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Patterns and Trends of Substance Use
Within and Across the Regions of Florida
March 2019
Xinguang “Jim” Chen, MD, PhDProfessor of Epidemiology
University of Florida, Gainesville, FL 32610
Learning Objectives
By attending this webinar, participants are expect to: Gain an understanding of the current trends and levels of
alcohol, tobacco and other substance use among youth and adults in Florida;
Become aware of the within Florida and cross-Managing Entity Regions differences in adolescent substance use;
Learn about current trends to help in developing and improving substance use prevention and treatment services in Florida.
Overview Part 1
Section I. Introduction
Section II. Patterns and Trends of Alcohol Use
Section III. Patterns and Trends of Tobacco Use
Section IV. Patterns and Trends of Marijuana Use
Section V. Novel Psychoactive Substance Use
Section VI. Patterns and Trends of Opioids Use
Section VII. Patterns and Trends of Cocaine Use
Overview Part 2
Section VIII. Patterns and Trends of Methamphetamine use
Section IX. Use of Rx. Benzodiazepines
Section X. Reference List
National Data Used
Most recent national data were used for
Florida-National comparisons
Main data sources:
The Youth Risk Behavior Surveillance System (YRBSS)
The Behavioral Risk Factor Surveillance System (BRFSS)
The National Survey on Drug Use and Health (NSDUH)
Florida Data Used State data were used for detailed substance and
within-state variations
Main data sources:
Florida Estimates of Population by BEBR
Florida Youth Substance Abuse Survey (FYSAS)
Drugs identified in deceased persons (Florida Medical
Examiners’ Annual Report
2018 Annual Report
I. Introduction-Population Density
Varying population density across the state with more people around the coastal lines.
I. Introduction-Black Population in Florida
Black population spread throughout the state of Florida with concentrations spotted in several areas.
Hispanic/Latino population concentrated in middle and southern Florida.
I. Introduction-Hispanic Population in Florida
Fewer young people living by the coastal regions in Florida.
I. Introduction-Population 17 and Younger in Florida
Man
agin
g E
ntity
Reg
ions
, T
he S
tate
of F
lori
da
Populations Served by Managing Entity Regions
CFCHS28% (5,827,644)
LSF19%
(3,855,378)SFBHN
14% (2,843,464)
CFBHN13% (2,745,218)
SEFBHN10% (2,076,919)
BBHC9% (1,897,976)
BBCBC7% (1,475,726)
Data source: 2018 Report from the Bureau of Economic and Business Research
Large Differences in Population Served by
Managing Entity RegionsThree Managing Entity Regions cover 61% of total Florida population
Central Florida Behavioral Health Network (CFBHN) (28%)
Lutheran Services Florida Health Systems ( LSF) (19%)
South Florida Behavioral Health Network (SFBHN) (14%)
The other four Managing Entity Regions cover less than 40%
II. Alcohol Use
Underage drinking and binge
drinking
Underage binge drinking by
Managing Entity Regions
Adult drinking
II.1 Underage Alcohol Use
Underage drinking
Age of onset
Underage binge drinking
74.5 73.5 71.3
56.5
78.2 74.9 74.3 75.0 72.5 70.866.2 63.2 60.4
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Rate
of l
ifetim
e d
rinki
ng (%
)
Florida USA
Lifetime Alcohol Use High School Students
Florida vs. U.S., 2001-2017
Data source: 2001-2017 YRBS
National Comparison-Lifetime Use
Lifetime underage drinking in Florida
Continues to decline
Lower than national average
25.4 24.223.3
19.5
17.5
15.6
16.8
25.6
23.8
21.120.5
18.617.2
15.5
10.0
12.0
14.0
16.0
18.0
20.0
22.0
24.0
26.0
28.0
Rate
of I
nitia
tion
(%)
Florida USA
High School Students Initiated Alcohol Use by 13Florida vs. U.S., 2005-2017
Data source: 2005-2017 YRBS
