Substance Use Trends in Pennsylvania

- I welcome all of you to our presentation today on Substance Use Trends in Pennsylvania.

This is being brought to you by Penn State Extension, specifically the Substance Use Education team, whose work is focused on educating people about the science behind substance use and addiction, and mainly, to reduce stigma.

A little bit about Penn State Extension, if you're not familiar, we are the land-grant university in Pennsylvania, so we have an obligation to make sure that all people have access to science-based education and information.

So extension educators work in teams, and our teams focus on specific content areas.

We're located in all counties across Pennsylvania.

My name is Denise Continenza, and I'm an extension educator on the Food, Families, and Communities team.

And I work on creating, delivering, and evaluating programs that impact children, youth, and families.

And within that, substance use prevention, education, and support for people in recovery is a big part of what I do.

I'm going to turn it over to my colleague and friend, Glenn Sterner, who has been a wonderful partner over the years to work with on this topic.

Glenn comes to us from the Penn State Abington campus, where he is an associate professor of criminal justice.

He also is a member of the Social Science Research and Center, and he sits on the Opioid Overdose Task Force in Pennsylvania.

He's a founding member of the Penn State Consortium to combat substance use and addiction, and he is a member of their advisory board.

And every year, we invite Glenn to come and talk with us about the substance use trends in Pennsylvania.

Each year, I hope he says, "Gee, we don't really need to do that because nothing has changed." But the reality is that this is a topic that never goes away and just changes.

So I thank you, Glenn, for being with us today, and I'm really looking forward to horrible hearing your presentation.

So I am going to stop sharing now and turn it over to you.

If you would like closed captioning, everyone should have the bar on your controls that allow you to open the closed captioning.

We have live captioning today, so, you know, please take advantage of that.

If you have questions and answers, please post them in the Q&A box, and we will, at the end of, we'll leave time at the end for discussion, and then I will read those questions to Glenn.

All right, and this is being recorded.

And as a participant registrant and participant, you'll receive the copy probably within the week, and there's a good chance it's gonna go on our Extension website.

So thank you, Glenn.

- That is, Denise, again, thanks for having me here.

I think this is, what, my fourth year giving this update on some of the trends associated with substance use in Pennsylvania. You know, one of the things that I am incredibly excited about is that Penn State Extension touches every single county in the Commonwealth of Pennsylvania, and the Extension system touches every single county across the country.

So it's a really fabulous reason for us to be thinking about how does that disseminate knowledge across, not just Pennsylvania, but across the entire country.

And so, Extension, I think, plays just an incredible role within the work that we're doing at the institution, but within communities all the way down to individual families and within our communities.

So very happy to be here.

Really excited that we have had such a great response to this webinar, and really happy to share continued information.

So one of the things that I will offer is that if you have any interest in this issue moving forward, I'm always happy to be a resource.

My email will be shared with you all at the end of the presentation.

But for now, what I wanna do is talk to you a little bit about what we're gonna be doing today.

So first, I wanna make sure that we are all on the same page, this is what I always like to do, I wanna make sure that we're very clear about the differences between substance use and substance use disorders, because those are very distinct issues.

And then we're gonna talk a little bit about some of the current substance use trends in Pennsylvania and the United States, and then finding out some ideas around some of these emerging substance use issues, things that you might have heard a little bit about that are talked about in the media, or may have heard from talking with loved ones, but just to provide a little bit of clarity there.

And then, finally, one of the key aspects of all of this is not just talking about the trends, but what can we do about these things.

And so, we're gonna talk a little bit about how do you find evidence-based practice for addressing substance use issues in communities, not, hopefully, here in just Pennsylvania, but frankly, anywhere.

And so, I'm gonna share with you a little bit about that difference between substance use and substance use disorders.

I find that sometimes having other folks explain this to me who know this subject inside and out is really important.

So I'm gonna share with you a small video clip from the CDC, and just to give you a little bit of taste of what this means.

So here we go.

- [Announcer] Does use of alcohol or drugs ever seem out of control for you or a loved one?

Has it ever seemed like the line between fun and dysfunction is unclear?

About 60% of Americans age 12 and older currently use alcohol or drugs.

For some, this use can become an addiction or what we call substance use disorder, or an SUD.

An SUD involves out-of-control use of a substance, even though it causes you harm.

People with an SUD become focused on using the substance to the point where they have problems with day-to-day functioning.

People with serious SUD will continue to use substances even when they know it is causing or can cause harm.

Heavy substance use directly impacts the body and mind and can affect parts of the brain that control how you think, make decisions, learn, remember, and control your behavior.

How can I help someone struggling with substance use disorders?

Learn all you can, speak up, and offer constructive support, and don't wait for them to hit bottom.

Substance use disorders are treatable, and recovery is possible.

For more information on substance use disorders, including treatment options, please visit www.psychiatry.org.

Does...

- So that was actually from the APA, American Psychological Association, and I'll share some more resources from them in the near future, but what I thought that video really did was help to set the stage, right?

So we know that there are differences between substance use and substance use disorders.

Lots of people use substances, right?

Like, if you drink coffee on a regular basis, you're using caffeine, that is a stimulant that is a substance.

If you ever have a drink of alcohol, you're using a substance.

And so, we tend to provide this discussion around substances as illicit drugs, and really, that's not the case.

And so, I wanted us to, first of all, understand that substance use is really thinking about this from the CDC.

So it refers to the use of selected substances, including alcohol, tobacco products, drugs, inhalants, and other substances that can be consumed, inhaled, injected, or otherwise absorbed into the body with possible dependence and/or detrimental effects.

So we talk about substance use, and there's a whole host of reasons why people engage in substances.

