IN THE CIRCUIT COURT OF THE FIFTEENTH JUDICIAL CIRCUIT IN AND FOR PALM BEACH COUNTY, FLORIDA PRESENTMENT OF THE PALM BEACH COUNTY GRAND JURY REPORT ON THE PROLIFERATION OF FRAUD AND ABUSE IN FLORIDA'S ADDICTION TREATMENT INDUSTRY FALL TERM A.D. 2016 ************************************** DAVE ARONBERG State Attorney ALAN JOHNSON Chief Assistant State Attorney JUSTIN CHAPMAN Assistant State Attorney December 8, 2016 - TABLE OF CONTENTS INTRODUCTION ..................................................................................................... 1 OVERVIEW .............................................................................................................. 4 FINDINGS AND RECOMMENDATIONS: .......................................................... 13 I. MARKETING ............................................................................................... A. Prohibit deceptive advertising ....................................................... B. Provide disclaimers and other useful information ......................... C. Require licensing for marketing and admissions .......................... 13 15 15 16 II. PATIENT HOUSING .................................................................................. 16 A. Require DCF license and FARR certification for commercial recovery housing, especially when connected to treatment .......... 18 B. Eliminate loophole that allows for patient referrals to uncertified recovery residences owned by a provider ................... 21 C. Prohibit patient referrals from uncertified recovery residences to treatment providers .................................................. 22 III. ENABLE DCF TO TAKE ACTION ......................................................... 23 A. Treat license as a privilege instead of a right ................................ 24 B. Provide better resources by raising license and service fees ......... 26 IV. STRENGTHEN PATIENT BROKERING STATUTE ............................ 27 A. Prohibit the solicitation or receipt of any "benefit" ...................... 28 B. Increase criminal penalties and minimum fines ............................ 28 C. Create penalty enhancements for large-scale brokering ............... 29 D. Add brokering to Statewide Prosecution's jurisdiction ................. 29 V. ENABLE LAW ENFORCMENT TO TAKE ACTION ............................. 31 A. Reduce impractical privacy restrictions on investigation ............. 32 B. Promote education and inter-agency collaboration ....................... 33 CONCLUSION ....... ................................................................................................ 33 SUMMARY OF RECOMMENDATIONS ............................................................ 34 - - - - - - - - - - - - EXHIBIT LIST ........................................................................................................ 35 LEGAL AUTHORITY ............................................................................................ 36 DISTRIBUTION REQUEST .................................................................................. 38 CERTIFICATE OF PRESENTMENT .................................................................... 39 11 INTRODUCTION In the midst of the growing national health crisis involving opioid addiction, Dave Aronberg, State Attorney for the Fifteenth Judicial Circuit of Florida, called for this Grand Jury to investigate how government agencies are addressing the proliferation of fraud and abuse occurring within the addiction treatment industry. This Grand Jury was further asked to make appropriate findings and recommendations on how these agencies can better perform their duties to ensure that communities remain safe and individuals with substance use disorders are protected. "[A] grand jury may investigate the actions .of public bodies and officials concerning the use of public funds." In re Grand Jury Invest. of Fla. Dept. Health & Rehab. Servs., 659 So. 2d 347, 350 (Fla. 1st DCA 1995). Such a grand jury has the "right to express the view of the citizenry with respect to public bodies and officials in terms of a 'presentment,' describing misconduct, errors, and incidences in which public funds are improperly employed." Miami Herald Pub. Co. v. Marko, 352 So. 2d 518, 522 (Fla. 1977). As explained in Kelly v. Sturgis, 453 So. 2d 1179, 1182 (Fla. 5th DCA 1984): Grand juries have a lawful function to investigate possible unlawful actions for all persons, private citizens and public officials alike, and to return indictments when warranted. As Marko notes, grand juries also have a lawful and proper function to consider the actions of public bodies and officials in the use of public funds and 1 report or present findings and recommendations as to practices, procedures, incompetency, inefficiency, mistakes and misconduct involving public offices and public monies. 352 So. 2d at 522. See also Appeal of Untreiner, 391 So. 2d 272 (Fla. 1st DCA 1980). Kelly v. Sturgis, 453 So. 2d 1179, 1182 (Fla. 5th DCA 1984). In accepting this important assignment, the Grand Jury reviewed five major areas of concern in regulatory oversight and enforcement: (I) marketing, (2) commercial group housing designed for persons in recovery (also known as recovery residences, sober homes, or halfway houses), (3) the ability of the Department of Children and Families to take action, (4) the strength and clarity of the patient brokering statute, and (5) law enforcement's ability to take action. The Grand Jury heard testimony and received evidence from a wide range of sources, including the Department of Children and Families (DCF), Florida Association of Recovery Residences (FARR), Florida Certification Board (FCB), Florida Alcohol and Drug Abuse Association (F ADAA), Florida Attorney General's Office of Statewide Prosecution, Palm Beach County Fire Rescue, the insurance industry, law enforcement, treatment industry professionals (including a psychiatrist, a licensed clinical social worker, and a marketing director), parents of children victimized by abuses like patient brokering, a City Commissioner, owners of recovery residences, private and municipal attorneys who extensively litigated treatment and recovery housing issues over the past decade, and residents from local communities impacted by the proliferation of recovery residences. 2 In this report, we discuss the economic, statutory, and regulatory forces that make Florida the premier medical tourism destination for substance abuse treatment and recovery housing. We identify the main types of fraud and abuse occurring within the treatment industry and how bad actors have managed to avoid detection for so long. We then explain what tools DCF, FARR, and local law enforcement agencies need to provide meaningful oversight in this industry. Finally, we make recommendations on how to clarify and enhance criminal laws to more effectively address the increase in patient brokering, which is one of the most common, damaging, and lucrative ways that this vulnerable class of consumers is being exploited. 3 OVERVIEW Over the past decade, federal laws have collectively impacted the substance abuse treatment industry in ways that could not have been predicted. First, the Mental Health Parity and Addiction Equity Act of 2008 (Parity Act) placed behavioral health on a par with physical health, which resulted in a drastic increase in coverage for substance abuse treatment. See 29 U.S.C. § 1185a (2009). Subsequently, the Patient Protection and Affordable Care Act (ACA) allowed young adults to stay on their parents' policies until age 26, eliminated exclusions for pre-existing conditions, and required treatment for mental health and substance abuse to be included on every insurance policy. See 124 Stat. 119 (2010). These laws inadvertently created a lucrative opportunity for bad actors to exploit a vulnerable class of young adults suffering from addiction. Addiction is also recognized as a disability under the Americans With Disabilities Act (ADA) and Fair Housing Act (FHA). See 42 U.S.C. § 12101 (2008); 42 U.S.C. § 3602 (2016). Over the past decade, bad actors have been using these laws to hide their exploitation of the very people that these laws were meant to protect. This is especially true in the business of recovery housing, where many unregulated homes have become unsafe and overcrowded "flophouses" where crimes like rape, theft, human trafficking, prostitution, and illegal drug use are commonplace. 4 While there is no way to accurately assess the number 1 of these unregulated businesses in Florida, one indication is the number of reasonable accommodation requests made by recovery residences to avoid local zoning restrictions. In one municipality alone, there have been 550 requests by recovery residences for reasonable accommodation. Unfortunately, the most common way of identifying a house as a recovery residence occurs during calls for service. These calls range from overdoses, crimes committed inside the house, or general complaints from the community. These unregulated businesses not only harm their residents directly, but indirectly harm others in recovery by perpetuating a negative stigma. The Grand Jury finds that the problem is the unregulated businesses that house these residents, not the residents themselves. The average substance use disorder (SUD) patients in Florida are young adults from out-of-state with little to no independent source of income. 2 This demographic has proven to be a critical component of "the Florida model," which is loosely defined as outpatient treatment coupled with recovery housing. The model has proven to be extremely lucrative given the ease of setting up and operating an outpatient treatment center (which can be opened in any strip mall) while warehousing patients off-site in unregulated homes. 1 2 DCF Recovery Residence Report, p.8 (Oct. 1, 2013). Optum White Paper: Young adults and the behavioral health system, p.4 (2014). 5 The problem is that most of these young adult patients from out-of-state cannot afford housing while in treatment. Without a consistent form of patient housing, this model would not work. Currently, patient housing is often paid by treatment providers in exchange for illegal patient referrals. Out-of-state patients are targeted by Florida treatment providers because they typically have out-of-network plans. In a recent Optum report, it was estimated that reimbursement for out-of-network treatment was, on average, three times the amount paid for the same in-network services. 3 Additionally, SUD patients of this demographic are generally unwilling or unable to cooperate with law enforcement. These characteristics, coupled with impractical privacy restrictions on oversight, make this patient population exceptionally vulnerable to patient brokering and other forms of exploitation. The Grand Jury finds that the main criminal and regulatory violations occurring within Florida's substance abuse treatment industry involve deceptive marketing, insurance fraud, and patient brokering. It begins with the deceptive marketing that draws in this vulnerable class of consumers. Online marketers use Google search terms to essentially hijack the good name and reputation of notable treatment providers only to route the caller to the highest bidder, which could 3 Optum White Paper: Young adults and the behavioral health system, p.4 (2014). 