National Comparison-Alcohol Use OnsetAlcohol use initiation by age 13 in
Florida similar to the national
average - continued to decline
An increasing trend from 2015 to
2017
Past 30-Day Alcohol Use Adolescents 12-17
Florida vs. U.S., 2006-2017
16.8 16.215.3
14.412.6 12.5 12.8 12.3
10.79.2 9.9
17.116.1
14.7 14.813.6 13.1 12.9
11.3 11.79.9
9.110.0
0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
22.5
25.0
Rate
of p
ast 3
0-d
ay a
lcoh
ol u
se (%
)
Florida USA
Data source: 2006-2017 NSDUH
National Comparison-Current Alcohol UseCurrent alcohol use in Florida
similar to the national average -
continues to decline
An increasing trend from 2015 to
2017
10.49.6
8.27.6
6.9 6.86.4
5.64.9 5.1
10.69.9
8.7 8.8
7.87.3 7.1
6.2 6.2 5.9
4.75.3
0.0
1.2
2.4
3.6
4.8
6.0
7.2
8.4
9.6
10.8
12.0
Rat
e of
bin
ge d
rinki
ng (%
)
Florida USA
Binge Drinking Among Adolescents 12-17Florida vs. U.S., 2006-2017
Data source: 2006-2017 NSDUH
National Comparison-Underage Binge Drinking
Binge drinking in Florida similar to
the national average - continues to
decline
A slow increase from 2015 to 2017
II.2 Underage Drinking by Managing Entity Regions
Lifetime use
Use in the past 30 days
Binge drinking
36.5 36.435.2
36.834.6
36.8 36.1
38.7
34.1 34.632.3 34.3 32.5
34.730.6
35.838.9 38.0 37.0
39.436.6
39.241.7 41.8
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Total Male Female
Lifetime Alcohol Use Adolescents in Florida by
Gender & Managing Entity Regions, 2018
Data source: 2018 FYSAS
Difference in Lifetime Use by Managing Entity Regions
Small differences in lifetime use across Managing Entity Regions (35% to 39%)
Girls were more likely than boys to drink in all Managing Entity Regions, particularly South Florida Behavioral Health Network (SFBHN) (42% vs. 31%)
Past 30-Day DrinkingAdolescents in Florida by
Gender & Managing Entity Regions, 2018
15.3
16.9
13.1
15.8
13.5
15.6 15.7 15.5
13.815.4
11.0
13.712.5
14.312.9
13.9
16.818.3
15.2
17.8
14.5
17.018.3
17.2
0.0
2.5
5.0
7.5
10.0
12.5
15.0
17.5
20.0
22.5
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Rat
e of
pas
t 30-
day
alco
hol u
se (%
)
Total Male Female
Data source: 2018 FYSAS
Difference in Past 30 Day Alcohol Use by Managing Entity Regions
Large differences in past 30-day use across Managing Entities Regions (13% to 17%)
Girls were more likely than boys to drink in all Managing Entities Regions, particularly South Florida Behavioral Health Network (SFBHN) (18% vs. 13%)
Binge Drinking (30 Days)Youth in Florida by
Gender & Managing Entity Regions, 2018
6.8
7.6
5.8
7.0
5.9
7.1
8.8
6.3
6.98.0
6.8 7.36.1
7.0 6.85.9
6.7 7.2
4.6
6.75.6
7.1
10.4
6.7
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
11.0
12.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Rat
e of
bin
ge d
rinki
ng (%
)
Total Male Female
Data source: 2018 FYSAS
Difference in 30-Day Binge Drinking by Managing Entity Regions
Relative small differences in binge drinking across Managing Entity Regions (6% to 9%)
Girls were more likely than boys to binge drink in all Managing Entity Regions, particularly South Florida Behavioral Health Network (SFBHN) (10% vs. 7%)
II.3. Adult Alcohol Use Florida vs. the United States
Use in past 30 days
Binge drinking
Drinking in the Past 30 Days Among Adults
Florida vs. U.S., 2006-2016
53.6 51.355.3 55.3 54.4 52.7
52.2 51.9 52.1 53.0 52.0 53.5
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
Rate
of p
ast 3
0-d
ay d
rinki
ng (%
)
Florida USA
Data source: 2006-16 BRFSS
Binge drinking in Past 30 Days Among Adults
Florida vs. U.S., 2006-2016
13.8 13.0 13.7
16.515.0 15.5
15.1 15.1 14.816.8 16.0 16.9
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Bing
e dr
inki
ng (%
)
Florida USA
Data source: 2006-16 BRFSS
Difference in Alcohol Use in Adults between Florida and the U.S.