And frankly, the literature doesn't agree with regards to what those reasons all are, but there are many, right?

So it can be everything from recreational use to social use, all the way to potentially self-medication.

And when we find, though, that substance use turns into something that is more problematic, that's when we start to have to have this discussion around the concept of substance use disorders.

And so, these are the criteria for the what's called the DSM-5, it's the just Diagnostic Statistical Manual for Psychiatric and Psychological Disorders.

These are the criteria for a substance use disorder within that diagnostic manual.

Note here that this is, first of all, my sharing with this to you is not meant for you to start thinking about your own self-diagnostics, this is something that should only be done with a professional to really diagnose a substance use disorder.

But along those lines, if you are noticing that there are some problematic behaviors that either you, yourself, or some people that you love or know might be exhibiting, it might be worth it just to reach out to them and say, "Hey, look, do you need some help?" Remember, in that video, they said, "Don't let them hit rock bottom," that's a concept that we've really heard a lot about, that concept of rock bottom, and that's not necessarily always something that we really hope that people have to go through.

We know that if you reach out to individuals who might be struggling earlier, getting them into treatment as early as possible, that has a higher likelihood of success.

So I shared these with you only to help you to understand that when we think about substance use disorder and substance use, it is very distinct.

So substance use disorder really talks a little bit about these issues that compound across a person's substance use.

And so, it can include using in larger amounts for longer than intended, wanting to cut down, or stop using, but not managing to, spending a lot of time to obtain, use, or recover from use, cravings, the inability to manage commitments due to use, continuing to use, even when it causes problems in relationships, giving up important activities because of use, continuing to use, even when it puts you in danger, continuing to use, even when physical or psychological problems may be made worse by use, increasing tolerance, withdrawal symptoms.

So across substance use disorder, you might find that some of your, you or your loved ones might exhibit some of these behaviors, and maybe not consistently over time, that's why it's really important to connect with a professional.

But the other part of this is that we think of substance use disorder as a scale, as a spectrum, and this is why it's important to understand that, you know, when we think about the lower end of the scale, it's like roughly fewer than two symptoms, and roughly no disorder is really there, but there might be some things you might want to just talk about in order to address some of the problematic issues associated with use, and thinking about how do you utilize substances, specifically thinking along the terms of alcohol even, in ways that don't lead to future issues.

But when you have two to three symptoms, that's when you're starting to get into this concept of, like, a mild disorder, four to five, moderate disorder, and six or more symptoms, that's when we really think about this as a severe disorder, or even what we would consider addiction.

So addiction really is towards the more extreme end of a substance use disorder.

So you typically hear SUD, substance use disorder, or addiction kind of used interchangeably, but really, when we're talking about addiction, it's really something that's a bit more extreme.

And so, when you're thinking about the concept of substance use, which is just using a substance, no potential issues there, all the way to a substance use disorder, which is exhibiting problematic behaviors associated with your substance use, that's the importance of understanding those differences.

Now, let's say that you have someone, or you yourself might be exhibiting some of these symptoms, there are ways to make sure that you can get assistance in order to address them.

And again, I recommend that finding ways to have that conversation early and as early as possible, because like I said before, that increases their likelihood of being successful in that recovery process and understanding how to manage some of those, you know, potentially problematic behaviors, and that is through places like, for example, the American Psychiatric Association, that video provided some good information around where to access this.

But this really is giving you some just a bit more education around what actually is a substance use disorder, what to maybe think about.

There's also the National Institute on Drug Abuse, and they have a really wonderful publication about what is drug addiction, which is very specific to illicit drugs, and how that moves from just recreational use or experimenting potentially into this full-blown substance use disorder and addiction.

We also have, so let's say that you are trying to find treatment, the SAMHSA, or the Substance Abuse and Mental Health Services Administration, has a really great treatment finder that is available to anyone.

You can go onto their website, it's findtreatment.gov, and this will get you access to even down to your local level as far as access to treatment.

Shatterproof, a national or nonprofit organization addressing issues associated with addiction and substance use, has developed also their treatment atlas for finding treatment.

And so, their spans a little bit more, it might have different information from SAMHSA.

So I really recommend that you take a look at both of those locations because they provide different resources associated with the different treatment opportunities that they have on their websites.

But this one is treatmentatlas.org.

If you know someone who is in crisis, whether that is from substance use issues or mental health, there's a national, this is new, within the last couple of years, and this is really great, and it's now national, it's a hotline for mental health and substance use disorders.

Just dial 988, like we dial 911, dial 988, they will connect you to resources in order to get you connected to people all the way down to your local level.

And in Pennsylvania, we have the Pennsylvania Department of Drug and Alcohol Programs.

They're your best bet to go to for resources.

They have, on their website, an opportunity to look at some of the local needs, and so, local resources associated with treatment all the way to recovery support services.

They're doing a fabulous job of expanding ways to really think about that spectrum of ways that we can think, from prevention all the way to recovery, with regards to substance use issues that are facing our communities and our commonwealth.

I will also note that through the Department of Drug Alcohol and Programs, in Pennsylvania, you also have access to what are called single-county authorities, these are the individuals who charged with making sure that we have access to substance use and other gambling-related issues, excuse me, gambling addiction-related issues in the Commonwealth of Pennsylvania.

And so, each county has one, and some counties share an SCA, but every single county in the Commonwealth of Pennsylvania has access to an SCA.

So I really recommend that you look for those folks if you are really specifically trying to connect with somebody locally that can help you discuss some of those options, they're very knowledgeable.

But now that we've talked a little bit about substance use and substance use disorders, one of the things that I wanna also highlight is that, unfortunately, you know, we have people that move into that substance use disorder realm.