6 simply be another referral agency. Parents acting out of desperation and ignorance are easily convinced to send their young adult children far from home in hopes of effective treatment. The evolution of technology has far surpassed the few laws that exist to govern such conduct. Insurance fraud is another maJor problem in Florida's substance abuse treatment industry. For example, a point of care (POC) urinalysis (UA) test kit is readily available over the counter and costs under ten dollars. On the other hand, confirmatory and quantitative testing at a lab involves sophisticated instruments, tests for specific and collateral drugs (panels), and results in charges that can exceed five thousand dollars per test. In many cases, confirmatory and quantitative tests are ordered by treatment providers multiple times per week. Doctors may sign off on such testing as being medically necessary. There are many instances, however, where no prior authorization is required before a claim is paid. As one major insurance carrier explained: claims for confirmatory testing and other treatment are paid without prior doctor authorization based on "access to care" requirements found in federal law. In other words, clinical care is routinely billed and paid without any proof of medical necessity. Some providers bill for services never rendered and others submit falsely labeled samples. Even when confirmatory tests are ordered by a doctor, many are never reviewed, evincing the lack of medical necessity in the first place. 7 Although insurance companies generally only pay a percentage of the billed amount for out-of-network services, it is not unusual for treatment providers to receive hundreds of thousands of dollars in insurance payments for confirmatory tests for a single patient over the course of treatment. In one example shown to the Grand Jury, a well-known treatment provider billed a single patient's insurance over $600,000, mainly for drug tests, in just a seven-month period. 4 In addition to deceptive advertising and insurance fraud, patient brokering is a major problem in this industry as well. The Grand Jury heard testimony that the average patient referral fee to a recovery residence from a treatment provider is $500 per week per patient. The more the treatment provider bills, the more the provider can pay in kickbacks to obtain more patients. This leads patients away from quality treatment providers to businesses that are only concerned with billing as much as possible. The amount of patient brokering that occurs in one area can actually be used as a yard-stick to measure the other forms of fraud and abuse occurring within the industry. Meanwhile, treatment suffers and overdose rates . . contmue to nse. 5 4 The 24-year-old Ohio-native who came to Florida to receive this "treatment" died after that seven-month period from a Carfentanil overdose. 5 Delray Beach Overdose Statistics (2016); Lake Worth Overdose Statistics (2016); Boynton Beach Overdose Statistics (2016); Zack McDonald, Bay County battles to keep opioid epidemic at bay, Panama City News Herald, Oct. 8, 2016. 8 According to the most recent national statistics, an opioid-related death occurs every 19 minutes. The introduction of Fentanyl, one hundred times more potent than morphine, and Carfentanil, an elephant tranquilizer one thousand times more potent than morphine, have made heroin even deadlier. FDLE recently reported a dramatic increase in opioid-related deaths throughout the state 6, and there have been 406 opioid related overdose deaths in Palm Beach County alone through October of this year. Palm Beach County Fire Rescue reported more than 3,000 instances where Narcan, an opioid antidote, was deployed. 7 The Grand Jury finds this type of epidemic to be devastating to local resources. The average cost of a Palm Beach County Fire Rescue response to an overdose is between $1,000 and $1,500. Additionally, Palm Beach County Fire Rescue spent $55,725 on Narcan for the 2015 fiscal year, and another $182,900 in 2016. First responders have also reported higher rates of post traumatic stress disorder (PTSD) based on having to deal with multiple overdose deaths on a daily basis. To combat the proliferation of fraud and abuse in the treatment industry during the current heroin epidemic, the Grand Jury recommends a number of 6 FDLE, 2015 Annual Report, Drugs Identified in Deceased Persons by Florida Medical Examiners (Sept. 2016). 7 Palm Beach County Fire Rescue Narcan Use Statistics (1/1116 - 10/24/16). 9 legislative and regulatory changes. The Legislature has the ability to act on these recommendations. When it comes to the business of health care, the Legislature has already made statements of intent on its ability to regulate: [S]uch professions shall be regulated only for the preservation of the health, safety, and welfare of the public under the police powers of the state. Such professions shall be regulated when: (a) Their unregulated practice can harm or endanger the health, safety, and welfare of the public, and when the potential for such harm is recognizable and clearly outweighs any anticompetitive impact which may result from regulation. (b) The public is not effectively protected by other means, including, but not limited to, other state statutes, local ordinances, or federal legislation. (c) Less restrictive means of regulation are not available. § 456.003(1), (2)(a)-(c), Fla. Stat. (2016) (emphasis added). We find that the unregulated practices within the substance abuse treatment industry and connected business of recovery housing have harmed and endangered the health, safety, and welfare of the public and persons suffering from SUDs. We find that the potential for such harm is recognizable and clearly outweighs any anticompetitive impact that may result from regulation. We also find that the public has clearly not been protected by other means, and less restrictive means are not available. This Grand Jury has identified five (5) areas in need of legislative and regulatory change. First, deceptive marketing should be strictly prohibited, and willful, intentional, and material misrepresentations should be punished with criminal 10 sanctions. Treatment providers should be held accountable for the conduct of the marketers they employ. Advertising for substance abuse treatment should be held to a higher standard like advertising in other health care fields, and should provide consumers with important information in the form of upfront disclaimers. Marketing and admissions personnel who have direct contact with this vulnerable class of consumers should also be licensed and/or certified to ensure they possess minimum education, training, and experience. Second, there should be oversight on businesses designed to provide housing and other services for persons in recovery. At the very least, oversight is needed on businesses that engage in commerce with treatment providers. This can be accomplished by: (1) requiring FARR certification and DCF licensing for certain types of commercial recovery housing, (2) prohibiting treatment providers from referring patients to any uncertified recovery residences, and (3) prohibiting treatment providers from accepting referrals from uncertified recovery residences. Third, DCF should be adequately funded and staffed to take action against violators and perform inspections with greater depth and frequency. This can be accomplished by treating licenses as a privilege rather than a right, and by providing DCF with the resources it needs to regulate this massive industry. The Grand Jury finds that this can be done in a state revenue neutral manner by raising license and service fees. 11 Fourth, the patient brokering statute should be clarified and strengthened. Given the great lengths to which patient brokers have gone to creatively disguise their kickbacks as legitimate activities, the patient brokering statute should be amended to prohibit the solicitation or receipt of any "benefit" in exchange for patient referrals or acceptance of treatment. Moreover, serious crimes should have senous consequences. The Grand Jury finds that patient brokering 1s a very senous crime, with potentially deadly results. Penalties for patient brokering should be enhanced, especially when it involves large-scale brokering. Minimum fines should also be reflective of the outrageous profits made by patient brokers. Additionally, the Florida Attorney General's Office of Statewide Prosecution should be given concurrent jurisdiction with the State Attorney's Offices to assist in the prosecution of patient brokering. Finally, the Grand Jury recommends that law enforcement be given better tools to deal with the current types of fraud and abuse. This would include reducing impractical privacy restrictions that prevent legitimate investigation, and promoting more education among local law enforcement agencies on both state and federal privacy laws. The Grand Jury finds that this can be achieved through better collaboration between government agencies and private business, especially . . msurance compames. 12 FINDINGS AND RECOMMENDATIONS I. MARKETING The Grand Jury finds that people suffering from addiction and their families are often in an extremely vulnerable position while seeking treatment services. This vulnerable class of consumers is more prone to being victimized by deceptive marketing practices that are harmful to the recovery process. Neither DCF nor any regulatory agency, however, currently provides adequate oversight of the marketing practices of treatment providers. There is even less oversight for online marketing, which is one of the most common methods of marketing used by an industry that draws a majority of its patients from other states. The Grand Jury has found that a number of harmful marketing practices have become standard practice in Florida's private substance abuse treatment industry. The main abuses consist of: (1) false representation of services, (2) false representation of location, and (3) real-time auctioning of patients through clearing houses, also known as "lead generators." We heard testimony from industry professionals with extensive experience in online marketing of addiction treatment services. One witness demonstrated how online marketers use Google search terms to essentially hijack the name and reputation of notable treatment providers only to route the caller to another referral agency. 13 For example, 8 a person looking for treatment in Seattle types the following search terms into a Google search bar: "Drug Rehab Seattle." A marketer's listing appears in the search results as "Drug Rehab Seattle." The listing purports to be a treatment center in Seattle. But when the person calls the number listed, the marketer silently routes the call to one of five different customers of the marketer. Some of those customers are simply other call centers or referral services. Others might be good or bad treatment centers in Florida that have paid the marketer for the referral. One of the problems with this practice is the monetary conflict of interest created once a "lead" is already paid for. For example, when a treatment center pays $1,000 for a lead, they are compelled to convince that caller to go to their treatment center, regardless of what the caller says or whether that particular treatment is in the caller's best interest. The level of care recommended will also be influenced by this monetary incentive. A person calling about outpatient treatment may be urged to get more intensive (and expensive) treatment under this scenario. The Grand Jury finds that deceptive marketing practices like these are detrimental to a patient's chances of receiving quality care and the appropriate level of care. 8 These practices are also harmful to the reputation of quality Deceptive Marketing Exhibit# 1, p.1 (2016). 