1. Center for Social Work Research The University of Texas at Austin
Prescription Drug Epidemic in the United States and Texas: A Look at the Numbers
Jane Maxwell, Ph.D.
Center for Social Work Research
The University of Texas at Austin
Jane Maxwell, UT Addiction Research Institute,

2. Age-adjusted Rate of Drug Overdose Deaths by State: 2010 vs 2015
MMWR / December 30, 2016 / Vol. 65 / Nos. 50 &

3. Opioid Death Rates in States: 2010-2015
 Increases in Drug and Opioid Involved Overdose Deaths-United States,
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
Opioid Death Rates in States:
 Increases in Drug and Opioid Involved Overdose Deaths-United States, MMWR Dec. 2016

4. Number of Drug Poisoning Deaths: United States: 1999—2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
Jane Maxwell, UT Addiction Research Institute,

5. Number of Drug Poisoning Deaths: Texas: 1999—2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
Jane Maxwell, UT Addiction Research Institute,

6. US and Texas Drug Deaths
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
US and Texas Drug Deaths
U,.S.
Texas
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File.
Jane Maxwell, UT Addiction Research Institute,

7. Heroin Sources and Supply Routes
SWA
Mexican
SEA
So. Amer

8. Mexican Black Tar Heroin
Mexican Brown (“Cheese”)
South American Heroin
& “new” Mexican White Heroin

9. Fentanyl and Alprazolam (Xanax)
Jane Maxwell, UT Addiction Research Institute,

10. Opioids of Concern Hydrocodone (Vicotin, Lortab) Oxycodone (OxyContin)
Methadone (for pain)
Hydromorphone
Percodan
Dilaudid
Tramadol
Fentanyl (Acetyl & Butryl)
U-47700
MT-45
W-18
Jane Maxwell, UT Addiction Research Institute,

11. Abused Pharmaceutical Drugs Identified by Forensic Labs by US Region: NFLIS 2016
DEA NFLIS

12. Indicators of Heroin Trends in Texas: 1998-2015
Source: Texas Drug Trends:
Source:
Jane Maxwell, UT Addiction Research Institute,

13. Other Opiates
Cost difference? Heroin cap in Texas is $10-$20 vs. $5-$80 for old crushable OxyContin, $1-$10 for newer hard to crush, and $5 for counterfeit Oxy containing fentanyl.
Still problem with pain pill mills: Houston Cocktail “Holy Trinity”: oxycodone, soma, alprazolam (Xanax). Fentanyl now being pressed into these pain pills.
Evidence in Florida of decreasing pain pill problems due to Prescription Monitoring Programs but heroin is up.
Reports of difficulty in using “hardened” extended release pills so they prefer immediate release pills or shift to heroin.

14. Rates per 100,000 of Drug Poisoning Deaths Involving Heroin in the US: 1999-2015
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File
Jane Maxwell, UT Addiction Research Institute,

15. Rates per 100,000 of Deaths Involving Other Opiates, Other Synthetics, Methadone, & Other Unspecified Narcotics in the US: :
Source: CDC/NCHS WONDER-National Vital Statistics System, Mortality File,
Jane Maxwell, UT Addiction Research Institute,

16. Source For Pain Relievers Obtained for Most Recent Misuse for People Ages 12 or Older Who Misused Them by Past Year Initiation Status, and Disorder Status: NSDUH 2015
Jane Maxwell, UT Addiction Research Institute,

17. Results from the Texas School Surveys 2006-2016: Grades 7-12
Percent
2006
2008
2010
2012
2014
2016
Ever Used in Lifetime?
Heroin
1.5
1.4
1.1
0.5
0.7
Oxy & Hydro
5.0
Hydrocodone
6.3
5.3
7.5
4.5
Oxycodone
3.5
3.6
2.2
Valium & Xanax
4.0
Valium 3
2.4 2
0.9
Xanax
5.2
3.9
2.8
Very easy to get heroin?
8.5
5.7
4.9
3.1
Very dangerous for kids to use heroin?
86.6
86.7
86.1
87.6
89.6
Source: Texas DSHS
Jane Maxwell, UT Addiction Research Institute,

18. 1999 vs Overdose Death Rates per 100,000 in Texas Counties Due to Heroin, Other Opiates, Other Synthetic Opiates, Methadone, & Benzodiazepines
2010
2015
Bexar County
6.8
6.1
Brazoria County
7.3
Unreliable
Collin County
4.2
Dallas County
4.5
6.4
Denton County
Unreliable 
El Paso County
4.1
3.7
Fort Bend County
3.9
Galveston County
15.4
7.4
Harris County
6.2
Montgomery County
6.6
6.5
Nueces County
12.9
10.6
Tarrant County
2.0
4.4
Travis County
5.1
7.9
Statewide
4.7
5.0
Counties with fewer than 20 deaths were suppressed but termed "unreliable“ for Bell, Brazoria, Brazos, Fort Bend, Hidalgo, Liberty, Lubbock, McLennan, Nacogdoches, Smith, Webb, Williamson  
Jane Maxwell, UT Addiction Research Institute,

19. Medicare Part D Opioid Prescribing Mapping Tool
Medicare Part D Opioid Prescribing Mapping Tool
CMS.gov/research Statistics Data Medicare {provider Charge Data
Jane Maxwell, UT Addiction Research Institute,

20. 22
Jane Maxwell, UT Addiction Research Institute,

21. Pill Mill Pharmacy Shelves23
Jane Maxwell, UT Addiction Research Institute,

22. Medications to Treat Opioid Dependence
Buprenorphine
Methadone
Naltrexone
Naloxone
Jane Maxwell, UT Addiction Research Institute,

23. US Opioid and Heroin Patients Receiving Methadone or Prescriptions for Buprenorphine or Naltrexone vs. Abuse/Dependent or Past Month Users of Pain Relievers Nonmedically or Heroin: 2012
* Number of individuals receiving buprenorphine or naltrexone from IMS plus number of patients receiving methadone from NSSATS. Source: IMS Total Patient Tracker, Sept 2014 and SAMHSA NSSATS. Buprenorphine data exclude forms indicated for pain. Oral naltrexone factored for opioid dependence use. Methadone patients from SAMHSA, N-SSATS 2012.
Jane Maxwell, UT Addiction Research Institute,

24. /(
AND-REPORTS/MEDICARE-PROVIDER-CHARGE-DATA/OPIOIDMAP.HTML
GOOD LINKS
Jane Maxwell, UT Addiction Research Institute,

25. Jane C. Maxwell, Ph.D. Research Professor Addiction Research Institute Center for Social Work Research The University of Texas at Austin 1717 West 6th, Suite 335 Austin, Texas
Jane Maxwell, UT Addiction Research Institute,