Not everybody who uses a substance, not everybody who engages in recreational use, not even anybody who, you know, comes in contact with prescription opioid painkillers, not everyone is going to move into that substance misuse and substance use disorder experience.

And so, it's one of the things that I always highlight, is that it's actually quite few people that actually do that.

And so, note that even if you know that there are individuals who are using substances and are utilizing them recreationally, that doesn't necessarily mean that they have a problematic use issue.

But you might want to, like I said, mentioned before, just discuss with them anything that you might be noticing, or connect them to resources accordingly.

But one of the unfortunate in, you know, one of the things that we've noted in the Commonwealth of Pennsylvania and across the United States is that we have been facing an overdose crisis.

You know, we used to call it the opioid crisis, I used to call it the opioid crisis.

But you'll see within some of the data that we're about to share that that's not necessarily the only issue that we need to be thinking about.

So instead of thinking about this as an opioid crisis, I like to think of this as an overdose or a substance use crisis that's affecting all of our communities in Pennsylvania and across the United States.

So let's talk a little bit about some of those trends that are facing us currently and how they've been changing.

So these are the most recent data, 2022, where we should be coming out with 2023 data roughly in any week now.

Usually, those are released in end of June, in July sometime because it takes a long time to aggregate all those data up.

But, so 2022 is our most recent data with regards to overdose deaths across the country.

And you'll see that, you know, Denise had alluded to it before, I come here always with bad news, and I, unfortunately, have some bad news to share again.

We have increased the amounts of individuals who have passed away from an unintentional drug overdose, and that is, in 2022, we hit our peak again, 107,941 United States residents passed away from a drug overdose, unfortunately.

We do see that the increase in overdose deaths has increased among men more precipitously, more than women overall.

We've seen women actually level out and maybe even decrease a little bit, whereas men continue to increase and with regard to their overall overdose deaths.

And so, this is a trend that we're monitoring and something that we wanna make sure that we're thinking about when we're starting to reach out to populations that might need, first of all, a little bit of help getting into treatment, but also awareness of some of the issues associated with substance use.

And when we start to think about some of the actual substances contributing to overdose deaths, you know, I mentioned before, most of what we've talked a lot about have been opioids, and certainly, opioids continue to be the leading driver in overdose deaths in the United States, particularly synthetic opioids.

So that gray line, the one that's very, all the way up to the top right here, those are synthetic opioids, specifically what we see driving there, and you should be not surprised by this, but this word, fentanyl, this very strong, very potent opioid and its other related similar versions of fentanyl, so carfentanyl, fentanyl, in that realm of these, these synthetic opioids that have been infiltrating and poisoning our drug supply.

We also have seen an increase in psychostimulants, but we, you know, like I mentioned before, luckily, we have seen that level off a little bit, which is good.

So we're hoping that we actually see that go down in the future.

And that is different from cocaine, we still see cocaine continuing to rise here, and that's likely because it's also being adulterated with fentanyl.

When you do a toxicology screen of somebody, and you see that there are multiple substances in their system when they pass away, we note that it's really hard to distinguish whether or not they were taken at the same time or intentionally discussed, excuse me, intentionally ingested, and then utilize at the same time, or whether it's something that was just completely accident, that somebody might have gotten a poisoned version of cocaine.

These are things that you can't necessarily always understand.

So I do share some good news.

And so, here's my bit of good news that we get to talk a little bit about.

We've talked previously in years about the issues associated with heroin and the issues associated with prescription opioid painkillers, things like OxyContin, oxycodone, here is some good news.

So this blue, this darker blue line here, that is heroin, we've started to see overdose deaths that are very specific to heroin go down over time, that's good.

We're starting to see that, but that is likely because we see fentanyl increasing.

So people are masking their heroin as fentanyl, essentially like counterfeit heroin.

In other good news, though, we do see prescription opioid painkillers, those overdose deaths going down over time, so that's also good.

We also see benzodiazepines, that's been a substance that we've slowly seen creep up in overdose death, toxicology screens, and that is bending the curve as well.

So we're also starting to see a little bit here where some of these substances may be, hopefully, decreasing in their use patterns over time.

When we start to look at just specifically opioids, we continue to see that opioids continue, as I mentioned before, to lead the country with regards to the months of overdose deaths, you know, over two, over four-fifths of all of the overdose deaths in the United States are associated with some sort of an opioid.

Prescription opioids, again, this is my, I shared this slide again because there is a little bit of good news here, because even prescription opiates in combination with synthetic opiates.

So when you find that somebody who has OxyContin or something like that in their system as well as maybe fentanyl, that combination is actually decreasing over time.

And so, we're, again, we're likely, hopefully, seeing, and this is in large part due to some of the ways that we've thought about access and thought about messaging around prescription opioid painkillers in the United States, hopefully, some of those are decreasing over time.

Again, heroin here is something that we have seen drop off dramatically.

And I will say, I don't know that we expect, particularly, I don't think we were expecting this, it has dropped off so much so that we now see that heroin without any other opioid is completely back to its, you know, roughly 1990 level.

We still see, though, that there is heroin in combination with synthetic opioids, other than methadone, higher than that, but much lower than what we saw before.

So there is good news, but that also lets us know that probably what's happening is that when you are obtaining illicit heroin from the streets, it's likely being sold as heroin, but probably it is most likely just solely fentanyl, and that's what we've been discussing with our law enforcement partners, that when they talk about heroin that's being sold on the streets, it's likely not heroin.

And that's why there's important opportunities for us to think about what we consider drug checking, so this is a harm reduction strategy to make sure that you're not poisoned by use, even if you are utilizing within your substance use disorder.