Slightly lower past 30-day alcohol use among Florida adults than the nation (52.7% vs. 53.5%)
Adults in Florida were less likely to engage in binge drinking in the past 30 days than U.S. adults in general (15.5% vs. 16.9%)
III. Tobacco Use
Combustible cigarettes
Electronic cigarettes
III.1 Combustible Cigarettes Adolescents
Life time for national comparison
Past 30-day smoking by
Managing Entity Regions
Lifetime Cigarette Smoking High School Students
Florida vs. U.S., 2001-2017
57.453.8 47.6
18.6
63.958.4
54.350.3
46.3 44.7 41.132.3 28.9
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
Lifet
ime
ciga
rette
smok
ing
(%)
Florida USA
Data source: 2001-17 YRBSS
Lifetime Smoking Rate Comparison with National Average
Lifetime smoking rate continues to
decline in Florida as in the nation
The rate of smoking was lower in Florida
than in the Nation (18.6% vs. 28.9%)
The rate of 18.6% remains high in 2017
Past 30-Day Cigarette Smoking Youth in Florida by
Gender & Managing Entity Regions 2018
2.5
3.9
1.3
2.4
1.9
3.4
2.2
1.7
2.4
4.0
1.4
2.11.8
3.5
1.9
1.1
2.6
3.7
1.1
2.7
2.0
3.3
2.7
2.2
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Past
30-
day
cig
aret
te sm
okin
g (%
)
Total Male Female
Data source: 2018 FYSAS
Comparison Across Managing Entity Regions
Very low rates of past 30 day smoking
(1-4% with 2.5% statewide)
Large variations across Managing
Entity Regions
Past 30-Day Cigarette Smoking Adults (18+)
Florida vs. the U.S., 2006-2017
21.119.3
17.5 17.1 17.219.3
17.7 16.9 17.715.8 15.5
19.6 19.4
18.4 17.9 17.120.1
18.8 18.2 17.316.7 16.3
0.0
4.0
8.0
12.0
16.0
20.0
24.0
28.0
% o
f pas
t 30-
day
use
Florida USA
Data source: 2006-16 BRFSS
National Comparisons –Adult Combustible Cigarette Smoking
Rate and time trend of adult smoking in Florida were similar to those of the nation—keep going down
The rate for Florida adults continues to decline compared to the national average in 2017 (15.5% vs. 16.3%)
III.2. Use of Electronic Cigarettes
Adolescents
Adults
Changes in Past 30-Day E-Cigarette Use among
Youth in Florida, 2016-2018
25.8
9.6 10.68.4
5.1
12.8
27.1
13.7 14.0 13.5
6.4
19.2
0.0
3.0
6.0
9.0
12.0
15.0
18.0
21.0
24.0
27.0
30.0
Lifetime Past 30-dayuse
Male Female Middleschool
High school
% o
f e-c
igar
ette
use
2016 2018
Data source: 2018 FYSAS
Increase in E-Cigarette Use in Youth
Both lifetime and past 30-day use
increased from 2017 to 2018
Increased more in girls than in boys
Increased more in older youth than
younger youth
Past 30-Day E-Cigarette UseYouth in Florida by
Gender & Managing Entity Regions 2018
13.714.8
11.1
15.8
12.513.2 12.8
15.2
14.0 14.911.2
16.1
12.113.2 13.3
15.6
1…
14.8
10.9
15.6 12.713.3
12.3
14.8
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
20.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
E-ci
gare
tte u
se (%
)
Total MaleFemale
Data source: 2018 FYSAS
Managing Entity Regions Differences
13.7% of youth throughout Florida reported having used e-cigarettes in the past 30 days
Three Managing Entity Regions with higher rates: Big Bend Community Based Care (BBCBC), Central Florida Cares Health Systems (CFCHS) and Southeast Florida Behavioral Health Network (SEFBHN) and One Managing Entity Region Broward Behavioral Health Coalition (BBHC) with relatively lower rate (11.1%)
E-Cigarette Use Among Adults
The level in Florida is similar to the national average with a slightly higher lifetime use
E-Cigarette Use Among Adults (18+)Florida vs. the United States
20.2
4.7
21.6
4.5
0.0
5.0
10.0
15.0
20.0
25.0
Lifetime use Past 30-day use
E-C
igar
ette
use
(%)
Florida USA
Data source: 2016 BRFSS
IV. Marijuana Use
Adolescent use and adult use
Florida and US comparison