14 treatment providers who have worked hard to establish their reputation. Accordingly, we make the following recommendations: A. Prohibit deceptive advertising The Grand Jury recommends that materially deceptive advertising for substance abuse treatment be punishable by criminal sanctions. We also recommend that treatment providers be held accountable for the actions of the marketers they employ. A provider should not simply pay a flat fee to a marketing company and then look the other way while that company engages in improper conduct like patient brokering. If a marketing agent or entity violates the law, the provider who benefits from such service should be liable as well. B. Provide disclaimers and other useful information The Grand Jury recommends that a marketing entity or agent must be upfront and truthful about who they are, what they do, and where they are located. At the very least, disclaimers should be made to notify patients about material information and other potential conflicts of interest. Material information would include where to report fraud and abuse (as most out-of-state consumers may not even realize that DCF is the agency that regulates substance abuse treatment in Florida) and where to find success rates on providers and recovery residences. We recommend that providers continue to keep consumers informed throughout the continuum of care by making such information readily accessible. 15 C. Require licensing for marketing and admissions Given the vulnerability of this class of consumers, the Grand Jury finds that marketers and admissions personnel that have direct contact with current and future patients should have minimum education, training, and expenence. Marketers and admissions personnel should be licensed by DCF or certified by a credentialing agency like interventionists who provide similar services, 9 and they should be prohibited from diagnosing or recommending specific levels of care without the appropriate license or certification to do so. At the very least, marketing entities operating in Florida should be licensed by a Florida consumer protection agency and have a registered agent located in Florida. II. PATIENT HOUSING The Grand Jury received evidence from a number of sources that recovery residences operating under nationally recognized standards, such as those created by the National Alliance for Recovery Residences (NARR), are proven to be highly beneficial to recovery. The Florida Association of Recovery Residences (FARR) adopts NARR standards. 10 One owner who has been operating a recovery residence under these standards for over 20 years has reported a 70% success rate 9 Carey Davidson, Navigating the Maze ofAddiction Treatment, TogetherAZ Blog: An Ethical Compass, Oct. 31, 2016. 10 NARR/FARR Overview; NARR Quality Standards (July 15, 2015). 16 in outcomes. The Grand Jury finds that recovery residences operating under these nationally approved standards benefit those in recovery and, in tum, the communities in which they exist. In contrast, the Grand Jury has seen evidence of horrendous abuses that occur in recovery residences that operate with no standards. For example, some residents were given drugs so that they could go back into detox, some were sexually abused, and others were forced to work in labor pools. 11 There is currently no oversight on these businesses that house this vulnerable class. Even community housing that is a part of a DCF license has no oversight other than fire code compliance. This has proven to be extremely harmful to patients. The Grand Jury also received extensive testimony about many patients' financial need for housing during treatment. Detox, residential treatment, partial hospitalization (PHP), and intensive outpatient (IOP) are time-consuming levels of care, and are not conducive to working normal hours. Even after finishing inpatient treatment, most out-of-state, young adult patients don't have local jobs lined up or the resources to afford housing. As a result, patients receiving these levels of care are often unable to afford housing during such treatment. Given this reality, some type of financial assistance for housing is needed. 11 Susan Taylor Martin, Addicts say recovery program stole their money, Tampa Bay Times, Nov. 18, 2012. 17 Currently, this financial assistance for housing is typically paid through patient brokering. A treatment provider pays a patient's rent at a recovery residence in exchange for referring the resident to the provider for treatment. Alternatively, a provider will refer the patient to housing owned by the provider after being discharged from inpatient treatment. Both treatment providers and recovery residences offer incentives such as gym memberships, scooters, cigarettes, clothes, and gift cards to keep patients at a particular provider or recovery residence. Brokers known as "body snatchers" approach patients and convince them to move to other recovery residences and/or providers that offer "better stuff." The Grand Jury finds that it would be difficult, if not impossible, to eliminate these practices altogether without addressing the legitimate need for financial assistance with patient housing. Therefore, the Grand Jury makes the following recommendations: A. Require DCF licensure and FARR certification of commercial recovery housing, especially when connected to treatment The Grand Jury recommends that commercial 12 recovery residences be licensed by DCF and certified by FARR. At the very least, commercial recovery residences that contract with treatment providers should be licensed by DCF and certified by FARR. Allowing providers to contract with unregulated sober homes 12 Unlike the traditional "Oxford" model that has become a rarity in Florida, commercial recovery residences are for-profit businesses operated by a third party. 18 is like allowing hospitals to contract with unlicensed food vendors. The safety concerns for patients are obvious. A similar law already exists that prohibits treatment providers from referring clients to non-certified recovery residences. See § 397.407(11), Fla. Stat. (2016). If a treatment provider is prohibited from referring a patient to a non-certified home, it should certainly be prohibited from hiring a non-certified home as an independent contractor to provide housing and other treatment-related services for the patient. One way to accomplish the oversight needed while also addressing patients' need for financial assistance with housing would be to create a new DCF license that allows treatment providers to assist PHP and IOP patients with housing by providing a limited, needs-based scholarship for rent. The first and most important requirement for this license would be FARR certification of the housing component in addition to periodic inspections by DCF. This requirement could be waived for publicly funded providers under contract with a Managing Entity. 13 The limitations on this license would also have to be clear and strictly enforced. Patients would have to apply for the scholarship based on financial need. The scholarship would be paid directly to the licensed/certified recovery residence, would be capped at $200 per week for a maximum of 12 weeks, and could only be 13 According to DCF, treatment providers that contract with the Managing Entities for public funds are held to higher standards. 19 used for rent. This is not only to promote self-sufficient reintegration, but to avoid the strong economic motive to promote a cycle of unnecessary treatment and/or relapse. The Grand Jury heard testimony about countless patients who have fallen prey to this cycle of dependence and its devastating impacts on recovery. It is not uncommon for a person to be in this cycle of treatment/relapse for years. Ultimately, the scholarship amount and time limits could be periodically changed by DCF based on the standard length of time that IOP treatment is designed to last and the fair market value of rent in the area. The Grand Jury finds that this license would properly regulate commerce between the business of recovery housing and treatment while protecting the health, safety, and welfare of the patients in recovery. The Grand Jury finds that the Legislature already requires mandatory licensure for similar group housing for disabled individuals, and the reasoning behind such licensure equally applies to recovery residences. 14 14 The '"Assisted living facility' means any building ... which undertakes through its ownership or management to provide housing, meals, and one or more personal services for a period exceeding 24 hours to one or more adults who are not relatives of the owner or administrator." § 429.02(5), Fla. Stat. (2015). "'Personal services' means . .. supervision of the activities of daily living and the selfadministration of medication and other similar services ... " § 429.02(17), Fla. Stat. "'Supervision' means reminding residents to engage in activities of daily living and the self-administration of medication, and, when necessary, observing or providing verbal cuing to residents while they perform these activities." § 429.02(24), Fla. Stat. "'Activities of daily living' means functions and tasks for self care ... " § 429.02(1), Fla. Stat. 20 purpose of the Assisted Living Facilities Act is: to promote the availability of appropriate service for ... adults with disabilities in the least restrictive and most homelike environment, to encourage the development of facilities that promote dignity, individuality, privacy, and decision making ability of such persons, to provide for the health, safety, and welfare of residents ... , to promote continued improvement of such facilities, to encourage the development of innovative and affordable facilities particularly for persons with low to moderate incomes, to ensure that all agencies of the state cooperate in the protection of such residents, and to ensure that needed economic, social, mental health, health, and leisure services are made available to residents . . . through the efforts of [AHCA] [DCF], [DOH], assisted living facilities, and other community agencies. § 429.01(2), Fla. Stat. (2014) (emphasis added). The Grand Jury believes that disabled individuals living in recovery residences deserve the same type of protection as those living in Assisted Living Facilities or Adult Family Care Homes. B. Eliminate loophole that allows for patient referrals to uncertified recovery residences owned by a provider As discussed above, the Grand Jury finds that there is a need for oversight on patient housing during PHP and IOP treatment, which most often takes place immediately after discharge from inpatient treatment. Accordingly, the Grand Jury finds that the Legislature should eliminate the loophole found in Florida Statute section 397.407(11) that allows treatment providers to refer patients to uncertified recovery residences that they own. 21 This loophole only benefits treatment providers who can afford to own patient housing in addition to an inpatient treatment center, and allows them to refer patients to non-certified recovery residences which have no DCF or FARR oversight. In other words, it allows providers to send patients to unverified and unregulated recovery residences while those patients are in their most vulnerable state of recovery (during or immediately after inpatient treatment). This is contrary to the purpose of recently enacted section 397.407 (11 ), which was designed to protect patients from being referred to unregulated recovery residences. The fact that the provider happens to have an ownership interest in the uncertified recovery residence does nothing to protect this vulnerable class of disabled consumers. Therefore, we recommend that this loophole for providerowned referrals be closed. C. Prohibit patient referrals from uncertified recovery residences to treatment providers Additionally, the Grand Jury heard testimony on how patient brokering most often occurs as referrals from the recovery residences to the treatment providers. As a result, we recommend