So we wanna make sure that you stay alive so that we can get into treatment.

So by doing so, we have the ability here to utilize what are called fentanyl testing strips, there's also xylazine, and I'll talk about that, but there are different testing strips to make sure that the substances that you are utilizing are not poisoned with them.

Again, benzodiazepines has been decreasing over time, even in conjunction with synthetic opioids.

But here's our, maybe our greatest concern at this stage, we are seeing this stimulants in combination with synthetic opioids.

So most of the time, what this combination is is methamphetamine in conjunction with fentanyl.

And so, sometimes those things are intentionally sought because that methamphetamine, that stimulant, can overcome some of the depressant issues associated with utilizing fentanyl.

And so, that's why people might utilize them in concert with one another.

Sometimes, sometimes methamphetamine might be laced with fentanyl, but most of the time, what you're likely seeing is some combination of utilizing these substances at the same time, because fentanyl is so strong, in order to counteract the potential effects, you might utilize methamphetamine, but over time, the use of those can build up in your system, that will then lead you to an overdose, which is likely what we're seeing within these trends going on, particularly within that combination of methamphetamine, the stimulants in combination with synthetic opiates.

Antidepressants have continued to rise slightly, but really have leveled off, that's not something that we're particularly concerned with at this point, but something that we always want to at least be aware of.

But here's where I get to actually, again, share a little bit of good news.

So these are what are called provisional drug overdose deaths, this is through the CDC, these are not verified, so sometimes these might go up a little bit, just a heads up.

But these are basically, you know, initial counts of what we are seeing with regards to trends associated with drug overdose deaths.

What you're seeing in January 2023 to 2024 is that we might actually be seeing some of these overdose deaths come down.

This is likely associated with some of the messaging around the dangers of fentanyl and fentanyl-laced illicit drug supplies.

It's also likely associated with harm reduction strategies, so again, hopefully, getting the word out there that you can check drug supplies specifically to make sure that you're not being poisoned.

And then the use of naloxone continues to be something that we are really focused on, because this is just one, overdose deaths are only one indicator of the issues associated substance, and it's not the only indicator, but this lets us know that maybe some things upstream are, hopefully, working, and that's something that we're gonna continue to focus on as we start to address issues of substance (faintly speaking).

When we think about the change geographically across the country, when we think about the percent change in drug overdose deaths between, you know, roughly January 2023 and 2024, the good news is, is that on the East Coast, in the eastern part of the country, we're actually seeing a positive trend, that we're reducing overdose deaths by and large, except for only a couple of the states, whereas much of the increase in overdose deaths is on the western side of the country.

For those of you who have been following this over time, this is a little bit flip-flopped.

For much of the history of the opioid crisis and the overdose crisis, the East Coast, and particularly, in Pennsylvania, Appalachians and Ohio, West Virginia, we've really been hit hard by overdose deaths here.

But this lets us know that maybe something is occurring that we need to keep our eye on, particularly in the western side of the state, of the country, in order to address some of the emerging drug use issues that might be facing us all.

But what about Pennsylvania specifically?

So let's take a look at some of the trends that we are facing here.

The good news, in 2022, we actually saw a decrease in the overdose deaths compared to 2021, roughly a 4% decrease, but there's still quite a few people who are dying here in Pennsylvania.

5,158 people died in 2022 from an drug overdose death.

And frankly, one is too many, but that is a high number when we start to look across the entire country, and we, again, were among the highest as far as the actual number of deaths as well as the rates of overdose deaths.

And if you think about like this, roughly, every two hours, one Pennsylvanian died from a drug overdose in 2022, almost, you know, three-quarters, 70% or so, were men, and a little over half were people who died of home.

And so, one of the things that is a risk factor is utilizing by yourself and utilizing in a place that is not around others.

And so, when you use substances in your home by yourself, you're at a higher risk of overdose death because there's nobody there to administer naloxone, watch you, you know, make sure that you, you know, are going to be okay.

So these are increased risk factors when we start to think about the potential for overdose death.

Roughly 84% of the overdose deaths in 2022 in Pennsylvania were opioid-related, and of those, unfortunately, we see most of them are associated with fentanyl.

So fentanyl is very heavily involved in the illicit drug supply here in Pennsylvania.

We know that many of our substances and many of our drugs are frankly poisoned by fentanyl.

Here in Pennsylvania, it is unfortunately something that is ever present.

When we look at the overall drug trends, again, 2023 is still provisional, and this may change, and this may go up a little bit, but again, I share this because it does look like we might have, hopefully, found a downturn in some of the overdose deaths associated with drugs within the Commonwealth of Pennsylvania.

2023 is lower than 2022. 2022 is lower than 2021.

We hit peak in 2021, again, in the pandemic.

But thankfully, we're starting to see some of these overdose deaths decrease.

And I, you know, I mentioned before about the opioids and fentanyl, but we still see any stimulants as well as cocaine being something that is really, something that we're really concerned with.

But if you look up towards here, xylazine, this is something that I've talked a little bit about before in these presentations, but xylazine, and what I'm gonna talk about what that actually is in the emerging issues.

But xylazine is increasingly part of the problems here in Pennsylvania, and roughly, about a quarter of all of the deaths involve xylazine within somebody's system.

And so, when we think about the trends and the most common drugs contributing to the cause of death within Pennsylvania, we look at opioids, that has continued to always be, you know, very high, opioids, not fentanyl, have gone up over time, but we, you know, we saw the emergence of xylazine, and that has done nothing but go up.

Many of these others are, again, thankfully, benzodiazepines are going down or nothing of.