Differences Across Managing
Entity Regions
Synthetic marijuana
35.0 36.439.1 38.7 36.6 34.5
38.1 36.8 39.940.7
38.6 35.6
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
Lifet
ime
mar
ijuan
a us
e (%
)
Florida USA
Lifetime Marijuana UseHigh School Students
Florida vs. U.S., 2007-2017
Data source: 2007-17 YRBSS
Lifetime Marijuana Use High School StudentsNational Comparison
Long-time trend similar to national average
Slightly lower than national level in lifetime use
Slower decline relative to the national trend
6.9
6.6 6.36.9 6.8
7.0
7.5 7.5
6.8
7.0 7.5
6.5 6.7
6.77.2
7.67.0 7.3
7.1
7.47.1
6.4 6.6
1.0
2.0
3.0
4.0
5.0
6.0
7.0
8.0
9.0
10.0
Mar
ijuan
a us
e in
the
past
30
day
s (%
)
Florida USA
Past 30-Day Marijuana UseAdolescents (12-17)
Florida vs. U.S. 2006-2017
Data source: 2006-17 NSDUH
Current Marijuana Use High School Students National Comparison
Long-time trend similar to national average: Around 6.5 to 7.5%
Continued increase from 6.8% in 2014-15 to 7.0% in 2015-16, further to 7.5% in 2016-17
Lifetime Marijuana UseYouth in Florida by
Gender & School Grade, 2006-2018
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
50.0
Lifet
ime
mar
ijuan
a us
e (%
)
Total MaleFemale Middle schoolHigh school
Data source: 2018 FYSAS
Past 30-Day Marijuana Use Youth in Florida by
Gender & School Grade, 2006-2018
0.0
3.0
6.0
9.0
12.0
15.0
18.0
21.0
24.0
27.0
30.0
Mar
ijuan
a us
e in
the
past
30
day
s (%
)
Total MaleFemale Middle schoolHigh school
Data source: 2018 FYSAS
Age and Gender Patterns
Converging gender differences in past
30-day marijuana use in recent years
Gender difference in lifetime use
crossover from 2016 to 2018 (more
girls than boys used marijuana)
Cross-Managing Entity Regions Comparison
Age of onset of use
Use in the past 30 days
Initiated Marijuana Use by Age 13 by Gender & Managing Entity Regions, 2018
Data source: 2018 FYSAS
10.6 10.5
7.3
11.5
8.1
12.5
5.9
10.4
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Perc
ent (
%)
Male Female
Past 30-day Marijuana UseYouth in Florida by
Gender & Managing Entity Regions 2018
10.9
10.0 9.6
11.5
8.5
12.0
10.4
13.2
10.79.5 9.3
11.68.9
11.59.7
12.011.0 10.49.9
11.4 8.0
1…10.5
14.3
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
18.0
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Rate
of p
ast 3
0-d
ay m
ariju
ana
use
(%)
Total Male Female
Data source: 2018 FYSAS
Cross-Managing Entity Regions Comparison
Boys were more likely than boys to initiate marijuana use in
2018
Girls were also more likely to use marijuana in the past 30 days
Differences in both the rate of initiation and use in the past 30
days with higher rates in three Managing Entity Regions
(Central Florida Behavioral Health Network (CFBHN),
Lutheran Services Florida Health Systems (LSF) and Southeast
Florida Behavioral Health Network (SEFBHN))
Synthetic Marijuana Use
Florida and national comparisons
Synthetic Marijuana UseHigh School Students in Florida, 2012-2018
13.0
8.8
4.93.5
4.3
1.4 1.0 1.1
0.0
3.0
6.0
9.0
12.0
15.0
Rate
of s
ynth
etic
mar
ijuan
a us
e (%
)
Lifetime Past 30-day
Data source: 2018 FYSAS
IV.2 Adult Marijuana Use
Florida and national comparisons
Marijuana Use in the Past 30 DaysAdults (18+)
Florida vs. U.S., 2006-2017
5.4 5.5 5.8 6.0 6.3 6.6 7.07.6 7.9 7.7
8.86.0 5.7 6.1
6.6 6.9 6.9 7.3 7.68.6 8.5
9.09.8
0.0
1.5
3.0
4.5
6.0
7.5
9.0
10.5
12.0
13.5
Mar
ijuan
a us
e in
the
past
30
day
s (%
)
Florida USA
Data source: 2006-2017 NSDUH
Florida and U.S. Differences in Adult Marijuana Use
Past 30-day marijuana use among adults increased progressively
in Florida as well as in the Nation since 2006
Adults in Florida were less likely to use marijuana in the past 30
days since 2006.