that referrals from uncertified recovery residences to treatment providers be prohibited. The Grand Jury recommends amending section 397.407(11 ), Fla. Stat. as follows: Effective July 1, WM 2017, a service provider licensed under this part may not refer a prospective, current or discharged patient to.1 22 or accept a referral from, a recovery residence unless the recovery residence holds a valid certificate of compliance as provided in s. 397.487 and is actively managed by a certified recovery residence administrator as provided in 397.4871 or the recovery residence is owned and operated by a licensed service provider or a licensed service provider's wholly owned subsidiary. For purposes of this subsection, the term "refer" means to inform a patient by any means about the name, address, or other details of the recovery residence. However, this subsection does not require a licensed service provider to refer any patient to a recovery residence. This section shall not apply to publicly funded treatment providers, licensed by the Department and under contract to .a Managing Entity. III. ENABLE DCF TO TAKE ACTION The Grand Jury heard testimony from a number of industry professionals on the inability of DCF to take swift and reasonable action when faced with blatant violations of both DCF regulations and criminal law. Expensive and time- consuming procedures like a Chapter 120 administrative hearing are required before DCF can suspend or revoke a license. At best, a treatment provider found in violation of regulations will negotiate a voluntary withdrawal of their license, but then be able to immediately reapply for a new license with no time limit or higher level of scrutiny. We find that DCF's difficulties in taking reasonable action stems from the fact that a license to provide substance abuse treatment is treated as a right, rather than a privilege. This prevents DCF from acting efficiently for the benefit of the patients who are being exploited and abused across the board. We believe a license for substance abuse treatment should be treated the 23 same as a license in other health care fields. The Grand Jury also received extensive testimony and evidence about DCF' s lack of resources. 15 As of August 31, 2016, there were 931 substance abuse treatment providers licensed in Florida, holding 3,417 separate component licenses. The Southeast Region (Palm Beach, Broward and the Treasure Coast) had 321 licensed providers, holding 1,307 component licenses. From April-July, 2016, the Southeast Region alone received 241 Provider Application Packets for the licensure of 606 program components (63 from new providers). The Southeast Region currently has only 9 licensing specialists. The total number of licensing specialists in the 6 state regions combined is 25. Licensing specialists also have the duty and obligation to perform any monitoring of programs in addition to processing licenses and license renewals. The Grand Jury also heard testimony that these same licensing specialists routinely leave DCF to make more money by working for treatment providers. The Office of Inspector General (OIG) is tasked with providing support, but they also have inadequate resources. Overall, DCF is grossly understaffed and underfunded to regulate this billion-dollar industry. Therefore, the Grand Jury makes the following recommendations: 15 DCF Response to Sober Homes Task Force Request (Sept. 13, 2016). 24 A. Treat license as a privilege instead of a right The Grand Jury recommends treating the issuance of a license for substance abuse treatment a privilege, rather than a right. This can be done by adopting the language used in the Assisted Living Facilities Act, which states: "The principle that a license issued under this part is a public trust and a privilege and is not an entitlement should guide the finder of fact or trier of law at any administrative proceeding or in a court action initiated by the Agency for Health Care Administration [AHCA] to enforce this part." § 429.01(3), Fla. Stat. (2016). Doing so would allow DCF to adopt a system similar to that used by AHCA, with greater ability to monitor as well as license. For example, anyone can open a substance abuse treatment center. If licenses were treated as a privilege, DCF could require reasonable qualifications for ownership and administration of treatment facilities. Treating licenses as a privilege would also allow DCF greater flexibility to deny or delay the issuance of licenses where there are compliance concerns. The Grand Jury further recommends whenever a license is revoked or surrendered, re-application should require a minimum waiting period and greater scrutiny. Finally, the Grand Jury heard testimony that an unlimited number of treatment providers have been allowed to open in a given geographical location which has created a supply of treatment services that far outweighs demand. The 25 Grand Jury heard testimony about how this imbalance in supply and demand encourages patient brokering, poaching, and other forms of abuse by bad actors in the industry. If licenses were treated as a privilege, DCF could counteract this problem by requiring a certificate of need for new treatment facilities to open. The Grand Jury finds that this practice is already done in other health care fields and would be beneficial to the substance abuse treatment industry as well. B. Provide better resources by raising licensing and service fees The Grand Jury finds that DCF's current resources for regulating the substance abuse treatment industry are grossly inadequate. Given the volume of providers, DCF clearly needs more staff and training to achieve meaningful oversight. This can be accomplished in a revenue neutral way. Licensing and service fees should be increased to reflect the lucrative profit margin of a typical treatment provider. Likewise, the Grand Jury has received evidence that FARR, much like DCF, is grossly underfunded and understaffed to accommodate the needed oversight of recovery residences throughout the State of Florida. Therefore, we recommend that FARR be adequately funded as well by increasing certification and service fees. Alternatively, if raising fees for both DCF and FARR are unable to adequately fund the oversight needed for this industry, we urge the Legislature to consider appointing another health agency such as DOH or AHCA to regulate substance abuse treatment. 26 IV. STRENGTHEN PATIENT BROKERING STATUTE Anti-kickback statutes like Florida's patient brokering statute are designed to prevent healthcare fraud and abusive practices resulting from provider decisions that are based on self-interest rather than cost, quality of care, or necessity of services. See United States v. Patel, 778 F.3d 607, 612 (7th Cir. 2015). These statutes are also designed to "protect patients from doctors whose medical judgments might be clouded by improper financial considerations." See id. The Grand Jury heard testimony from victims and families who have been devastated by patient brokering. The Grand Jury also heard testimony from a number of industry professionals who have seen the negative · impacts of patient brokering on recovery. We find that patieht brokering is extremely harmful to recovery, and such practices during the current heroin epidemic have contributed to the exhaustion of public resources, an increase in overdoses, and death. The public has a vested interest in eliminating patient brokering and making sure persons with SUDs are treated successfully. The Grand Jury also heard testimony from industry professionals who have openly stated that patient brokering is the standard, not the exception, in Florida's substance abuse treatment industry. Over the years, different ways of covering up kickbacks have been developed, such as "case management" contracts between treatment providers and recovery residences. Brokers hide kickbacks in many 27 different ways, such as luxurious amenities, cigarettes, plane flights, scooters, vacations, and gift cards. To combat this elusive and devastating practice, the Grand Jury makes the following recommendations: A. Prohibit the solicitation or receipt of any "benefit" The Grand Jury recommends that Florida's patient brokering statute, § 817.505, Fla. Stat. (2016), be amended to prohibit the solicitation or receipt of any "benefit" in exchange for referring patients to, or accepting treatment from, a particular treatment provider. This would put both patient brokers and legitimate industry professionals on notice that any inducement or reward for the referral or acceptance of patients is clearly prohibited. B. Increase criminal penalties and minimum fines Currently, patient brokering is a third degree felony of the lowest level under the Criminal Punishment Code with no minimum fine. See 817.505(4), Fla. Stat. Given the devastating effects of this crime, the Grand Jury recommends that patient brokering be raised from a level 1 to a level 5 felony. The Grand Jury also recommends that offenders be ordered to pay minimum fines that reflect the high profits of patient brokering. 28 Between California and Florida 16, the average referral fee for a new patient can easily run up to $5,000. A typical patient broker can make up to $500 per week for every patient sent to a provider. Brokers with multiple recovery residences make up to $10,000 per week. Currently, there is no minimum fine for patient brokering, no matter how many counts are charged. Meanwhile, there is currently a minimum $500,000 fine for unlawfully possessing 25 grams or more of oxycodone. See § 893.135(1)(c)3.c., Fla. Stat. (2016). Minimum fines like this should be mandated to provide enough financial deterrent to those who make hundreds of thousands of dollars a year from brokering multiple patients. C. Create penalty enhancement for large-scale brokering For large-scale patient brokering, involving 10 or more patients at a time, the penalty should be increased to a second degree felony, level 7. For large-scale brokering, involving 20 or more patients, the penalty should be increased to a first degree felony, level 8. Recidivist brokers who continue to broker patients should likewise face enhanced penalties. Similar penalty enhancements can also be found in the identity theft statute. See§ 817.568, Fla. Stat. (2016). D. Add brokering to Statewide Prosecution's jurisdiction Currently, patient brokering is not defined as racketeering activity under the 16 According to one out-of-state industry professional, Palm Beach International Airport is infamous for having patient brokers trolling for new arrivals. 29 RICO statute. See§ 895.02(8)(a), Fla. Stat. (2016). As discussed above, however, patient brokering routinely involves fraud (in disguising kickbacks) and is utilized by those committing other forms of healthcare fraud. As recently observed by the Eleventh Circuit, defendants commit fraud, like falsifying records to justify ordering more than what is necessary to enhance the amount of kickbacks. See United States v. Vernon, 723 F.3d 1234, 1241 (11th Cir. 2013). Specifically, the Grand Jury received evidence on how kickbacks are increased by billing for unnecessary UA confirmatory and quantitative testing. The Grand Jury heard testimony from the Florida Attorney General's Office of Statewide Prosecution, which is designed to handle prosecutions of multi-county organized fraud schemes such as this. Statewide Prosecution, however, currently does not have jurisdiction to prosecute patient brokering despite the resources and desire to do so. Accordingly, we recommend that the RICO statute be amended to include patient brokering as a predicate offense, and to amend Florida Statute section 16.56, to give the Office of Statewide Prosecution concurrent jurisdiction with the State Attorney's Offices over patient brokering so that they can assist local law enforcement agencies in the investigation and prosecution of these fraudulent criminal enterprises throughout the state. 