So methamphetamines, it has actually leveled off for us here in Pennsylvania, but other stimulants, including cocaine, because it is so very easy to adulterate cocaine and poison cocaine, essentially, with fentanyl, that that's likely what's occurring here with this rise of overdose.

When we take a look at overdose deaths by county, the highest numbers, again, continue to be within our major population centers, but we still see a smattering of them across the Commonwealth of Pennsylvania.

Those that are in white are not reported publicly.

And it is nice, though, to see that there are some counties who have dropped to zero overdose deaths, particularly in 2022.

Now, we'll see about those changes in 2023, and we're gonna continue to monitor these.

When we look at the trends and demographic trends associated with overdose deaths in Pennsylvania, not surprisingly, men outnumber women two to one, roughly or so, 'cause that has been the trend for many, many years at this stage following national trends.

We have seen the, what I would consider the overtaking of overdose deaths of non-Hispanic populations by Hispanic populations.

So we see an increase in overdose deaths in Hispanic populations, which we're very concerned with.

And there has been a lot of concerted efforts to reach out to Hispanic populations within the Commonwealth of Pennsylvania to make sure that we can address some of these rising issues.

We've also started to see that, you know, previously, most individuals associated with overdose deaths and opioids have been individuals who were in the, you know, the 30s to 40s, and sometimes 50s range, and that they were, you know, primarily white, overwhelmingly white in some circumstances.

We are now seeing that the, unfortunately, Black populations across the Commonwealth of Pennsylvania are dying at a faster and faster rate from a drug overdose death than white populations, and that increase has been something that has been, something we've been very concerned with, but something that we're also seeing that is accelerating, not necessarily slowing down.

So that's something that we really wanna make sure that we're thinking about now and into the future.

When we look at age, you know, we typically think of substance use and drug use as something that is a young person's experience, when, in reality, with regards to opioids and the overdose crisis, it's really people in the 35 to 44 range that we're the most concerned with, 'cause those are the individuals that are dying at the fastest rates.

But we still see those within the 45 to 54 range.

Again, we're really concerned with these older populations as they continue forward, but 25 to 34, and then 55 to 64, we, you know, these are the key ages that we're really trying to address issues of overdose here, and getting them into treatment so that we can make sure that they have a long, happy, healthy recovery for the rest of their lives.

As I mentioned before, overdose deaths are only one of the indicators.

And so, I wanna share with you a few of the others.

And this is about substance use trends, and this comes from the National Survey on Drug Use and Health, put out by SAMHSA, and this is released every two years, so 2022 is our most recent year of understanding the past year drug use.

And so, in the United States, you know, more people than not do not use illicit drugs, just to put that out there, most people in the United States do not use illicit drugs.

But in the past year, you know, about a quarter of all United States citizens, residents, I should say, used drugs in some way, shape, or form, and the majority of it is cannabis, marijuana.

And so, if we look at the breakdown of past year drug use in the United States, most of it is around cannabis and marijuana use.

And likely, once we understand that that, as we see the policy landscape change, we will likely see some of these shift and understand illicit drug use a little bit differently into the future.

But we see, you know, prescription pain reliever misuse continues to be something that we're quite concerned with.

Hallucinogens has actually continued to grow a bit over time.

And, but if you take a look at the various substances here, you see that heroin is very low.

You know, we don't even measure for fentanyl and those types of things and other types of illicit opioids, because most of the time, people are not specifically seeking them out.

They're typically adultery.

And so, we don't measure those use patterns.

But when we take a look at, among the people who are utilizing opioids within the past year, you know, roughly 1 million of them are associated with heroin use, and in some way, shape, or form, they might be combining, you know, prescription pain reliever misuse and heroin use, so about 587,000, so 6.6% of opioid misusers.

So you see this overlap between heroin use and prescription opioid pain reliever use, and that's likely because people are transitioning or can no longer get access to prescription opioid painkillers because it makes it a little bit harder.

And so, you might see some switching between the two for those people who might have to move into maybe utilizing heroin from illicit sources because they can no longer meet the needs of their substance use disorder if they're actively in that process.

When we look at stimulant misuse among people age 12 or older in the United States, you know, roughly, you know, 5.3 million people utilize cocaine, 3 million people use prescription stimulants only, and then 2.7 million people use methamphetamine, and then there are various combinations here that you start to see are more prevalent, and frankly, are, you know, are more common.

And so, polysubstance use is something that we're consistently concerned with because it puts you at a higher risk for some of these, like I said before, issues associated with overdose, but also, potentially, into some of those issues associated with substance use disorder.

Not all of these individuals who are utilizing stimulants in the past year have a substance use disorder, just to know.

And so, when we think about the actual trends associated with substance use disorder, I mentioned before that we think of this as a scale, from mild to very severe.

And so, you know, roughly about 4.87 million Americans, a little bit more than one in six Americans who are 12 or older had a substance use disorder within the past year, about one in five had a severe disorder, about one in five had a moderate disorder, and more than half had a mild disorder.

So when we talk about individuals who might have a substance use disorder, again, very few of those who actually do are actually in that moderate to severe range, not necessarily within that mild range.

And when we take a look at the different types of substance use disorder, so we've also taken a look at, of those who might have a substance use disorder, we boil it down a little bit more, those who might have what we call a drug use disorder, drug use disorder here is specifically illicit drugs or misusing sometimes even prescription drugs.

But here is what we're looking at specifically, so not alcohol, not tobacco, is what, basically, what this starts to peel off.

And we see that only about 10% of Americans, you know, roughly have some sort of drug use disorder, and of those, only about 2.2%, so 6.1 million of those have what we call an opioid use disorder.