V. Novel Psychoactive Substance Use
FYSAS data indicate low rate of use of tryptamines (LSD, DMT, Psilocybin, 5-MeO-DiPT) in adolescents in 2018
Tryptamine was detected only in 4 deceased persons from 2017 Medical Examiners data
VI. Use of Opioids
Use of fentanyl analogs
Nonmedical use of opioids
Heroin use
1026 965
16851588
0
250
500
750
1000
1250
1500
1750
2000
2250
Num
ber o
f cas
es
2016 2017
Fentanyl analogs Detected Deaths caused by the drugs
Increases in Fentanyl Use Among Florida Residents
From 2016 to 2017
Data source: Florida Medical Examiners Commission Report, 2016 and 2017
5085 55646514
8572 885561.4 64.8 66.6
72.0 71.2
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0
2000
4000
6000
8000
10000
12000
14000
2012 2013 2014 2015 2016 2017 2018
Dea
ths c
ause
d b
y th
e d
rug
(%)
Num
ber o
f dea
ths w
ith th
e d
rug
Deaths with the drugdetected% Deaths caused by thedrug
Nonmedical Opioid Use During 2016-2017
Note: Fentanyl analogs and heroin were excluded Data source: Florida Medical Examiners Commission Report, 2016 and 2017
Opioid Use in Florida during 2016-17 Data From the
Medical Examiners Report
There was a big increase in fentanyl
use in Florida
There was a reduced rate of
nonmedical use of opioids from 2016
to 2017
Changes in Nonmedical Use of 11 Specific Opioids in Florida
2013-2017
0
500
1000
1500
2000
2500
Num
ber o
f cas
es
Buprenorphine
Codeine
Fentanyl
Hydrocodone
Hydromorphone
Meperidine
Methadone
Morphine
Oxycodone
Oxymorphone
Tradadol
Data source: Florida Medical Examiners Commission Report, 2013-2017
Three Groups of Specific Opioids Data
From the Medical Examiners Report
Rapid growth with high levels of recent use (3):
Fentanyl: quickest increase with highest level
Hydromorphone, high level and slow down in increase
Oxycodone, high level, first to slow down in increase among the three
Relatively stable (5)
Low but increasing (2): Buprenorphine and meperidine
Fentanyl and MorphineTwo Most Frequently Used Opioids
in Florida, 2017
23.6
12.3
83.5
30.9
29.7
10.0
58.8 64.5
47.6
20.3 21.1
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0
500
1000
1500
2000
2500
Deaths with opioidsDeaths caused by opioids% Deaths caused by the drug
Data source: Florida Medical Examiners Commission Report, 2017
Trends in Heroin Use in Florida 2013-2017
199
447
799
1023 1057
193
408
733
952 944
0
200
400
600
800
1000
1200
1400
Num
ber o
f dea
ths
Deaths with heroin
Deaths due to heroin
Data source: Florida Medical Examiners Commission Report, 2013-17
Slowing Down - Heroin Use
The number of deaths with heroin detected increased from
2016 to 2017 at a lower rate than before
The number of deaths attributed to heroin use declined
during the same period
Both indicators remained at high level in 2017 (1057 for
the former and 944 for the later)
Very high rates of drug attributed death in 2017 (89%)
VII. Cocaine Use
National comparison
Age, gender and school grade
differences
Cocaine Use Among Youth (12-17)
Florida vs. U.S., 2013-2017
1.5
1.2 1.0 1.00.9
0.7
0.5
0.80.6 0.6 0.5
0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
1.8
Used
in th
e pa
st y
ear (
%)
Florida USA
Data source: 2006-2017 NSDUH
Lifetime Cocaine Use AmongYouth (11-18) in Florida by
Gender & School Grade
2.9
2.3
1.9 1.8
1.4
3.1
2.6
2.11.9
1.6
2.7
1.91.6 1.6
1.3
1.8
1.10.9 0.8 0.8
3.8
3.1
2.5 2.5
1.9
Lifet
ime
coca
ine
use
(%)
Total Male Female Middle school High school
Data source: 2010-18 FYSAS
Characteristics of Adolescent Cocaine Use
