3.3%
5.8%
2008
0.4%
3.8%
5.5%
2.9%
3.9%
5.2%
2009
0.2%
6.9%
6.6%
3.6%
3.7%
6.9%
2010
1.1%
7.8%
8.7%
4.4%
3.6%
8.0%
METHAMPHETAMINE (METH)
• Meth prevalence in general population fairly low
– Past-year use among Hoosiers ages 12+ is an
estimated 0.8% [1]
• Percentage of Indiana treatment admissions with
reported meth use (9.3%) [7]
– Highest use among females, whites, and people ages
25-34
• ISP clandestine meth lab seizures at an all-time
high in 2012 (1,663) [8]
Key Concern: Meth Use in
Indiana’s Treatment Population
14%
12%
10%
8%
6%
4%
2%
0%
Indiana
U.S.
2000
4.0%
6.5%
2001
5.3%
7.4%
2002
7.1%
8.5%
2003
8.2%
9.3%
2004
9.2%
10.2%
Note: Meth use reported at treatment admission
Source: Treatment Episode Data System, 2000-2010 [7]
2005
10.9%
11.8%
2006
10.5%
12.0%
2007
9.2%
11.1%
2008
9.2%
9.3%
2009
9.4%
8.5%
2010
9.3%
8.9%
Key Concern:
Meth Labs in Indiana
1,800
1,600
1,400
1,200
1,000
800
600
400
200
0
Number of Lab Seizures
Number of Arrests
1995
6
6
1996
13
13
1997
28
25
1998
43
39
1999
129
117
2000
314
248
2001
542
395
2002
732
587
2003
1011
860
2004
1115
885
2005
992
674
2006
766
530
Source: Indiana State Police Lab Seizures, 1995-2012 [8]
2007
820
534
2008
1059
739
2009
1343
1031
2010
1346
1212
2011
1363
1328
2012
1663
1448
PRESCRIPTION (Rx) DRUGS
• Most commonly abused types
– Pain relievers (opioids)
– CNS depressants (sedatives, tranquilizers)
– Stimulants
• 6% of Hoosiers ages 12+ reported nonmedical
pain reliever use in past year [1]
– Highest rate among 18-25 year-olds (14%)
• Percentage of Indiana treatment admissions with
Rx abuse (20%) [7]
– Highest use among females, whites, and 25-34 year
olds
Controlled Rx Drugs
Dispensed in Indiana
2008
2009
2010
2011
5,849,460
(50.3%)
3,558,007
(30.6%)
6,376,664
(50.2%)
3,902,414
(30.7%)
5,591,679
(49.3%)
3,514,361
(31.0%)
5,830,367
(45.8%)
3,889,652
(30.5%)
Stimulants
1,149,939
(9.9%)
1,353,939
(10.6%)
1,309,265
(11.5%)
1,419,003
(11.1%)
Others
1,077,686
(9.3%)
1,080,914
(8.5%)
926,234
(8.2%)
1,604,214
(12.6%)
Total
11,635,092
(100.0%)
12,713,931
(100.0%)
11,341,539
(100.0%)
12,743,236
(100.0%)
Opioids
CNS Depressants
Source: Indiana Board of Pharmacy, 2012 [9]
Key Concern: Rx Abuse in Indiana’s
Treatment Population
22%
20%
18%
16%
14%
12%
10%
8%
6%
4%
2%
0%
2000
IN: Rx
11.6%
US: Rx
7.7%
IN: Pain Reliever 5.5%
US: Pain Reliever 3.3%
2001
10.9%
9.0%
6.0%
4.2%
2002
11.6%
9.6%
6.4%
4.8%
2003
12.6%
10.0%
7.5%
5.4%
2004
12.8%
10.9%
7.9%
6.3%
2005
14.5%
11.0%
9.1%
6.8%
2006
15.5%
10.8%
10.2%
7.5%
Note: Nonmedical Rx use reported at treatment admission
Source: Treatment Episode Data System, 2000-2010 [7]
2007
16.5%
12.4%
11.3%
8.8%
2008
18.9%
14.0%
13.7%
10.2%
2009
19.1%
16.2%
13.6%
11.9%
2010
20.2%
19.1%
15.2%
14.2%
POLYSUBSTANCE ABUSE
• Use of two or more (2+) substances
• Percentage of Indiana treatment admissions
with 2+ use (56%) [7]
– Highest use among women, whites, 25-34 yearolds
• Most polysubstance abuse involved alcohol
and marijuana [7]
Key Concern: Polysubstance Use in
Indiana’s Treatment Population
70%
60%
50%
40%
30%
20%
10%
0%
3 Drugs Reported
2 Drugs Reported
2000
21.9%
34.6%
2001
21.3%
35.6%
2002
21.7%
36.3%
2003
22.0%
36.2%
2004
23.6%
36.3%
2005
27.5%
35.0%
2006
25.9%
34.6%
2007
23.9%
35.3%
Note: Two or more substances reported at treatment admission
Source: Treatment Episode Data System, 2000-2010 [7]
2008
25.0%
35.4%
2009
25.9%
31.8%
2010
27.8%
28.4%
Special Populations:
Returning Veterans (OIF/OEF)
• No state-specific info
• Nationally, 22% diagnosed with PTSD and
17% with depression
• Deployed personnel experienced higher rates
of work & family stress
• Only 18% who screened positive for alcohol
abuse is receiving mental health services
[11]
Special Populations:
Indiana’s Offender Population
• 28,000+ adults were incarcerated within IDOC in
2011