And so, about, you know, among people who are in the 12 or older range, a little over one in five had an opioid use disorder, or about 2% overall, of those with a drug use disorder, I should say.

So we talk about substance use, and we talk about indicators of substance use issues in our community, that's why it's so important for us to really think about this within these various indicators.

So we see drug overdose deaths, we see past use, we see opioid use and other drug use disorders as indicators.

We also can look at what's called emergency room visits.

So emergency room visits help us to explore when you present with an overdose, but it may not necessarily be fatal.

The more that you're seeking out, specifically emergency room assistance, that tells us that you have acute issues that you might be going to the hospital assistant for.

Sometimes that is very early in your opioid use or other substance use disorders, sometimes that is in the middle, and then sometimes that's at the very end.

So there are various touch points that we wanna make sure that we're thinking about when you come into an emergency room.

But across use patterns, we've seen, you know, it spike, but overall, we're starting to see, again, these are preliminary numbers, but in 2022, 2021, we're starting to see that trend go down because that tells us that fewer people are presenting with an overdose, which is, frankly, that's a good thing.

We can also take a look at use youth patterns, and so, excuse me, youth use patterns.

And so, within Pennsylvania, we have what's called the Pennsylvania Youth Survey, PAYS.

Now, these data do are not the totality of all individuals in Pennsylvania, but this gives us an understanding of rough trends when we start to look at youth use patterns.

And so, I put this out here because we still see that among youth, the most prevalent when we look at the youth use patterns is alcohol and cabinets.

We still do see some vaping and cigarette use, specifically, we're really concerned about vaping and e-cigarette and their long-term health impacts.

But when we think about drug use and substance use within youth patterns, these are our major concerns with regards to use because they have the highest rates across, you know, like I mentioned, from sixth all the way to 12th grade with regards to their use.

And what we wanna make sure that is, particularly for those who are interested in prevention, is that understanding of when we can delay use, the longer that we can delay use, the least likelihood that people then, oh, I should say, the lower likelihood that individuals then are engaging in substance use patterns that might be problematic over time.

And there are ways for us to then utilize evidence-based practice to, hopefully, delay and provide strategies for youth patterns to, hopefully, go over time.

When we look at early initiation, so this is when, so when we start to look at when people are starting to use these various substances, so within the past 30-day use, we see, again, alcohol and marijuana, vaping tends to be the highest among all the substances, but we do see something that we wanna continue to monitor, that prescription, though, over-the-counter drug use medications, this is lifetime use of youth within Pennsylvania populations.

We do see, frankly, that use of prescription pain relievers has gone down over time, so that's good news, we're seeing that people are less willing to utilize those things, particularly, if you take a look at 12th graders, that has been the biggest precipitous decrease, which is, again, a good sign.

We've seen some of these others used over-the-counter drugs to get high, so fewer of those types of things are occurring, prescription stimulants are going down.

So we do see some really good trends with regards to some of the youth use population, use, excuse me, use within youth populations, that is a very difficult thing to get over my tongue.

We also wanted to take a look at some of these other things, so other drugs, so cocaine, methamphetamines, and heroin.

There's actually quite, there's quite a little, you know, use within youth populations here in Pennsylvania, that's a good sign, it's really good, like there are indicators that we are happy about, that there isn't use amongst this group.

Methamphetamine, heroin, again, has gone down, has always been low, but these are certainly trends that we wanna keep track of.

Hallucinogens has actually gone down, even though that is, again, you know, a fair higher use than some of these other substances.

Ecstasy and molly have gone down, synthetic drugs, you know, roughly about the same, this includes things like spice and those other synthetic cannabinoids, those types of drugs that are available out there.

But we do see that those trends have not increased, some regards decreased or roughly seen the same.

So we have a mixed bag of issues here in Pennsylvania.

We have good trends with regards to some of the youth population use.

We tend to see youth population use decreasing over time among most of the categories of substances, including legal drugs, well, it's illegal for them, but alcohol all the way to illicit drugs in illicit markets.

We are starting to see a decrease in overdose stats.

We're starting to see emergency room admissions and seeking out decline over time.

So this is telling us that things are moving in a positive trend, and we need to continue to keep pushing.

But what can sometimes sabotage that work is what we call emerging substances, these are substances that we're not familiar with, they might be infiltrating the drug supply, they might be something new that's designer that is posing potential health risks, both from the individual all the way to the public health level risks.

And so, we wanna keep an eye on that.

One of them is counterfeit pills.

So for those of you who don't know, you can buy pill presses off of places, even like eBay to Amazon.

I wouldn't recommend that because (laughs) you must know that there are agencies out there that are monitoring those sales.

But because you can buy all these different components, there are the potential to then press pills on an individual basis.

And frankly, we have seen that occur, both within Pennsylvania, but also imported in bulk.

And so, basically, these are pills that are pressed to resemble prescription opioid painkillers in most of the cases.

We've seen this concept of rainbow fentanyl pills.

These pictures here, you might have seen.

And the rhetoric has been that they're trying to advertise them to children.

And frankly, that is not necessarily the case, we don't actually find that.

And additionally, rainbow fentanyl pills are not necessarily widespread.

Most of the time what you're finding is that you're seeing pills that are pressed to resemble Percocets, OxyContin, those types of things, because they are much cheaper to obtain and much cheaper to sell rather than the real thing.

So that's what you should be more concerned with rather than rainbow fentanyl pills, for example.

There's also this other class of drugs that has been popping up, it's called nitazenes, these are other types of synthetic opioids, the potency of these can potentially surpass fentanyl.