Historical trends similar to the national
average
Current level of use remained low in 2018
Obvious gender (boys more likely than girls
to use) and school grade differences
Managing Entity Regions and Gender Difference in Past 30-day Cocaine Use
Youth (11-18) in Florida, 2018
Data source: 2018 FYSAS
0.4
0.5
0.0
0.5
0.2
0.5
0.4
0.5
0.5 0.5
0.0
0.7
0.2
0.60.5
0.30.4
0.6
0.0
0.4
0.2
0.5
0.2
0.7
0.0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
The State BBCBC BBHC CFBHN CFCHS LSF SFBHN SEFBHN
Total Male Female
Managing Entity Regions Differences in Adolescent Cocaine Use Large variation in adolescent cocaine use based on FYSAS data
No adolescents in Broward reported past 30-day cocaine use
Higher rate of cocaine reported in past 30-day use in four Managing Entity Regions
Big Bend Community Based Care (BBCBC)
Lutheran Services Florida Health Systems ( LSF)
South Florida Behavioral Health Network (SFBHN)
Southeast Florida Behavioral Health Network (SEFBHN)
The Growth in Cocaine Use Among Florida Residents Slowed in 2016-2017
13371508
1834
28823129
607 720967
17692012
45.4 47.752.7
61.4 64.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0
500
1000
1500
2000
2500
3000
3500
1 2 3 4 5Death with cocaine Death caused by cocaine % Cause of death
2013 2014 2015 2016 2017
Data source: Florida Medical Examiners Commission Report, 2017
Cocaine use grew: by 10.5 % from 2014 to 2015 by 16.5% from 2015 to 2016by 4.7 % from 2016 to 2017 (slower growth)
Historical Trends and Recent Change in Cocaine Use by Managing Entity Regions in Florida
0
100
200
300
400
500
600
700
800
900
1000
Num
ber o
f occ
urre
nces
BBCBC BBHC CFBHN CFCHSLSF SFBHN SEFBHN
Data source: Florida Medical Examiners Commission Report, 2017
Continuous Increase in Cocaine Use from Medical Examiners’ Data
Both the number of deaths with cocaine detected and the deaths attributed to the drug increased from 2016 to 2017
Substantial Managing Entity Regions-differences in cocaine use since last report
Three Managing Entity Regions with highest level and fast rate of increase:
Central Florida Behavioral Health Network (CFBHN)
Central Florida Cares Health Systems (CFCHS)
Lutheran Services Florida Health Systems ( LSF)
The one Managing Entity Region with lowest level and no increase: Big Bend (BBCBC)
VIII. Methamphetamine Use
Use among youth from FYSAS data
Results from Medical Examiners data
Low Rates of Lifetime and Past 30-Day Use of Methamphetamine
Youth in Florida
2.1
1.41.3
1.0 1.0
0.7 0.70.70.5 0.5 0.5 0.5
0.4 0.4
0.0
0.5
1.0
1.5
2.0
2.5
Met
ham
phet
amin
e us
e (%
)
Lifetime Past 30-day
Data source: Updated with 2018 FYSAS
VIII.1 Methamphetamine Use Among Florida Youth
Both lifetime and past 30-day use
remained at low levels from 2017 to 2018
Continued Increases inMethamphetamine Use In Florida from 2016 to 2017
46.740.6
51.1 52.7 54.1
169217
305
621
858
79 88
156
327
464
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
80.0
90.0
100.0
0
100
200
300
400
500
600
700
800
900
1000
2013 2014 2015 2016 2017
Cau
se o
f dea
th (%
)
Num
ber o
f dea
ths
% Cause of deathDeath with the drugDeath caused by the drug
Data source: Florida Medical Examiners Commission Report, 2017
VIII.2 Data from the Medical Examiners Report
There was a rapid increase in deaths detected
with methamphetamine from 2016 to 2017
There was also an increase in deaths
attributed to the drug during the same period
Potential underreport of methamphetamine
use among Florida adolescents.