30 V. ENABLE LAW ENFORCEMENT TO TAKE ACTION The Grand Jury heard testimony from law enforcement with extensive experience in the field of health care fraud. One of the biggest hurdles to investigations in this industry is that the victims of patient brokering (the patients themselves) rarely report these crimes. In many cases, patients are complicit because they receive free rent, amenities, and other benefits from engaging in the crime. Moreover, many out-of-state young adult patients have a mistrust of police to begin with. We also heard that state officials, along with members of the FBI and United States Attorney's Office, have conducted investigations into a number of treatment providers and recovery residences. In doing so, they found that there are privacy laws specific to mental health and substance abuse treatment that are extremely burdensome and impractical in their application. Law enforcement officers face criminal penalties for violating these laws. See 42 C.F .R. § 2.4. One of the most onerous restrictions requires notification for the disclosure of patient records, which could compromise the integrity of ongoing investigations. As a general matter, confidentiality is paramount to the integrity of an ongoing criminal investigation. When criminals realize they are being investigated, they take measures to evade prosecution. Thus, notification of an investigation to the suspected criminals or to persons that would likely advise those 31 criminals of the investigation is harmful to the investigation itself. Currently, courts have full discretion whether or not to require patient notification. 42 C.F.R. § 2.66(b). Under state law, the timing of patient notification is less clear. Section 397.501 states that protected parties must be given "adequate notice" whenever disclosure is sought. See§ 397.501(7)(h), Fla. Stat. (2016). "Adequate notice" is not defined anywhere in Chapter 397. The State has argued that section 397.501 incorporates the federal confidentiality regulations found in 42 C.F.R. §§ 2.1-2.67, and under those federal confidentiality regulations, "adequate notice" does not mean "prior notice." At least one Palm Beach County judge has rejected this argument and refused to authorize disclosure of records without first notifying all protected parties. As a practical matter, the State cannot give notice to patients before the State knows who those patients are, and the State would be violating privacy rights by seeking out information that identified anyone as a patient without prior authorization. Accordingly, the Grand Jury makes the following recommendations: A. Reduce impractical privacy restrictions on investigation The Grand Jury recommends that section 397.501(7)(h) expressly permit disclosure of patient records without prior notification under the same circumstances found in section 42 C.F.R. § 2.66(b). This strikes a fair balance 32 between the privacy rights of patients and the need for law enforcement to investigate crimes that are being committed against those same patients. B. Promote education and inter-agency collaboration The Grand Jury also finds that most local law enforcement agencies are lacking in education on how to navigate the many federal and state privacy laws in this industry. Therefore, the Grand Jury recommends more training and education of local law enforcement on how to properly comply with federal and state privacy laws in the course of their investigations. Agencies like DCF, DOH, AHCA, FARR, and local law enforcement need to have better protocols in place for sharing information and working together on these types of investigations in the substance abuse treatment industry. CONCLUSION The Grand Jury finds a compelling and urgent need for both increased oversight and enforcement in Florida's substance abuse treatment industry. The problems outlined in this report exist throughout our state and continue to spread throughout the country. Although there is no simple answer to these complex problems, we believe our recommendations provide a step in the right direction and can be implemented without any negative fiscal impact on state resources. The Grand Jury strongly urges the Legislature to consider the recommendations in this report and take appropriate action before these problems worsen. -33 SUMMARY OF RECOMMENDATIONS > Prohibit deceptive advertising and punish with criminal sanctions. > Require disclaimers that notify patients and families about material information. > Require marketers and admissions personnel to be licensed. > Require DCF license and FARR certification for commercial recovery residences, especially those that contract with treatment providers. > Eliminate loophole that allows for patient referrals to uncertified recovery residences owned by a treatment provider. > Prohibit treatment providers from accepting patient referrals from uncertified recovery residences. > Treat license as a privilege rather than a right. > Require credentials such as a background check for owning a treatment center. > Require certificate of need for new treatment providers. > Provide adequate resources to DCF and FARR by raising fees. > Amend § 817.505, Fla. Stat. to prohibit the solicitation or receipt of any "benefit" in exchange for referrals or treatment. > Increase criminal penalties and minimum fines for patient brokering. > Create penalty enhancements for large-scale patient brokering. > Enable the Office of Statewide Prosecution to prosecute patient brokering. > Amend§ 397.501(7)(h), Fla. Stat. to allow disclosure of patient records without prior notification under the same circumstances as found in 42 C.F.R. § 2.66(b). > Educate local law enforcement on privacy laws and promote better inter-agency collaboration. 34 EXHIBIT LIST EXHIBIT PAGE(S) Boynton Beach Overdose Statistics (2016) ............................................................... 8 Carey Davidson, Navigating the Maze ofAddiction Treatment, TogetherAZ Blog: An Ethical Compass, Oct. 31, 2016 ..................................................................... 16 DCF Recovery Residence Report, p.8 (Oct. 1, 2013) .................................... ........... 5 DCF Response to Sober Homes Task Force Request (Sept. 13, 2016) .................. 23 Deceptive Marketing Exhibit # 1 (2016) .................................................................. 14 Delray Beach Overdose Statistics (2016) .................................................................. 8 FDLE, 2015 Annual Report, Drugs Identified in Deceased Persons by Florida Medical Examiners (Sept. 2016) ............................................................................ 9 Lake Worth Overdose Statistics (2016) .................................................................... 8 NARRIF ARR Overview .... ...................................................................................... 16 NARR Quality Standards (July 15, 2015) ............................................................... 16 Optum White Paper: Young adults and the behavioral health system (2014) ...... 5, 6 Palm Beach County Fire Rescue Narcan Use Statistics (1/1/16- 10/24/16) ........ ... 9 Susan Taylor Martin, Addicts say recovery program stole their money, Tampa Bay Times, Nov. 18, 2012 ........................................................................................... 17 Zack McDonald, Bay County battles to keep opioid epidemic at bay, Panama City News Herald, Oct. 8, 2016 ..................................................................................... 8 35 LEGAL AUTHORITY PAGE(S) CASES Appeal of Untreiner, 391 So. 2d 272 (Fla. 1st DCA 1980) ...................................... 2 In re Grand Jury Invest. ofFla. Dept. Health & Rehab. Servs., 659 So. 2d 347 (Fla. 1st DCA 1995) ............................................................................................... 1 Kellyv. Sturgis, 453 So. 2d 1179 (Fla. 5thDCA 1984) ............................. ........... 1, 2 Miami Herald Pub. Co. v. Marko, 352 So. 2d 518 (Fla. 1977) ................................ 1 United States v. Patel, 778 F .3d 607 (7th Cir. 2015) .............................................. 26 United States v. Vernon, 723 F.3d 1234 (11th Cir. 2013) ......................... .............. 29 STATUTES 29 U.S.C. § 1185a (2009) ....................................................................... ................... 4 42 C.F.R. § 2.4 ......................... ..... ........................................................................... 31 42 C.F.R. § 2.66 ................................................................................................. 31, 32 42 C.F.R. §§ 2.1-2.67 ............. ........................................................................... 30, 31 42 U.S.C. § 12101 (2008) ............................ .. .................... ............. :......................... . 4 42 u.s.c. § 3602(2016) .................. .......................................................................... 4 124 Stat. 119 (2010) ............................ .......... ....... ..................................................... 4 § 16.56, Fla. Stat. (2016) .................. .............................. ............ .. ........................... 30 § 397.407, Fla. Stat. (2016) ............................ ........ ................... .................. 19, 21, 22 § 397.501, Fla. Stat. (2016) ............. ...... ............................. ......................... 31, 32, 36 36 § 429.01, Fla. Stat. (2016) ................................................................................. 21, 25 § 456.003, Fla. Stat. (2016) ..................................................................................... 10 § 817.505, Fla. Stat. (2016) ......................................................................... 27, 28, 34 § 817.568, Fla. Stat. (2016) ..................................................................................... 29 § 893.135, Fla. Stat. (2016) ..................................................................................... 28 § 895.02, Fla. Stat. (2016) ....................................................................................... 29 37 DISTRIBUTION REQUEST The Grand Jury requests this Presentment and Report be furnished to the following: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23 . 24. 25. 26. 27. 28. 29. 30. 31. 