Harolyn Tarr, MPH
Manager and Principal Epidemiologist
Detroit Department of Health and Wellness Promotion
 Review
the burden of heroin and
prescription drug mortality (deaths) and
morbidity (hospitalizations and
treatment)
 Review
patterns in narcotic law arrests in
Macomb County
 Understand
heroin and prescription drug
use among youth and young adult
population in Macomb County

Drug abuse is associated with numerous negative health and
social outcomes which include:


Social consequences of drug abuse are also significant which
include:


increased mortality, injuries, overdose, sexually transmitted infections,
spontaneous abortions, hepatitis, liver and cardiovascular diseases, and
other life-threatening conditions.
loss of employment and productivity, school failure, increased crime and
imprisonment, decreased safety, family disintegration, domestic abuse,
child abuse, and mental and physical disabilities (Williams, 2007).
NIDA (2008) estimates the total overall cost of drug abuse in the
United States to exceed half a trillion dollars; approx. $181 billion
for illicit drugs, $168 billion for tobacco, and $185 billion for
alcohol.
National Institute on Drug Abuse (NIDA)
 Opioids
sometimes referred to as narcotics is
a drug that produces analgesic and sedative
effects.
 Although
Opioids are often prescribed and
manufactured as medications, they can be
manufactured and obtained illegally.
 Opioids
are generally separated into two
categories:


1) Heroin and
2) Opioids other than heroin, which consist almost entirely of
prescription pain relievers
 Opioid
abuse poses the greatest drug-related
threat to Macomb County.
 Opioid
poisonings accounted for 59 percent
of drug-related deaths in Macomb County in
2008.
 Between
2004 and 2008, there was a 102
percent increase in opioid poisoning deaths in
the County.
Source: Michigan Department of Community Health, Division of Vital Statistictics
Table 1. Macomb County Number of Drug-related Deaths by Selected Drug Category,
2004-2008
Drug Type
2008
2007
2006
2005
2004
Cocaine
12
18
12
19
12
Heroin
52
22
34
20
16
Prescription Drug
13
22
26
23
10
Methadone (Illicit)
8
3
6
9
3
Unspecified Narcotics
0
2
3
5
1
Michigan Department of Community Health, Division of Vital Statistics, 2004-2008

Heroin is notably the greatest drug threat to
communities and its abuse remains
widespread, affecting both suburban and
urban areas.

Demand for heroin is high and easily
accessible.

The popularity of heroin is due, in part, to
increased availability, low cost, and high
purity which can be effectively snorted or
smoked rather than injected.