And so, one of the things that we're continuously waiting to see and watching for is making sure that these, monitoring them within toxicology screens, because you have to test for them in order to monitor them, and so, that's what we've been doing, and we have seen that there are certain nitazenes that have been increasing over time with regards to they're popping up, some will pop up for a little while and then go back down.

But we are con consistently finding ways to make sure that we are addressing this, because sometimes, you might think that it's a fentanyl issue, and really, it might be one of these other substances.

There's also this concept of xylazine.

You probably have heard this out in popular press, xylazine, tranq.

So xylazine is mixed with fentanyl typically, it is a sedative, it is a veterinary anesthetic, and it is an adulterant to fentanyl-laced products, among others, but mostly in fentanyl, and this is where when we start to see where seizures have occurred, we in Pennsylvania are among the highest.

So Ohio, Pennsylvania, New Jersey are among the highest of where these, we're finding this within our drug supply, as I mentioned before, about a quarter of all of our opioid overdose deaths included that within those toxicology screens.

And so, we wanna be aware of this.

There are xylazine testing strips, but when you use Narcan and you find somebody who is overdosed, that does not reverse the effects of xylazine.

And so, that's why we're really concerned here, because unfortunately, Narcan and naloxone do not reverse the effects, and we do not have a way of saving people who have been poisoned by xylazine.

There's some other emerging substances that you should be aware of, that's called medetomidine, I can never pronounce that correctly, but it's another type of sedative that is utilizing veterinary medicine, it's replacing xylazine, so we're concerned about being able to maybe test for those types of things.

So just be aware that this is occurring.

So a couple of of interesting trends, so we have this, it's called fenethylline, it's called, or it's called Captagon, it's an amphetamine-type stimulant.

So you might see that emerging within discussion, and it's most commonly used around in the Arabian Peninsula.

But it has started, we've started to see it appear in some of the toxicology screens and some of the, what we call seizure data, within the criminal justice system, we're starting to see that pop up as well.

But in good news, synthetic cannabinoids, synthetic cathinones, or what we call bath salts, ecstasy, molly, we are see seeing a trend downwards of some of those substances that we were previously concerned with, so that's a good sign for us.

By the way, we have this group in Pennsylvania that's called Pennsylvania Groundhogs, this is a new group that has taken on independently of any government agency, it's a nonprofit group that is testing drugs to give us better alerts of some of the issues with the illicit system and the illicit drug supply.

You can sign up for alerts there, but they provide some of the most recent understanding of some of these emerging trends if you're really interested in them.

As well, so we've talked about trends, we've talked about some of the issues, we've talked about that there are some of the things that are going on with regards to some of those trends, in which I can see positive impacts.

But I wanna finish today with this concept of evidence-based practice for addressing substance use issues in the last, you know, few minutes that we have.

And so, when we talk about evidence-based, what we are really talking about is a spectrum.

And we wanna really, again, (chuckles)

invest in programs and initiatives and interventions that are in this green-to-yellow zone.

We wanna stay away from things that are harmful.

So in order for us to be able to do so, we need to make sure that we are evaluating the impacts of our interventions over time on public health and safety outcomes, so including overdose deaths, emergency room admissions, all the way to incarceration and connection with the criminal justice system.

And so, if we can find ways to renew some of those trends that we've talked about before and find approaches and interventions that are leading to those, we wanna make sure that we continue to invest in those things.

We wanna stop investing in those that either turn the tide the other way so that it can either have no effect or potentially increase the likelihood of overdose deaths, we wanna stop ourselves from doing those.

And so, that's why it's important to understand evidence-based practice.

And so, this ranges from things that are promising approaches.

The program is similar to other effective programs, but hasn't really been rigorously evaluated yet, so we wanna maybe explore some of that as we continue to grow the evidence-based.

We also wanna invest in things that are research-based, so this is a program that's based on sound theory informed by search, all the way to this very important area that we call evidence-based.

And so, evidence-based criteria are roughly these three.

And so, demonstrated effectiveness in rigorous scientific evaluations, including randomized control trials, was assessed in large studies with diverse populations or through multiple replications by independent researchers, and resulted in significant and sustained effects for a minimum of six months, that's a very high bar to reach.

And we know that not all initiatives are going to reach that, but we should continuously be striving to make sure that they do, that we are finding ways to evaluate and invest in those types of things, but in order for us to be able to grow that evidence base, we have to start thinking about creative ways to, you know, implement these interventions in our communities to then, hopefully, have a positive impact on these outcomes.

And one way to do that is to work with Penn State University's Evidence-Based Prevention and Intervention Support.

They are very great experts on evidence-based and how it is that you think through that process of developing evidence for the interventions that you want to evaluate over time, or implement evidence-based interventions in your communities, along with the University of Pittsburgh's Overdose Reduction Technical Assistance Center.

They've recently been very successful in demonstrating that the work that they do in coalitions and counties has actually reduced overdose deaths, thanks to their interventions, and thanks to their work.

And so, we wanna continue to invest in these experiences that, again, reduce overdose deaths and these other indicators.

There's also the, from SAMHSA, there's the Evidence-Based Practices Resource Center.

And so, if you go there, you can look and see specifically what issues that you are facing in your communities, whether that's overdose deaths to needing treatment, to needing prevention, you can take a look and see what's available there, and you can then connect with folks at SAMHSA in order to help get technical assistance support.

One really great resource is through Brandeis University, and you can actually go to this location, you can type in some of the things where you can both put in what your communities might need in order to address some of these substance use issues.

And then it connects you to specifically evidence-based practices in order for you to address those issues that you're facing.

And so, I wrap up with potential opportunity here for just a few minutes for some questions.