32. Honorable Rick Scott, Governor Honorable Jeff Atwater, Chief Financial Officer Honorable Pam Bondi, Attorney General Honorable Joe Negron, Senate President Honorable Steve Crisafulli, House Speaker Honorable Jeff Clemens, State Senator Honorable Bobby Powell, State Senator Honorable Kevin Rader, State Senator Honorable Ray Rodrigues, House Majority Leader Honorable Joseph Abruzzo, State Representative Honorable Lori Berman, State Representative Honorable Bill Hager, State Representative Honorable Al Jacquet, State Representative Honorable MaryLynn Magar, State Representative Honorable Rick Roth, State Representative Honorable David Silvers, State Representative Honorable Emily Slosberg, State Representative Honorable Matt Willhite, State Representative Honorable Mary Lou Berger, Palm Beach County Major Honorable Gary R. Nikolits, Palm Beach County Property Appraiser Honorable Ric L. Bradshaw, Palm Beach County Sheriff Honorable Ken Lawson, Dept. of Business & Professional Regulation Secretary Honorable Mike Carroll, Dept. of Children and Families Secretary Honorable Drew Breakspear, Office of Financial Regulation Commissioner Honorable Dr. Celeste Philip, Dept. ofHealth Surgeon General Honorable Justin Senior, Agency for Health Care Administration Interim Secretary Honorable David Altmaier, Office of Insurance Regulation Commissioner Honorable Rick Swearingen, Florida Dept. of Law Enforcement Commissioner Honorable Barbara Palmer, Agency for Persons with Disabilities Executive Director Verdenia C. Baker, Palm Beach County Administrator Richard Radcliffe, Palm Beach County League of Cities Executive Director Christina Henson, Palm Beach County Criminal Justice Commission 38 CERTIFICATE OF PRESENTMENT The Grand Jury respectfully submits this Presentment this _ _ _ day of December, 2016. As authorized and required by law, we have advised the Grand Jury returning this presentment. I, DAVID ARONBERG, State Attorney and Legal Advisor, Palm Beach County Grand Jury - Fall Term 2016, hereby certify that I, as authorized and required by law, have advised the Grand Jury which returned this report on this _ _ _ day of ,2016. DAYID ARONBERG State Attorney, Fifteenth Judicial Circuit of Florida Legal Advisor Palm Beach County Grand Jury, Fall Term 2016 I, ALAN JOHNSON, Chief Assistant State Attorney and Legal Advisor, Palm Beach County Grand Jury - Fall Term 2016, hereby certify that I, as authorized and re · ed by law2!Q: ~~sed the Grand Jury which returned this on thi day of -M L ·, 2016. ALAN JOHNSON Chief Assistant State Attorney Legal Advisor Palm Beach County Grand Jury, Fall Term 2016 39 I, BRIAN L. FERNANDES, Chief Assistant State Attorney and Legal Advisor, Palm Beach County Grand Jury - Fall Term 2016, hereby certify that I, as authorized and required by law, have advised the Grand Jury which returned this S: a_day of ~' --1.-- , 2016. report on this BRI L. FERNA Chief Assistant State f\.ttorney Legal Advisor Palm Beach County Grand Jury, Fall Term 2016 I, JUSTIN CHAPMAN, Assistant State Attorney and Legal Advisor, Palm Beach County Grand Jury - Fall Term 2016, hereby certify that I, as authorized and re_quired by law, have advised the Grand Jury which returned this report on this f3"\1!. day , 2016. Legal Advisor Palm Beach County Grand Jury, Fall Term 2016 40 UCEtl't OF OfflCIAL iWD JURY &ECORD 15 Judk:illl artult PALM BEACH COUHTYf FLORIDA PA\.M &EACH COUNTY GRAND JURY PALM IEACH COUN'TY COURTHOUSE 205 N. DIXIE KIGMWAY OOM 4-A, JUVENILE BLOG. WEST PALM BEACH, FL ~1 ttcm Dlte 656. 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Drug Re-Nib I AlcDllol Rel'IBb I Noll northb•ft"8'Gll1YIJ'l'R"~r.;;iorni0Jb::t1l-nt1-etrr"l!~o.1r-'Uf T~ > P'°''""~n• ; *11.:r. rjOOh ·" r; eay ~ C.rtlJo4:,;;~~ui ·tJ d«u~.tit-111 . North Bay Recxwer'/ Cen!er Re,,.lews, Ra!Jngs ....,,,,....h•b~. ooni1 !st·no•lnort!>-b..,.reoow ry-cenl•r-:it· *** ~* =t:.:fa~ •UI 2 "!"'1J~-:; w·iJ W..- ~ ...lio'!" ,. .,; 1w.;i: _ , t:t Mbrl:l1 P..., Rt1cu....,·y ~d RV;11!:...U.Jlt. North Bay RG~ry Cen:or I Fa0&bo-ok h:l~.: ~..,..,,.'l>Ceta:X. c~m, F11•1:t>», e•r>A»l~•l,C•llanl;; i.•* .. T'T •?~1J?.~ 4.'." • 1:1 1.~s., • "Placement Service" • Refers callers to centers 866-858~4949 wr lwaistanclJ AvellebllJ OR • Do not appear to be listed with GARF or NAATP ··-....., Recent Media Coverage of Unethical Practices in Addition Treatment BUZZFEED, MAR 2016 In South Florida's Delray Beach, home to hundreds of rehab facilities and halfway houses, scams abound to profit off of addicts and their insurance policies. https://www.buzzfeed.com/catferguson/addjction-marketplace?utm term=. rqp3o85ZP9#.rv28yBgvmM PALM BEACH POST series·INSIDE THE GOLD RUSH http://www.mypalmbeachpost.com/s/soberhomes/ PALM BEACH POST, SEP 2016 Two years after FBI raids, no indictments against sober home operators 2 years have passed with no arrests of anyone connected with the raided sober homes or any other operators in Palm Beach County. No $100,000 cars seized or property confiscated. The . epic comeuppance never arrived. Business quietly resumed. http://www.mypalmbeachpost.com/news/news/state-reqionaVtwo-years-after-fbi-raids-no-indictments-against-s/nsT23/ SUN-SENTINEL, AUG 2016 Community leaders hope a new state law will help curb problems with sober homes, where people transition from rehabilitation facilities to "regular'' life. These homes were not monitored at all in Florida until July 1, when the state launched a voluntary certification program aimed at tracking and regulating them. http://www.sun-sentinel.com/news/palm-beach/fl-delray-beach-sober-homes-20150820-storv.html PALM BEACH POST, AUG 2016 Eric Snyder: Muscle-bound millionaire of addiction treatment under scrutiny Two years ago, Snyder, 29, caught the attention of a federal task force investigating hundreds of millions of dollars worth of insurance fraud, kickbacks and patient brokering in Palm Beach County's drug treatment industry. http://insurancenewsnet.com/oarticle/muscle-bound-millionaire-of-addiction-treatment-under-scrutinv PALM BEACH POST, MAY 2016 Insurer sues lab company, alleging addiction treatment kickbacks According to a United lawsuit, owners of Florida addiction treatment businesses were invited to invest in Sky's booming lab business. In exchange, they could reap tens of thousands of dollars a month. http://www.mypalmbeachpost.com/news/news/crime-law/insurer-sues-lab-company-alleging-addiction-treatm/nrGbs/ PALM BEACH POST, MAR 2016 The Florida Legislature responded to corruption in the drug treatment industry that spawned an FBI task force by killing bills by two local lawmakers that would have addressed shady business practices and by de-funding the Florida Association of Recovery Residences - the Boca Raton-based non-profit tasked with creating a voluntary certification program for sober homes. http://www.mypalmbeachpost.com/news/news/state-regional-govt-oolitics/session-ends-with-sober-home-leqislation-knocked-d/nghBR/ PALM BEACH POST, OCT 2015 Cigna pulls out of Fla. exchange, blames addiction treatment fraud http://www.mypalmbeachpost.com/news/news/ciqna-pulls-out-of-florida-exchange-blames-addjcti/nn4gx/ BUZZFEED, SEP 2015 Stories abound in Delray Beach of halfway house owners charging insurance companies thousands of dollars a month for simple urine tests, collecting illegal referral fees from rehab programs, and even finding ways to get addicts drugs in hopes that they will relapse. httos://www buzzfeed,com/catferguson/the-rehab-scam?utm term=.pf8K2eQ3DN#.dmwdK16Xza PALM BEACH POST, AUG 2015 Palm Beach County's $1 billion gold rush: Addiction treatment draws FBI http://www.mypalmbeachpost.com/news/news/countys-1-billion-qold-rush-addictjon-treatment-dr/nm9J9/ PALM BEACH POST, DEC 2014 FBI raids two halfway houses in Delray Beach "20 percent are bad operators and they're giving a bad name to the good operators and making it difficult for them to compete in the marketplace." http://www.mypalmbeachpost.com/news/news/crime-law/fbj-rajds-two-halfway-houses-in-delray-beach/njTwS/ HUFFPOST: The Rehab Industry Needs to Clean Up Its Act. Here's How by Maia Szalavitz !:!ttQ://www.huffinqtonpost.com/the-influence/the-rehab-industrv-needs-clean-up b 9210542.html DELRAY BEACH POLICI! DEPARTMENT ..... ...... 2016 OVERDOSES BY TYPE ~---~-----·-.--. --- --- - Jan Feb Mar HEROIN 25 43 64 FLAKKA 0 1 0 0 0 - -METH - - - - -- - -+-----11------... o O O 0 3 PILLS 4 Apr 45 -- ------ -~ __ 6 May Jun Jul 26 41 -- 66 ~---- I f!ARCANDEPLOY!IENTJ ~J,..~=t I I 70 I 10 I Dec O 0 O 54 -----·- --- - - -- I 406.00 -- 0 0 0 0 2.00 0 0 0 0 0 0 0 O --0.00 5 4 1 ·- 0 O 2_ o 32.00 2 7 4 0 .., ,. t I 6 --+------11------+----~ 0 A,. ., . _" . • • r- a I ,_____3 ___ ~ I I 12 I & I 0 44.00 0 _;;: I I 64 ~l 111 P. Heroln ,._- II 43 1 - 5-4 - - - • Fl•kka 45 , i > - - -- 42 41 Meth 40 30 ·-- YEAR 0 • • Nov 2016 Drug OVerdoses By Type I 60 I I so I I I "' Oct 0 ·; r I I 1' •• ,__ Sep 42 __ _ 1 ,, - OTHER - - -- -- -- -+-----11 - -----t-----1-----T---· 3 7 4 9 2 TOTAL o..-ROOSES Aug I2s : _ ____, 11--- ..........-----1 • Pills I I 20 T. i b 10 · oth · Unk 9 ~ ~--v- 0 ---r-· ....~ .- -.-- Jan Feb Mar 6 5 3 0 0 Apr May 3 2 0 Jun Jul Aug Sep 00 00 00 00 Oct Nov 00 00 Dec Delray Beach Police Department 20160VERDOSeDEATHS ~ Jan Feb Mar Apr May Jun Jlil Aug Sep Oct Nov Dec HEROIN 2 8 2 4 3 4 6 3 3 0 0 0 37.00 FLAKKA 0 0 0 0 0 0 0 0 0 0 0 0 0.00 METH 0 0 0 0 0 0 0 0 0 0 0 0 0.00 Pl.LS 0 0 1 0 1 1 0 0 0 0 0 0 3.00 OTHER/UNK 0 0 2 1 0 0 1 3 1 0 0 0 8.00 ~ 8. 6 s ,4 ~ • 8:· ' 4. 0 0 0 48, TOTAL OVE:RDOSES · ,, . DEATHS YEAR 2016DEATHS 9 8 8 • Heroin 8 7 • Fl•klao 6 • Meth 5 4 4 4 I ' 'i 3 I11 2 2 1 I -I 0 - · 000 an 1 II! (1 I~ 1G3EfJEtttj_o.o 1 - 1 . 1 1 00 &b Mac &l:C Ma~ luo 3 3 .IJ.ll 1 ll_ _I I .. I 1_ -: - , ··- Pills 3 oth-Unk 1 0 0 ·-- 0 000 n- 0 000 ··-· 0 000 ~- DELRAY BEACH POLICE DEPARTMENT Monthly Comp ·ALL COMBINED OVERDOSES ~:;;~-,--- Feb-2ou _ __ _ _ I _ 20 _ 1s_ 1_ 2 I 3_2 _ 1. 1 I I Mar s S7__j_ 74 I Apr I May I ~---!--E._-!- I 57 I 33 ! Jun I Jul Aug I 24 I s I 20 I 74 I 63 48 __J_ ·-t-------t----+-- - - - - l - - TOTALALLOVE!U>OSES I ~· I a · I ·,aQ J 82 ·- 1------- -------1 l~so I 12 l · 112 I .. ---+ Sep 1-o;;tj"~i--Dec I Total 19 I 33 I 25 I 25 I 19s 46 I o I o I ~ ! 484 --+- .r-,-,-- -.- -!----,--+I · .83 I · &!i I +----~------- '$3 · 1:< #s · l it" 879 MONTHLY COMPARISON 80 (All combined Drug Dwnlos.s} 74 74 70 -+-- - - - -- --'I 60 -+-----~---'I so ~1----1 ;R~1------1 t -I 40 - + - - -- --r. 32 20 10 L 0 ---, ~- - "--" -.~ '· 0 Jan Feb Mar Apr May Jun Jul Aug Sep I Oct Nov Dec a lOIS • 2016 September 2016 Heroin Overdoses Other . Overdoses (46) 0 Deaths ?Note Map May Not Depict All Locations" FLORIDA DEPARTMENT OF LAW ENFORCEMENT SEPTEMBER 2016 n·1 os'; Ide,ntifile·d in D·e'( P)e· s~ ons·:~; b1.P - ~/ ru '. ~_!·bi.~· ·... .' ' ~ j t._/ ~-= . -'eas·e,d ···=~~: .'.~ '.: '~:: r \ .~)j/ 't'· r~ 1·d · :q, M . \ r ' ftd ~ ! 1"': c~.Jar I E · ,·v?!m . 1·n· · ,e·'·· lf' s:··.· F ··-·- ' lY ,a . .~. ~ .:~ ~ . . --~~~- ; ~,1·---~- ~-----~--~ :-, · -·-~ - - ~ _ L t_., _} .. _! . ..: " : j . . .'1 .. ·: 11 1 ·'> r .. .....r .. ¥ •• • •• ~<'o ~ -·. ·_ .~ ~ ~~ . ·... . ~b . ~P4J;h.. •• I - ~q; . Mf:NT OF L.A-N . ~~~ ~~~Q ?2©Jl~ ~ITU.(fl)MCIDG ~@~©rm .... ' I .. ...-: ... .· .,, j I } ...! Data Collection The State of Florida's Bureau of Vital Statistics reported 194,304 deaths in Florida during 2015. Of the 24,740 deaths investigated by the state's medical examiners, toxicology results determined that the drugs listed below were present at the time .of death in 9,784 deaths. The medical examiners assessed whether the drug(s) identified was the cause of death or merely present at the time of death. The data were then submitted to the Medical Examiners Commission for presentation in this report. It is important to note that each death is a single case, while each time a drug is detected represents an occurrence. The vast majority of the 9,784 deaths had more than one drug occurrence. When reporting the data, the state's medical examiners were asked to distinguish between the drugs determined to be the cause of death and those drugs that were present in the body at the time of death. A drug is indicated as the cause of death only when, after examining all evidence, the autopsy, and toxicology results, the medical examiner determines the drug played a causal role in the death. lt is not uncommon for a decedent to have multiple drugs listed as a cause of death. However, a drug may not have played a causal role in the death even when the medical examiner determines the drug is present or identifiable in the decedent. Therefore, a decedent often is found to have multiple drugs listed as present; these are drug occurrences and are not equivalent to deaths. Data were collected on the following drugs: r~·~·~,l~~;~ml~es . ~ !I ~"'.'.'; .1 .. • • ,. ~-. ~ fBenzoci iazepi nes· !I •Amphet(lmine • Methamp"he-tamine ~ !,.~ .. .. ~ Et;1anol •Ethyl Alcohol ~"•1")_.;·: ·.