Heroin is sold on the street in small glassine
bags with some type of marking or brand
name on the package.
Office of National Drug Control Policy Clearinghouse, 2008
 Heroin
deaths, hospitalizations, and
treatment admissions are on an increasing
trend.
 The
County-wide heroin poisoning death rate
was 6.26 in 2008, a 200 percent from 2004 to
2008.
 In
2008, heroin accounted for 63 percent of
the total opioid related poisoning deaths in
the County.
Heroin
deaths and hospitalizations are higher
among males compared to females:
 Deaths
Rate: 5.74 deaths per 100,000 population
among males and 1.38 deaths per 100,000
population among females.
 Hospitalization
Rate: 7.3 hospitalizations per
100,000 for males and 4.0 hospitalizations per
100,000 population for females.
 Persons
aged 21-24 years had the highest heroin
poisoning death rate at 8.97 deaths per 100,000
population, followed by persons age 35-44 years
at 6.01 per 100,000 population.
 Persons
aged 15-24 years are hospitalized at a
higher rate (14.5 hospitalizations per 100,000)
compared to persons aged 25-44 years (9.1
hospitalizations per 100,000 population) and
persons 45-65 years (4.6 hospitalizations per
100,000 population).
Heroin Poisoning Deaths by Macomb Zip Codes and Cities, 2004-2008 Combined Years
ZIP Code
City
2007 Population
# of Deaths
48021
Eastpointe
33403
8
5 year Death Rate
per 100,000
4.8
48035
Clinton Township
35216
7
4.0
48038
Clinton Township
42309
6
2.8
48043
Mount Clemens
17289
8
9.3
48066
Roseville
49123
14
5.7
48080
Saint Clair Shores
23543
5
4.2
48089
Warren
34760
11
6.3
48091
Warren
32238
13
8.1
48093
Warren
22929
6
5.2
48310
Sterling Heights
43051
5
2.3
48313
Sterling Heights
35421
5
2.8
48316
Utica
24820
5
4.0
Zip codes with five or more deaths occurring during 2004-2008
Heroin Poisoning Hospitalizations by Macomb Zip Codes and Cities, 2004-2008 Combined Years
ZIP CODE
48015
48021
48026
48035
48038
48043
48045
48047
48065
48066
48080
48081
48082
48088
48089
48091
48092
48093
48310
48312
48313
48314
48316
48317
City
2007 Population
# of Hospitalization
2004-2008
5 year Hospitalization Rate per
100,000 population
Center Line
Eastpointe
Fraser
Clinton Township
Clinton Township
Mount Clemens
Harrison Township
New Baltimore
Romeo
Roseville
Saint Clair Shores
Saint Clair Shores
Saint Clair Shores
Warren
Warren
Warren
Warren
Warren
Sterling Heights
Sterling Heights
Sterling Heights
Sterling Heights
Utica
Utica
8526
33403
15552
35216
42309
17289
26131
38522
10807
49123
23543
22220
17495
22583
34760
32238
25802
22929
43051
33721
35421
21485
24820
28234
6
21
10
9
6
6
7
7
5
25
5
7
5
11
25
18
13
7
9
8
7
6
5
12
14.1
12.6
12.9
5.1
2.8
6.9
5.4
3.6
9.3
10.2
4.2
6.3
5.7
9.7
14.4
11.2
10.1
6.1
4.2
4.7
4.0
5.6
4.0
8.5
 The
city of Warren had the highest number of heroin
poisoning deaths (37 total deaths at 5.5 deaths per
100,000 population) during the period of 2004-2008.
 However,
the city of Roseville had a higher heroin
death rate at 5.7 deaths per 100,000 (14 total
deaths) over the five year period.
 Warren
and Roseville also experience the highest
hospitalization rates, 11.02 and 10.6 per 100,000
population, respectively.

Non-medical use of prescription drugs is an
emerging trend and has captured national and
media attention.

Studies have showed a significant increase in
prescription for pain relievers such as Vicodin,
Hydrocodone, OxyContin over the past five
years.

Data from the Michigan Automated Prescription
Service (MAPS) reports that 15,989,795
prescriptions were written in 2006; this
number increased to 17,254,281 in 2008

National studies also confirmed that giving
away and loaning of prescription pain relievers
are prevalent among youth and young adult
populations.
State Epidemiology Workgroup, 2010
 Prescription
pain relievers accounted for
32 percent of the total opioid involved
poisoning deaths in 2008.
 Prescription
pain reliever death rates
have been on a declining trend since 2006
while hospitalization rates due to
prescription pain reliever poisonings are
currently on an increasing trend.
Macomb County Number of Drug-related Deaths by Selected Drug Category, 2004-2008
Drug Type
2008
2007
2006
2005
2004
Cocaine
12
18
12
19
12
Heroin
52
22
34
20
16
Prescription Drug
13
22
26
23
10
Methadone (Illicit)
8
3
6
9
3
Unspecified Narcotics
0
2
3
5
1
Michigan Department of Community Health, Division of Vital Statistics, 2004-2008
 In
2008 death rate due to prescription pain
reliever poisonings was 1.57 deaths per
100,000.

Hospitalization rates was 16.3
hospitalizations per 100,000 population, a
rate two times higher than the heroin
hospitalization rate.
Macomb County
Rates of Hospitalizations for Poisoning by Prescription Pain
Reliever and Heroin, 2004-2008
By Primary and Secondary Diagnoses, Both Sexes, All Ages
18
16.3
16
Rates per 100,000 population
14
13.41
13.6
13.34
12
10.2
10
7.83
7.5
8
5.82
6
4
4
2.93
2
0
2004
2005
2006
2007
Rates per 100,000 population
Note: Hospitalizations are due to poisoning by Heroin (ICD9-CM Code 965.01)
Source: Michigan Department of Community Health, Michigan Resident Impatient Files, Division of Vital Records and Health Statistics
2008
 Prescription
pain reliever poisoning deaths
were higher among males (2.8 deaths per
100,000 population) when compared to females
(1.81 deaths per population).
 However,
hospitalizations are higher among
females (7.9 hospitalizations per 100,000
population) when compared to males (6.42
hospitalizations per 100,000 population) for the
five year period of 2004-2008.