• Substance abuse & mental illness are prevalent,
often contributing to incarceration and recidivism
• 5,500+ inmates received substance abuse
treatment services in 2011
– Most prevalent substances marijuana (81%), alcohol
(67%), cocaine/crack (35%), & opioids (30%)
[11]
Special Populations:
COD
• COD is a complex phenomenon with serious
consequences for individuals and society
– require different approaches to treatment than
singular disorder
• Among Indiana’s treatment population (n=96,706)
– SMI 49%
– SUD 23%
– COD 19%
• COD risk higher for men, whites, and younger individuals
• Women with COD respond not as well to treatment as men
[11]
Special Populations:
LGBT
• No state-specific info, developed survey
• Substance use
– Binge drinking: 42%
– Heavy drinking: 24%
– Lifetime illicit: 56%
• Mental health
– Depression: 54%
– Anxiety: 40%
[11]
Any Questions or Comments?
Center for Health Policy
The Center for Health Policy collaborates with state and local government,
as well as public and private healthcare organizations in health policy and
program development to conduct high quality program evaluation and
applied research on critical health policy-related issues.
Marion S. Greene, MPH
Public Health Research Analyst, Center for Health Policy
IU Richard M. Fairbanks School of Public Health at IUPUI
714 N Senate Ave, Suite 220
Indianapolis, IN 46202
317-278-3247
[email protected]
www.healthpolicy.iupui.edu
REFERENCES
[1] Substance Abuse and Mental Health Services Administration. (2012). National Survey on Drug Use and Health
(NSDUH). Retrieved December 12, 2012, from http://www.samhsa.gov/data/NSDUH.aspx
[2] Centers for Disease Control and Prevention. (1991-2011). High School Youth Risk Behavior Survey Data.
Retrieved December 12, 2012, from http://apps.nccd.cdc.gov/youthonline
[3] Gassman R., Jun, M. K., Samuel, S., Agley, J. D., Lee, J., Agley, B. D., Oi, S. E., Pardue, N. L., Pardue, S. E.,
Quiroz, J. E., Shuffle, L. A., Smith, J. N., & Smith, M.D. (2012). Alcohol, Tobacco, and Other Drug Use by Indiana
Children and Adolescents. Bloomington, IN: Indiana Prevention Resource Center.
[4] Inter-university Consortium for Political and Social Research, University of Michigan. (2012). Monitoring the
Future. Retrieved January 12, 2012, from http://www.monitoringthefuture.org/data/data.html
[5] Centers for Disease Control and Prevention. (2011). Behavioral Risk Factor Surveillance System Survey Data.
Retrieved December 12, 2012, from http://apps.nccd.cdc.gov/brfss/
[6] Indiana State Department of Health, Tobacco Prevention and Cessation Commission. (2011). Indiana Youth
Tobacco Survey, 2000-2010. Data set made available to the Center for Health Policy at IUPUI (September 27,
2011).
[7] Substance Abuse and Mental Health Data Archive. (2010). Treatment Episode Data Set - Admissions (TEDS-A),
2010. Available at http://www.icpsr.umich.edu/icpsrweb/SAMHDA/browse
[8] Indiana State Police. (2013). Final 2012 ISP lab stats. Received February 6, 2013, from Niki Crawford, First
Sergeant Commander, Methamphetamine Suppression Section, in an e-mail to the Center for Health Policy, Indiana
University Richard M. Fairbanks School of Public Health at IUPUI.
[9] Indiana Board of Pharmacy. (2012). INSPECT datasets for 2011. Received May 26, 2012, from the Indiana
Board of Pharmacy, Indiana Professional Licensing Agency.
[10] Centers for Disease Control and Prevention. (2012). Smoking and tobacco use: Fact sheets. Retrieved
December 12, 2012, from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/index.htm
[11] Indiana State Epidemiology and Outcomes Workgroup. (2013). Substance abuse and mental health concerns
in special populations in Indiana: A supplemental report to the 2012 state epidemiological profile. Indiana University
Center for Health Policy. Indianapolis, IN.