···• (.;_- t' i . Opioids ~-~~ !I •Aiprawlam •<;hlordiazep.oxide •Ckmatepam •Oia:zepam •·Estazolam • Hunitrazepam •Flurazepam •Lorazepam 't· ~.,. ,.,:.,. - ... •' ·.... ~ ·' Halluci.nog~nic~ ' t •Ph.encydidin'E! tPCP} •Phenetlhylarnines/ Pipe(azin:es ~ • Tryptamines th•,. .... . . ~ ·· · : •Midatofam · I •Nordiazepam •Oxazepam •Temazepam •Triazolam 2015 Medical Examiners Commission Drug Report ;•Buprenorpl1ine .•Codeine ;•Fentanyl •Heroin •Hydrocodone . •Hydrornorphone · •Meperidine · •Methadone •Morphine · •Oxycodor.1e •Oxymorpbone •Tramadol J""- . ~ I ~-·u~,~ ·..:-:. . -{ '' Inhalants . . • • ,•_; •Halpgenated •He.lit.Im •Hyd r.ocarbon •Nitrous Oxide • Other ·-~· · • Cannabinoids •Carisoprodol/ Meprobamatle •Cathi nones •·Cocairie •GHB •Ketamine •Sympathomimetic Arntnes •Synthetic Cannabifloids •Zolpidem Page i Highlights ./ Total drug-related deaths increased by 13.9 percent (1,197 more) when compared with 2014 . ./ 5,364 (12.4 percent more than 2014) individuals died with one or more prescription drugs in their system. The drugs were identified as either the cause of death or merely present in the decedent. These drugs may have also been mixed with illicit drugs and/or alcohol. ./ 2,530 (22.7 percent more than 2014) individuals died with at least one prescription drug in their system that was identified as the cause of death. These drugs may have been mixed with other prescription drugs, illicit drugs, and/or alcohol. ./ Prescription drugs (benzodiazepines, carisoprodol/meprobamate, zolpidem, and all opioids excluding heroin) continued to be found more often than illicit drugs, both as the cause of death and present at death. Prescription drugs account for 67.7 percent of all drug occurrences in this report when ethyl alcohol is excluded . ./ The five most frequently occurring drugs found in decedents were ethyl alcohol (4,762}, benzodiazepines (4,604, including 1,439 alprazolam occurrences), cocaine (1,834), cannabinoids (1,720), and morphine {1,483). The increase in positive cannabinoid findings is due to the increased surveillance by medical examiner offices and not a direct reflection of the increased use of cannabis by decedents . ./ The drugs that caused the most deaths were benzodiazepines (1,140, including 588 alprazolam deaths and 163 diazepam deaths}, cocaine (967), morphine (895), ethyl alcohol (810), heroin (733), fentanyl (705), oxycodone (565), methadone (290), and hydrocodone (236). Heroin (94.1 percent), fentanyl (77.4 percent), methadone (64.0 percent), morphine (60.4 percent), cocaine {52.7 percent), and oxycodone (52.3 percent) were listed as causing death in more than 50 percent of the deaths in which these drugs were found . ./ Occurrences of heroin increased by 74.3 percent and deaths caused by heroin increased by 79.7 percent when compared with 2014 . ./ Occurrences of fentanyl increased by 69.3 percent and deaths caused by fentanyl increased by 77 .6 percent when compared with 2014 . ./ Occurrences of methadone (8.3 percent) and hydrocodone (9.1 percent) decreased when compared with 2014. Also, deaths caused by methadone (22 less) and hydrocodone (14 less) decreased when compared to 2014 . ./ Occurrences of morphine increased by 24.3 percent and deaths caused by morphine (190 more) increased when compared to 2014 . ./ Occurrences of oxycodone increased by 10.5 percent and deaths caused by oxycodone increased by 20.2 percent when compared with 2014 . ./ Occurrences of tramadol decreased by 18.9 percent and deaths caused by tramadol (7 less) decreased when compared to 2014 . ./ Occurrences of cocaine increased by 21.6 percent and deaths caused by cocaine increased by 34.3 percent when compared with 2014 . ./ Alprazolam (Xanax), diazepam (Valium), and nordiazepam dominate the category of benzodiazepines. Occurrences of alprazolam increased by 9.3 percent, diazepam increased by 3.1 percent, and nordiazepam decreased by 0.9 percent when compared to 2014. Alprazolam, diazepam, and nordiazepam are rarely the sole cause of death, but are common as contributing to the cause of multi-drug deaths. Note that since the drugs diazepam and chlordiazepoxide (Librium) are normally broken down in the body into the drug nordiazepam, many occurrences of nordiazepam may represent ingestion of these other benzodiazepines . ./ Occurrences of methamphetamine (40.6 percent) and amphetamine (26.1 percent) increased when compared to 2014. Deaths caused by methamphetamine (68 more than 2014) and amphetamine (20 more than 2014) increased in 2015 . ./ Reporting of occurrences of illicit fentanyl analogs was not specifically requested by the Commission in 2015. Due to the rapid rise of deaths associated with fentanyl analogs, many districts voluntarily reported data; however, the data is not complete. A total of 96 occurrences of fentanyl analogs were reported for 2015, with the majority identified as acetyl fentanyl (65 percent). Refer to page 34 of the report for a representation of the frequency of occurrence of fentanyl analogs. Reporting of fentanyl analogs by all districts will begin with the 2016 Drugs Identified in Deceased Persons Reports. 2015 Medical Examiners Commission Drug Report Page ii Medical Examiners Commission Members Stephen J. Nelson, M.A., M.D., F.C.A.P. Chairman District 10 Medical Examiner 1021 Jim Keene Boulevard Winter Haven, Florida 33880 (863) 298-4600 Email: StephenNelson @polk-county.net Barbara C. Wolf, M.D. District 5 Medical Examiner Robin Giddens Sheppard, L.F.D. Vice President/Funeral Director, Hardage-Giddens Funeral Home Honorable James S. Purdy, J.D. Public Defender, Seventh Judicial Circuit Honorable Angela B. Corey, J.D. State Attorney, Fourth Judicial Circuit Honorable Paul "Rick" Beseler, M.S.C.J. Sheriff, Clay County Wesley Heidt, J.D. Office of the Attorney General Kenneth T. Jones State Registrar, Department of Health Honorable Carol Whitmore, R.N. Manatee County Commissioner Medical Examiners Commission Staff - Florida Department of Law Enforcement Post Office Box 1489 Tallahassee, Florida 32302 (850) 410-8600 MEC Website Chief of Policy and Special Programs Vickie Koenig (850) 410-8600 VickieKoeniq@fdle.state. f/. us Government Analyst II Doug Culbertson (850) 410-8609 DouqCulbertson @fdle.state. fl.us Research & Training Specialist Beth McNeil (850) 410-8608 BethMcNeil@fd/e.state. [I. us Deputy General Counsel James Martin, J.D. (850) 410-7676 JamesMartin @fdle.state. ff.us 20 I 5 Medical Examiners Commission Drug Report Page iii Table of Contents Map of Florida Medical Examiner Districts 1 Morphine Deaths 27 Summary of Drug Occurrences in Decedents 2 Morphine Deaths by Age 28 Frequency of Occurrence of Drugs in Decedents 4 Morphine Deaths by County 29 Comparison of Drug Occurrences in Decedents, 2014 - 2015 5 Fentanyl Deaths 30 Comparison of Drug Caused Deaths, 2013 - 2015 7 Fentanyl Deaths by Age 31 Frequency of Occurrence of Benzodiazepines 8 Fentanyl Deaths by County 32 Alprazolam Deaths 9 Historical Overview of Fentanyl Occurrences 33 Alprazolam Deaths by Age 10 Frequency of Occurrence of Fentanyl Analogs 34 Alprazolam Deaths by County 11 Prescription Drugs in Medical Examiner Deaths 35 Diazepam Deaths 12 Cocaine Deaths 36 Diazepam Deaths by Age 13 Cocaine Deaths by Age 37 Diazepam Deaths by County 14 Cocaine Deaths by County 38 Occurrences of Alprazolam and Diazepam, 2006 - 2015 15 Cocaine Related Deaths by Medical Examiner District 39 Oxycodone Deaths 16 Historical Overview of Cocaine Occurrences 40 Oxycodone Deaths by Age 17 Heroin Deaths 41 Oxycodone Deaths by County 18 Heroin Deaths by Age 42 Hydrocodone Deaths 19 Heroin Deaths by County 43 Hydrocodone Deaths by Age 20 Heroin Related Deaths by Medical Examiner District 44 Hydrocodone Deaths by County 21 Historical Overview of Heroin Occurrences 45 Methadone Deaths 22 Drug Detected at Death: Cause vs. Present 46 Methadone Deaths by Age 23 Manner of Death for Cases Reported 49 Methadone Deaths by County 24 Glossary 52 Occurrences of Hydrocodone, Oxycodone, and Methadone, 2006 - 2015 25 Deaths Caused by Hydrocodone, Oxycodone, and Methadone, 2006 - 2015 26 2015 Medical Examiners Commission Drug Report Page iv C-overage Map Florida Medical Examiner Districts District 1 Escambia Okaloosa Santa Rosa Walton District 2 Franklin Gadsde_n Leon Liberty Jefferson Taylor Wakulla District 3 *Covered by Columbia *4 Dixie *8 Hamilton *4 Lafayette *2 Madison *2 Suwannee *2 District 4 Duval Nassau Clay District 5 Citrus Hernando Lake Marion Sumter Dist rict 6 Pinellas Pasco District 7 Volusia District 8 Alach ua Baker Bradford Gilchrist Levy Union District 9 Orange Osceola District 10 Hardee Highlands Polk 2015 Medical Examiners Commission Dntg Report District 11 Miami-Dade District 18 Brevard District 12 DeSoto Manatee Sarasota District 19 Indian River Martin Okeechobee St Lucie District 13 Hillsborough District 14 Bay Calhoun Gulf Jackson Washington Holmes District 15 Palm Beach District 16 Monroe District 17 Broward District 20 Collier District 21 Glades Hendry Lee District 22 Charlotte District 23 Flagler Putnam St Johns District 24 *Covered by Seminole *7 Page 1 Summary of Drug Occurrences in Decedents 2015 DRUG PRESENT IN BODY CAUSE PRESENT TOTAL OCCU RRENCES Amphetamine 87 300 387 Methamphetamine 156 Atpi:azolam 588 851 Chlordiazepoxide 12 95 Clona;zepam 69 386 Diazepam 163 441 ,":• L' · ~-~ !~. ·-~C•.:.."'· ·;:e " . ")J. ~ ·~ <~~.:,,, -•... . ~. . ' ~5 I ~ ' . l,439 . ,•' 107 ,( . 455 . ,, .$04 2 Estazolam 0 2 Flunitrazepam 0 1 1 Flurazepam 0 8 8 Lo.razepam 28 208 •Midazolam 154 Nordiazepam 7 117 555 ESTl Oxazeparn 61 344 405 Temazepam 95 416 51-1 Triazolam 0 3 ·!J 810 3,952 4,762 Phencydidine (PCP) 2 0 2 ·P.nenethylamines/Piperazrnes 12 10 22 Tryptamines 2 0 r 236 ' 16l. v::. :.,: ' <,1 · ~- · .}. t·· _t.t .. ~· ' •i ...~'"- . . i, .· _, '." I-" .. -..~ . , 149 '·~ . ~~·~/·1·· ~ -~~-~~~7J'):,:~·;~-~~~<~~ ./f-,;_1 ,.~- I ,..: - ·~ :~ ~ .f!--~~ .. ~. ·_. '·' «~ 2015 Medical Examiners Commission J?rug Report 2 Page2 Summary of Drug Occurrences in Decedents (continued) DRUG PRESENT IN BODY CAUSE PRESENT Halogenated 8 Helium 42 20 Hydrncatbdn 10 Nitrous Oxide 2 ,.•¥tr.~!. Buprenorpl:iine ~~J.o;~j~:l Codeine 18 73 705 733 236 167 1 290 895 565 105 108 6 35 84 967 •:!~{1 ·,,.~c~. f ~f'-~c-:f:J :. c,i _1 c~- >~,... ;-~~-~-~~~, --~..., .1 1!L CL . '.; . 9'"'.""' ·.:.: . ·, '..,,.ill.Cl ,ll.jt.•. ' '!. . . .MJ:" ·'Iif'~ ?:. : ';_~ . Feri-taflyl Heroin 6~·:.p I~~~.• -~:~~ ~ ~~: ·:~~ ' .. ; ~:a·j'2. . 1'~ ?JI,· Hydromorphone ~~,,a. ·'.'' Meperidine lo :0 ;'• . ·~ . ·~ I ~;i~.,_r.:..'·:-£ Hydrocodone Methadone Morph·ine ·~~!' ' t-jf ~ ·1_;~3 '4Jl.','11~ . - . .. . -~,-~:~} _- r- Oxymorphone ·. ·:·<~ Cannabino•ids ~ ' ~~~-: ~ .•r Oxycodone __, -~>- ,f~-.., r .,.. ...., ~- .. ! Tramadol Carisoprodol/Meprobamate ·CathJnones ,, J .';: i.:.·'" l~ ·~ /Wt~-;-: Cocaine Syrnpathornimetic Amines 3 6 7 ,· •"" !( ·~ ~,:,r, ..:ili Synthetic Cannabinoids 11 f!!· Zotpidem so $.0 :· , ~ ~·..:,,.,~ I~'", 'n'~- ~ -~ . GHB Ketamine 0 1 0 53 405 206 46 444 354 TOTAL OCCURRENCES ', 50 ..,. ·.· 11 ' ~~),..: ······ ?· ' ~-'. '\ il 4'78:. I""~· · .!fl:~.;!: 779 . 68(( .~21 · • S. 7 4S3~ 163 588 516 284 331 1,714 94 1423 · · ' ·-•...,:';..! • · 1os:::i.· .I '.· •· . ~;8~ 439 i,no 129 .12.n 139 867 2 40 14 12 152 . :..~ . ·20 · ,, " ' l.;834 5' 46 '• -- 21 2.3 . 202 Note: The total occurrences for buprenorphine and cannabinoids are under reported due to the variability in analytical protocols in place at medical examiner offices. Medical examiners were asked ta identify any metabolites of parent drugs. Since heroin is rapidly metabolized to morphine, this may lead to a slight over-reporting of morphine-related deaths. Many deaths were found to have several drugs contributing to the death, and therefore, the count of specific drugs listed is greater than the number of deaths. 