And if you have any, you know, needs in the future, feel free to reach out to me, happy to be a resource for you, and happy to connect you to folks who may be able to answer questions a little bit better than even I can.

And so, we'll do that, and then I'm gonna also share with you, I think that the evaluation form is gonna be shared with you in the chat, I'll also put that up on the last slide here so that you can fill that out.

But at this point, we'll take maybe a couple minutes for some questions.

- Well, thank you so much, Glenn, and while we're waiting for people to post any comments, questions they have, you can just put them in the question and answer box, and we'll share those.

I just thank you so much, Glenn, for what you shared today, and I really feel encouraged.

I feel, you know, that the work we're doing in Pennsylvania really matters, and, you know, we're seeing change, we're seeing changes in trends, gradual changes.

We appreciate what you do to keep us informed, so we can keep our fingers on the pulse of those trends.

I just want to share my screen quickly. Whoops.

(laughs) I always have this issue when I share my screen.

Just to give you some, a little bit of information about Penn State Extension, and hopefully, you're seeing that.

If you want more information on any of our programs, you can go to extension.psu.edu, and Extension is just a wealth of information on every topic imaginable.

You can also sign up to receive information on a regular basis about topics that are of interest to you, whether it's related to substance use and addiction, raising children, raising a garden, whatever, Extension has sound information to share with you.

So I'm just gonna check and see if we have any questions here.

- We've got one question.

- We've got one. Okay.

Can you- - Can we start the question around- - Are you able to read, you able to read that? - Yeah, happy to.

So, Elise, you asked the question around trends with regards to the substance kratom.

So kratom is a synthetic cannabinoid, it is available over the counter in many locations.

You can get this, just as you were mentioning before.

One of the things, though, that we are not seeing is any specific spikes in either issues associated with overdose deaths or hospitalizations associated with this substance.

If you have greater concern around any of the health issues associated with kratom, you know, at least one of the things that I do recommend is you, there are some really great fact sheets through SAMHSA, they are available on their line, their website that I've previously shared, as well as there have been some public health, you know, postings on through the Department of Drug and Alcohol Programs.

But if you are very concerned about this, your local single-county authority has some information about this if you are facing issues in your communities, - Thanks, Glenn.

Yeah.

And that issue, I think, varies from county to county too.

Sometimes we see things in one part of the state that we don't see in another.

So connecting with those local resources are great.

And a question that, I was ready to type it, and Jackie said it herself, "What about the trend?

How do you see the impacts of the legalization of recreational marijuana affecting this?" - Yeah. Yeah.

This is a good, so this is a good question around the changing landscape around cannabis within the United States.

So one of the things that I will highlight here is that I'm gonna give you some scientific knowledge, I'm not here to advocate specifically for or against any type of policy as a federal funded researcher. But what we do know is this, so when we think about some of the issues associated with cannabis use across the spectrum, we actually see some reductions in cannabis-related issues when we start to see some of these things associated with legalization.

So when we take a look at both cases of states that have already legalized cannabis, so places like Colorado and other places across the country, we're actually seeing, in some cases, you might see a spike in the initial use, but they either level off or sometimes decrease use over time.

- [Denise] Interesting.

- And so, this is likely gonna be one of those trends that will, for places that become, where cannabis becomes legal and available, you will probably see a spike, but it will likely level off or even decrease over time, depending on the population.

We have seen a slight increase in cannabis use among youth populations, but we're actually starting to see that start to level off and even potentially decrease in some locations across, you know, both Pennsylvania, but across the country as well.

So this is something that we're gonna have to continue to monitor with regards to public health-related issues.

And I will also note that at Penn State, we have a really great cannabis-related research institute, headed by a good friend and colleague, Kent Vrana.

So if you're interested in following issues associated with cannabis, both in terms of its impact individuals, population and public health, as well as some other issues, I really highly recommend that you take a look at that.

- Great.

I'm not seeing any more questions, and we are a little past our time.

Can you, Glenn, just pop that slide with the screen, the QR code for the evaluation?

We so appreciate all of everyone's participation today.

We love getting feedback.

We love hearing how this impacts your work.

So we ask you to please take a moment to do the evaluation either now or later in the day.

You will be getting the recording of this presentation and the slides with, I would say, about a week.

And if anyone does need a certificate, I'm gonna put my email in the chat box.

If you need a certificate, please email me, and we'll make sure you get that.

Okay.

Thank you again, Glenn, so very much for all you did for us today.

- Of course.

- Oh, there's a quick question about where can you find the data.

Let me see, where can you find the data.

- Oh.

- To show the decrease level?

Oh yeah, I think it's something, the last thing you talked about.

- So the best place to, I can go up to the, best place to look for cannabis use data is, as I mentioned before, the Substance Use and Mental Health Services Administration, SAMHSA, they run the National Survey of Drug Use and Health, NSDUH.

If you search for that, they have an annual report that comes out over time, and they provide discussion around, you know, use trends and those types of things that are occurring.

So take a look there.

I really highly recommend that.

That's a way for you to kind of gauge substance use across multiple states and that national as well.

And if you're interested in monitoring this within youth populations in Pennsylvania, the PAYS data, P-A-Y-S, Pennsylvania Youth Survey, you can explore that.

And what's really cool about the PAYS data is that you can explore this by county.

- Oops, I unmuted. I forgot to unmute.

If there are no other questions, we're going to say thank you, and have a wonderful rest of your day.

Again, if you need a certificate, send me an email.

My email is in the chat box.

And thank you again, Glenn.

Look forward- - Of course.

- To working with you soon.

- [Glenn] You bet.

- Bye-bye, everybody.