Deaths were highest among persons aged 35-44
years (4.75 deaths per 100,000 population),
followed by persons aged 45-64 years (3.83 per
100,000 population) for the period of 2004 to
2008.

Hospitalizations were highest among persons
aged 45-64 years (12.0 per 100,000 populations),
followed by persons 65 years and older (11.19
per 100,000) for the period of 2004 to 2008.
 For
the period of 2004 to 2008, the city of
Warren had the highest number of prescription
pain reliever poisoning deaths (26 deaths, a
rate of 3.87).
 However,
the city of Eastpointe had a higher
death rate (5.4 deaths per 100,000
population), followed by Roseville (5.0 deaths
per 100,000 population) and Sterling Heights
(4.88 deaths per 100,000 population).
Pain Reliever Poisoning Deaths by Macomb Zip Codes and Cities,
2004-2008 Combined Years
Zip Code
City
2007 Population
# of Deaths
2004-2008
5 Year Death Rate per
100,000 Population
48021
Eastpointe
33403
9
5.4
48036
Clinton Township
22358
8
7.2
48042
Macomb
24170
6
5.0
48066
Roseville
49123
12
4.9
48081
Saint Clair Shores
22220
5
4.5
48088
Warren
22583
6
5.3
48089
Warren
34760
8
4.6
48091
Warren
32238
6
3.7
48310
Sterling Heights
43051
6
2.8
Prescription Pain Reliever Poisoning Hospitalizations by Macomb Zip Codes and Cities, 2004-2008 Combined Years
ZIP CODE
48015
48021
48026
48035
48036
48038
48042
48043
48044
48045
48047
48048
48051
48062
48065
48066
48080
48081
48082
48088
48089
48091
48092
48093
48094
48310
48312
48313
48314
48315
48316
48317
City
2007 Population
# of Hospitalization
2004-2008
5 year Hospitalization Rate per
100,000 population
Center Line
Eastpointe
Fraser
Clinton Township
Clinton Township
Clinton Township
Macomb
Mount Clemens
Macomb
Harrison Township
New Baltimore
New Haven
New Baltimore
Richmond
Romeo
Roseville
Saint Clair Shores
Saint Clair Shores
Saint Clair Shores
Warren
Warren
Warren
Warren
Warren
Washington
Sterling Heights
Sterling Heights
Sterling Heights
Sterling Heights
Utica
Utica
Utica
8526
33403
15552
35216
22358
42309
24170
17289
47457
26131
38522
7908
16573
9375
10807
49123
23543
22220
17495
22583
34760
32238
25802
22929
16801
43051
33721
35421
21485
26013
24820
28234
10
44
11
28
15
32
10
22
16
16
14
5
12
5
5
64
22
13
8
14
46
32
14
13
6
22
16
24
15
11
9
17
23.5
26.3
14.1
15.9
13.4
15.1
8.3
25.4
6.7
12.2
7.3
12.6
14.5
10.7
9.3
26.1
18.7
11.7
9.1
12.4
26.5
19.9
10.9
11.3
7.1
10.2
9.5
13.6
14.0
8.5
7.3
12.0

Macomb County ranked second among the
regional coordinating agencies for highest
number of opiate involved treatment admissions.

There was a 12.2 percent increase in opiate
involved treatment admissions from 2008 (5,673
admissions) to 2009 (5,058 admissions).

Of the 2009 total treatment admissions in
Macomb County for all substance type, heroin
admissions were highest (36 percent), followed
by admissions due to alcohol abuse (31 percent);
and 11 percent of the treatment admissions
were due to prescription pain relievers.
A
higher proportion of males (59.8 percent)
were in treatment compared to females
(42.2 percent) for opiate involved drug abuse
in 2009
 Persons aged 21-25 years accounted for the
largest proportion (22.3 percent) of those in
treatment for opiate involved drugs,
followed by persons age 26-29 years (16.4
percent).
 There
were 43,496 arrests made for nonindexed crimes.
 Of
those, approximately 20 percent were due
to arrests made for violation of narcotic laws
(3,980 total arrests), violation of liquor laws
(915 arrests) or driving under the influence
of alcohol or narcotics (3,530 arrests).

Consistent with Michigan and the U.S. trends, males are
arrested at a higher rate compared to females for narcotic
law violations:

80 percent of the narcotic law arrests among males (2,670 arrests)
and 20 percent for females (666 arrests).