IX. Medical Use of Rx Benzodiazepines
Benzodiazepines less likely as a cause of death relative to many other drugs
Stabilization of deaths detected with Rx benzodiazepines and attributed deaths from 2016 to 2017
Slow Down in Rx Benzodiazepines Use and Related Deaths Due to
Use in Florida, 2016-2017
25.3 27.424.8
27.5 27.1
4304 42824604
5167 5064
1091 1175 11401421 1374
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
0
1000
2000
3000
4000
5000
6000
7000
8000
2013 2014 2015 2016 2017
Cau
se o
f dea
th (%
)
Num
ber o
f dea
ths
% Cause of deathDeath with the drugDeath caused by the drug
Data source: Florida Medical Examiners Commission Report, 2017
3 Most Used Rx Benzodiazepines in 2017Alprazolam, Nordiazepam and Diazepam
1,889, 37%
638, 13%607, 12%
543, 11%
457, 9%
335, 7%
302, 6%
181, 3%
97, 2% 6, 0%
Alprazolam
Nordiazepam
Diazepam
Clonazepam
Temazepam
Oxazepam
Lorazepam
Midazolam
Chlordiazepoxide
Flurazepam
Data source: Florida Medical Examiners Commission Report, 2017
Three Most Commonly Detected
Rx Benzodiazepines
Alprazolam (37%)
Nordiazepam (13%)
Diazepam (12%)
ME RegionsAlprazolam Diazepam
2016 2017%
change 2016 2017%
changeState total 1851 1889 +2.1 664 607 -8.6By ME Regions
BBCBC 118 100 -15.3 42 24 -42.9BBHC 169 162 -4.1 37 34 -8.1CFBHN 562 502 -10.7 180 187 +3.9CFCHS 220 242 +10.0 79 80 +1.3LSF 312 360 +15.4 160 131 -18.1SFBHN 251 247 -1.6 60 61 +1.7SEFBHN 219 276 +26.0 106 90 -15.1
Data source: Updated with data from 2017 Florida Medical Examiners Commission Report.
Changes in Alprazolam and Diazepam Across Managing Entity Regions in
Florida During 2016-17
Managing Entity Regions Differences in Rx Alprazolam
During 2016-17
Statewide, a declining trend in Rx. Alprazolam
Four Managing Entity Regions with a declining trend, particularly the Big Bend Community Based Care (BBCBC) (-15.3%)
Four with an increasing trend, particularly the Southeast Florida Behavioral Health Network (SEFBHN) (+26%)
Managing Entity Regions Differences in Rx Diazepam
During 2016-17
Statewide, an increase in Rx. Diazepam
Three Managing Entity Regions with an increasing trend with the largest increase for the Central Florida Behavioral Health Network (CFBHN)
Four Managing Entity Regions with a declining trend with the largest decline in the Big Bend Community Based Care (BBCBC) (42.9%)
Summary Differences across Managing Entity Regions suggest potential improvements in substance abuse prevention and treatment in Florida.
Remaining challenges Prevent e-cigarettes and marijuana use
Prevent girls from trying and using alcohol and marijuana
Curb increases in use of opioids (particularly heroin), fentanyl and fentanyl analogs
Reduce differences in Benzodiazepine access and use across the Managing Entity Regions
X1. References Cited• Bureau of Economic and Business Research. Florida Estimates of
Population 2018.• Centers for Disease Control and Prevention. Behavioral Risk
Factor Surveillance System (BRFSS). BRFSS Web Enabled Analysis Tool.
• Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance System (YRBSS). Youth Online Data Analysis Tool.
• Patterns and Trends of Substance Use within and Across the Regions of Florida, May 2018.
• Crandall, Lee. Patterns and Trends of Substance Use Within and Across the Managing Entity Regions of Florida, May 2018.
• Florida Department of Children and Families. Florida Youth Substance Abuse Survey.
X2. References Cited• Florida Department of Law Enforcement. Drugs Identified in
Deceased Persons by Florida Medical Examiners, Annual Reports 2013-2017.
• Florida Department of Law Enforcement. 2017 Annual Uniform Crime Reports.
• National Institute on Drug Abuse. Opioid Overdose Crisis 2019. • Substance Abuse and Mental Health Services Administration
(SAMHSA). National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Data Archive.
• Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health (NSDUH). Interactive NSDUH State Estimates.
• Substance Abuse and Mental Health Services Administration (SAMHSA). National Survey on Drug Use and Health (NSDUH). NSDUH State Report.