Persons aged 18-24 consist of only 4.1 percent of the total
population in 2006, however 35 percent of the total narcotic
law arrests (1,100) made were among this age group.

There were 142 narcotic law arrests made to persons under 18
years of age.
Figure 19.
Macomb County Percentage of Narcotic Law Arrests by
Gender, 2006
20% (666)
80% (2,670)
MALE
FEMALE

Geographically, there were more narcotic law arrests
made by the city of Warren Police Department compared
to all other Department in the County.

In 2006, 25 percent (1,008 total) of the narcotic law
arrests were made by the city of Warren Police
Department. Eastpointe had the second highest number
of arrests made (327 arrests); followed by St. Clair
Shores with 245 total arrests.

There were no narcotic law arrests reported in the cities
of Armada, Memphis, or Mount Clemens. In addition, the
Macomb Sheriff made 504 arrests, Countywide.

In 2008, 8.0 percent (20 million people) of persons 12 or
older were current illicit drug users (NSDUH) .

Of youth aged 12-17, 9.3 percent reported current illicit
drugs user within the past month.

Nationally, marijuana continues to be the most frequently
used illicit drug among persons 12 or older at 6.7 percent,
followed by psychotherapeutics at 2.9 percent; inhalants
(1.1 percent) and hallucinogens (1.0 percent).

In 2008, 1.9 percent of persons aged 12 or older reported
non-medical use of pain relievers, nationally.

Five (5) percent of youth age 12-17 reported current
illicit drug use other than marijuana during the period
2004-2006, an 8.5 percent increase from the period of
1999-2002 in Macomb County (NSDUH).

Illicit drug use was highest among person aged 18-25
years (9.6 percent) compared to persons aged 12-17
years (5.0 percent) and person aged 26 or older (2.8
percent).

Macomb County residents aged 18-25 years also
presented higher current illicit drug use rates when
compared Michigan (9.3 percent) and the U.S. (8.5
percent) rates for current use (NSDUH).
 There
was an increase in heroin use among Macomb
high school students from 1.9 percent in 2007 to 3.4
percent in 2009 (YRBS).
 Macomb
students also reported higher heroin use
than the national rate (2.5 percent) but lower than
Michigan’s rate of five (5) percent.
 There
was a decrease in current non-medical use of
prescription pain relievers among Macomb students
from the period of 2008 to 2010 (MiPHY).
 Persons
aged 18-25 years also reported
higher rates of past year non-medical use of
pain relievers (15.4 percent) when compared
to persons aged 12-17 years (7.6 percent)
and persons 26 or older (4.3 percent) for the
period of 2004 -2006 (NSDUH).
 Rates
among this age group was higher in
Macomb when compare to the U.S. (12.2
percent) and Michigan (13.9 percent).

Boyd et. al found that 36 percent (or 965) of the students
who had a prescription for;




sleeping medication (Ambien, Halcion, Restoril),
sedative or anxiety medication (Ativan, Xanax, Valium, Klonopin),
stimulant medication for attention-deficit/hyperactivity disorder (Ritalin,
Adderall)
pain medication (Vicodin, OxyContin, Tylenol 3).

Opioid pain medications were more widely prescribed (46
percent lifetime and 33 percent past year prescription).

Girls were significantly more likely to a have a prescription
for pain medication and more likely to use them nonmedically than boys.

The study also showed current medical users were 2.9
times more likely to get approached to divert their
medications and there was evidence of trading
medications.

Students were also more likely to give away or loan
medications rather than trade or sell:





25 percent of those with pain medication prescription;
21 percent with stimulants;
20 percent of those with sleep medications;
and 15 percent with prescription for sedatives.
Overall 24 percent of those with prescription medication
gave away or loaned the medication with higher
percentage of giving away reported among girls compared
to boys.

Conduct ongoing community assessments;

Utilize data to target those in greatest need;

Build collaborative partnerships;

Utilize evidence-based and best practice
interventions;

Tap into the best analytical thinkers (federal,
state, community-based organization, academic
institutions);

Provide effective, progressive leadership
 Contact
Information
Harolyn Tarr, MPH
Manager and Principal Epidemiologist
Detroit Department of Health and Wellness
Promotion
Office of Health Information, Planning, Policy,
Evaluation, and Research (HIPPER)
1151 Taylor St. Room 354C
Detroit, MI 48202
Email: tarrh@detroitmi.gov
Phone: (313) 876-4340