2015 Medical Examiners Commission Drug Report Page] ,. .. Frequency of Occurrence of Drugs in Decedents 1 January - December 2015 r Amphetamine Clonazepam Methamphetamine 1.9% 2.2% 1.s% Cathinones I 1.1%" Cocatne Diazepam 2.9% Lorazepam 8.8% Tramadol Nordiazepam 3.2% 2.1%""""'. Oxymorphone_ •• 1.9% 2.0% Temazepam 2.5% 2.2% Hydromorphone 2.5% Codeine 2.3% L_ _ __ -·--·---------- -------·-··-··--.. -----··---- ·-·--·-···--·-··------ ·- - 1 The following drugs individually constituted less than 1 percent of drug frequencies and are not included: chlordiazepoxide, estazolam, flunitrazepam, flurazepam, midazolam, triazolam, of/ hallucinogenics, all inhalants, buprenorphine, meperidine, carisoprodol/meprobamate, GHB, ketamine, sympathomimetic amines, synthetic cannabinoids, and zo/pidem. Note: Percentages may not sum to 100 percent because of rounding. 2015 Medical Examiners Commission Drug Report Page 4 ;. , I i 0 " " ... .•:--. · • .:;t!·: ·a:: . ::i V) c: £ 0 ::::: 0 "' E "t:l cu <: 0 V) -s .E ::... ~ cu iii ..... ..a :?: ;:) 0 t3 ~ ~ <.,) '-5 ~ ...... ..... C:> "l Comparison of Drug Occurrences in Decedents 2014 to 2015 2014 2015 PERCENTAGE CHANGE Amphetamine 307 387 26.1% Metharnphetarnine 217 305 Alprazolam 1,316 92 382 586 2 0 9 191 163 678 385 477 1,439 107 455 1 3 DRUG PRESENT IN BODY Chlordiazepoxide ·c1onazepam mazepam Estazolam Flunitrazepam Flurazepam Lorazepam Midazolam Nordiazepam Oxazepam Temazeparn 604 2 1 8 236 161 672 405 511 4Ct:6%. I ' ~ ·9,3% 16,3% - i9;,:% :3,.1% •* " ' : . ~ ~· ... *· .. * 23.(3% -.t;~% · ~o.:9:% - . . -· .- - .. 5.f%: i.I% * ~'If' 4,270 4,762 Phencyclidine (PCP) 2 2 * Phenethylami·nes/Piperazines 17 22 * Tryptamines 1 2 * 11.5% "Due to the small number of occurrences, percent changes were not calculated. Note: Many deaths were found to have several drugs contributing to the death, and therefore, the count of specific drugs listed is greater than the number of deaths. 2015 Medical Examiners Commission Drug Report Page 5 Comparison of Drug Occurrences in Decedents (continued) "'• ~ 2014 2015 Hafr>genated 33 30 50 20 '5,1.$% 16 1 35 11 "' 71 Codeine 304 478 Fentanyl 538 447 911 779 6£h3% 748 444 14 494 680 521 8 453 1,483 1,081 ~SL1% .) ~ :· ! Ill~ , ~, ;;;.-~, ' .'i.-·' 1~,..:: ·-"~- ~": · '«,..,._·~o, '. w. :: .~. J~~;I, ffn-,J ~ -~t lr, '\'!9: . ~ DRUG PRESENT IN BODY + ..... .:-~ '-r ~,:(;~;~"~ ' .;_~~ ~.··· ;cl -: ~ •a }>:- o,,, Helium Hydrocarbon Nitrous Oxide Buprenorphine Heroin Hydrocodone Hydromorphone Meperidine Methadone .. tfi' ... :-i:~:;-; ·~t!~ ~;~.: Morphine :,~ -~t.;";,. ~ Oxycodone ::/" ~~.l~\'!. Oxymorphone \Ii .. ·~·' ·'.1c·r1·.~ ,~ ;· /'.I' ·_ ·:o,i~ Tramadol Cannabinoids Caris.oprodol/Meprobamate -~ ~ f ·~ -~ -'~ Cathinones .. Cocaine ··~·:,'' ..': .. :·:; "'· !: o.r.'·- ~· r. l,J...,.... - ;::: of; 0 • 11' 1:· ~ GHB Ketamine Sympathomimetic Amines Synthetic Cannabinoids Zolpidem 1,193 978 275 541 1,092 198 134 1,508 2 31 25 9 229 PERCENTAGECHANGE i< 2 389 439 1,720 129 223 1,834 5 46 21 23 202 "'' 1oi.9% ;_ . ... , .. 57;2% 7tt:3%' -~z., ' 17~3% . "' ··-8.3% 24.3%:· i0.s% 4~.!$% "18.9% II, 5)7.5~ :34'.a% .. 6fF4% 2LG% ' ) ~. 48.4.% 1 ·* * .· -11,8% •oue to the small number of occurrences, percent changes were nat calculated. 1 The increase in ketamine occurrences is largely due to the clinical use of ketamine as a sedative and anesthetic in the hospital. Note: Many deaths were found to have several drugs contributing to the death, and therefore, the count of specific drugs listed is greater than the number of deaths. 2015 Medical Examiners Commission Drug Report Page 6 Comparison of Drug Caused Deaths 2013 to 2015 1000 900 800 VI u 700 ~ 600 Cll c :::J u u ....00 500 Cll 400 .... ..c E :::J z 300 200 100 0 ~ q. ~ ~ ~7 ~ co ir ~ ~ ~ ~ % % iii January - December 2013 ~ ~- ?(I> ~,.. % •January - December 2014 ~ -<' ~ ~ ~~ co °O ?(I> -0-::S:. '?(I> ~ O)Q:- ~(I> uJanuary - December 2015 Note: Not all drugs are included in the above chart. 2015 Medical Examiners Commission Drug Report Page 7 Frequency of Occurrence of Benzodiazepines January - December 2015 l ------- -- ----------- - --------- - ----------------··-···--·---···--··---------·------ ----------·--------·------- ---- - - - - - --- ----- - - - ----1 Temaiepam 11.1% 2.3% I l _ __ _ ---------- ~~ - Note: Benzodiozepines not included individually constituted less than 1 percent of occurrences. Percentages may not sum to 100 percent because of rounding. Several benzodiazepines (for example, diozepam) are metabolized to other benzodiazepines in the body (for example, nordiazepam, oxazepam, and temazepam). Thus, occurrences of nordiazepam, oxazepam, and temazepam may be due to the ingestion of diazepam, chlordiazepoxide, and/or temazepam. 2015 Medical Examiners Commission Drug Report Page8 Alprazolam Deaths January- December 2015 Meditai Examiaer·Dist*t· : and Area 'of flo~i;ija District 1 2 3 4 5 6 7 Total wttf;iAlpraiolarn Ar.ea of Florida Total Cause Present Pensacola 71 9 30 6 8 49 27 58 33 10 29 41 3 5 38 10 78 8 2 27 26 47 44 47 13 56 3 69 30 4 10 10 7 4 6 49 157 36 80 14 33 9 24 40 29 16 22 16 10 23 1,4$~ .5'8'8 851 Tallahassee Live Oak 13 Jacksonville S7 Leesburg 37 St. Petersburg 1~6 Daytona Beach 4~ 8 9 10 Gainesville 12 Orlando Lakeland 99 11 Miami 75 204 12 13 14 15 Sarasota 80 Tampa Panama City West Palm Beach 127 27 .· !>eat'*~ ' 8:9 12 16 Florida Keys 17 18 19 20 Ft. Lauderdale 9$ Melbourne 70 Ft. Pierce Naples 33 26 21 Ft. Myers 32 22 Port Charlotte 23 23 24 St. Augustine 14 Sanford Statewh;,te.Totals 2015 Medical Examiners Commission Drug Report 72 Deathls;with Atpr.azolam ontv l)eaths with At.pr@zolain 'in wtth O~ger Qrl!~ C~~bi!)atioo tota1 Cause Present Total Cau~e Present 3 11 5 2 3 1 0 2 0 2 1 3 0 1 4 1 12 1 3 7 2 19 5 20 2 0 1 3 4 1 6~ 5 l 0 0 0 1 0 25 41 3 5 37 10 73 7 2 25 26 45 43 42 13 88 SS 11 27 6 7 45 26 46 32 7 65 47 138 31 60 12 33 8 21 36 28 15 20 0 1 ~l 2 2~ 6 25 2 1 1 5 4 1 1 3 2 0 3 118 s 0 1 0 2 0 0 0 1 1 0 0 22 9 1,2 ~2 36 119 ~~ 9. 90 73 1~~ . 74 102 1 25 2 1 0 3 2;9 26 3 67 30 4 10 9 6 4 6 96 1,.32~ 566 813 66 12 21 14 lS 10 20 755 Page 9 Alprazolam Deaths by Age January- December 2015 · · . M~diQal EX.9.~iner DiStriet.. an~ Area ef Florida Al!ilr~zmt~m c;~us¢d o~atb l Alprazpla)lil. . Present ~t Deatb .. Age of Decedent · Age of Decedent . Dist rict Area of Florida Total Total <18 18-25 26-34 35-50 >SO Tota.I <18 18-25 1 2 Pensacola 71 4J, 9 3 3 Live Oak 1.3 5 Jacksonville 87 3$ 10 0 0 12 5 Leesburg 37 li.O 6 St. Petersburg 136 7'8 2 0 1 4 2 6 2 0 4 1 7 3 3 0 7 0 11 2 0 1 0 1 0 2 59 17 1 3 10 5 19 4 1 8 10 16 16 21 3 17 3 23 12 2 3 3 3 1 1 202. 12 2 1 12 1 39 2 1 8 7 15 11 14 9 1 0 0 2 0 2 0 0 1 6 1 0 4 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 3 30 Tallahassee 1 7 8 9 Daytona Beach 41 Gainesville 12 99 10 Lakeland Orlando :8 2 27 75 . 204 47 2;@ 11 Miami 12 13 Sarasota 80 44 Tampa 117 47 14 Panama City 27 13 15 16 17 West Palm Beach 89 5'6 Florida Keys 12 93 18 19 Melbourne 20 Naples Ft. Lauderdale Ft. Pierce 21 Ft. Myers 22 23 24 Port Charlotte St. Augustine Sanford State\Nide Totals 3 69 lO 70 33 Zf;l 32 2'3 14 2~ 1,4~9 4· 10 10 7 4 6 58.8 2015 Medical Examiners Commission Drug Report 2 14 0 0 6 7 9 14 9 1 13 0 14 7 1 2 3 0 1 0 125 6 I• 8 . 49 11 58 33 · 10 72 4',9 3(? 0 2 0 ao 1 14 20 .33 9 24 0 0 0 0 9 40' 1 1 4 4 3 2 3 2'9 0 0 0 0 0 0 10 19 0 ' 1~9 157 i6 : 22 •. 16 10 23 SSl 4 8 6 3 2 11 8 26 3 10 2 10 0 2 2 5 0 1 0 2 1 113 •, 26-34 4 0 1 10 5 6 5 1 10 8 28 5 9 4 6 3 3 4 3 4 . 5 2 1 4 13,1 35-50 >50 8 3 2 13 5 12 11 0 26 11 2 5 20 18 36 8 20 4 9 32 14 7 24 15 65 20 40 4 7 3 13 21 10 3 6 12 11 2 8 7 4 7 11 236 3'61 10 10 8 7 3 Page JO Alprazolam Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 15.00 - 19.99 Comer 6!9war-O 20.00 - 24.99 .I > 25.00 2015 Medical Examiners Commission Drug Report ~ crdl" - ;1"' Page 11 Diazepam Deaths January- December 2015 Medical ,fixan:iiner . . . bistrrct . ' af\d Area pf Ffodd~ - ' Area oHiorida TotEd Death$ wlth · Diiiz:~am 1 Pensacola ' total 21 '2 Tallahassee 8 3 4 Live Oak 4 Jacksonville 61 Leesburg 24 0 St. Petersburg 59 25 41 Gainesville 9 4 47 24 18 22 5 9 Orlando 37 0 37 10 11 Lakeland 13 Miami s8 1 3 12 Sarasota 13 Tampa 14 15 16 17 18 19 20 21 22 23 24 Panama City 36 30 16 43 8 12 55 18 14 12 28 D:istrict 5 6 7, 8 Daytona Beach West Palm Beach Florida Keys Cau-se Present 8 1 1 14 13 1 7 0 3 (1) 1 3 18 16 4 15 1 Naples 17 Ft. Myers 18 Sanford 0 0 32 0 0 0 Ft. Pierce 28 32 12 4 0 0 0 10 14 0 0 0 0 14 9 13 St. Augustine Present 0 19 41 Port Charlotte 0 1 () 0 0 () 6 1 0 1 4 2 1 0 () 0 Only. Cause 13 3 7 Melbourne 0 5 5 1 l?otal .' · 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 Ft. Lauderdale Statewide TOtats De~ths--w.tt~ ' Dia~epam 1 1 1 0 0 0 0 6 1 0 2 4 2 0 0 0 0 0 0 0 Deaths wttbo: Dja~E!pam ln Cq~~lO.at,on V'lth Qt~~r Qrugs Cause Prese.nt Total 20 8 12 1 7 8 4 1 3 14 46 60 24 24 0 41 17 S'S 22 25 3 4 5 9 37 0 37 1 12 13 52 3 49 18 17 35 16 30 14 14 4 10 15 39 24 1 5 6 8 18 10 41 13 28 32 0 32 5 12 17 18 5 13 1 4 3 0 14 14 7 0 7 2 0 2 5 0 5 604 163 441 21 1 20 583 isz 421 2015 Medical Examiners Commission Drug Report Page 12 Diazepam Deaths by Age January- December 2015 Medit~I ~1faminer Distri·tt: . . -an:d-A:rea of •fto.rida . .··:"'.' '" ·. Area of Florida Total District 1 Pensacola 21 ·' , .,.flia~~pa.m ·. Cau,sed ·tl'eath ( Tallahassee s Live Oak 4 4 Jacksonville 61 5 Leesburg 6 f 26·34 35-50 >$0 TQta'i <18 18-25 26c34 35.-50 >SO 8 0 0 2 3 3 13 0 3 4 5 0 0 0 0 1 0 7 1 7 2 0 7 1 1 0 5 3 0 0 1 0 0 0 0 4 0 1 0 0 0 0 0 0 0 1 1 3 2 1 1 14 0 7 Daytona Beach 25 3 8 9 Gainesville 9 Orlando 3] 10 Lakeland 13 4 0 1 11 12 Miami 58 3 Sarasota 36 18 Tampa 3~ 16. Panama City 1~ West Palm Beach 43 8 · 4 15 0 0 0 0 0 0 0 0 0 0 0 0 17 Ft. Lauderdale 19 1 9 1,8 Melbourne 41 13 .o l9 Ft. Pierce 3:2 0 0 20 21 22 Naples 17 18 Port Charlotte 4 23 St. Augustine 24 Sanford 14 7 5 5 1 0 0 604 163 StateW:ide totals oi~zep.am Pre$~~t ~tiPe~th . Age of b~cederii 18-25 41 Ft. Myers . <18 St. Petersburg Florida Keys . Tot9I 24 59 i3 14 lS 16 ., Age of Decedent - 2 3 . 20 I 5 Medical Kr.aminers Commission Drug Report 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2 5 1 0 0 0 0 0 2 0 3 0 2 1 0 0 0 0 0 0 17 47 0 15 0 2 0 1 1 7 7 1 4 1 0 5 0 20 2 2 0 0 2 11 7 3 8 0 7 7 0 0 32 0 1 0 0 2 0 5 3 1 12 13 3 0 0 0 0 0 14 0 0 55 0 7 441 0 6 89 24 18 22 5 ';37 1 ;12 0 1 55 i8 14 l~ 28 t ;LQ 28 0 0 1 0 1 2 2 4 2 3 11 2 2 1 3 2 1 2 7 5 1 2 26 12 11 11 2 20 6 38 13 9 6 13 3 5 19 22 1 9 4 1 3 2 7 2 1 1 0 2 1 3 12 52 117 254 14 10 0 0 0 7 4 9 3 9 1 1 4 2 1 0 1 1 0 1 0 2 0 1 0 0 4 10 2 0 0 1 9 Page 13 Diazepam Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 15.00-19.99 Collier Broward 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report Page 14 Occurrences of Alprazolam and Diazepam (Present and Cause) 2006 to 2015 2500 --1 ~-------- ! ! 2000 I Vl lstrict and Area o~ Florida District Area of Florida 1 Pensacola ~. 31 14 I 20 13 3 1 1 2 7 3 38 20 46 0 1 2 4 1 7 4 3 4 75 35 ''12 7 18 14 ·o 0 94 32 Gainesville Orlando 72 Lakeland Ft. Lauderdale 42 78 47 70 20 80 20 61 Melbourne 76 Ft. Pierce 63 Naples 20 R Myers 17 28 19 31 27 36 7 47 1 3 19 53 0 3 4 .n. 4 0 0 0 0 0 5 0 0 20 34 21 11 0 1 13 5 8 29 74 9.78 $36 4.42 0 6 72 6 4 41 3 13 2 2 1 0 33 15 17 29 31 7 26 14 9 St. Augustine 24 Sanford 14 5 5 9 1,081 565 516 2015 Medical Examiners Commission Drug Report 0 5 26 14 14 26 27 6 23 6 1 8 4 45 5 39 46 32 13 13 4 39 21 11 13 13 7 71 2 Port Charlotte 44 47 32 2 Ci) 63 3'6 Florida Keys 5 11 9 West Palm Beach 41 16 32 7 2(} 0 16 17 18 19 20 21 22 2 67 4 9 15 6 18 5 Tampa 11 2 7 8 Panama City I 8 2 8 7 44 23 47 20 34 13 I · Present 5 41 19 55 18 16 28 17 31 25 35 3 5 0 1 14 Statewide TQti!lS Cause 21 8 7 45 22 60 15 1:0 Sarasota I 34 83 42 106 32 2.5 Miami Tot:al Cause Live Oak Daytona Beach ·Present Tota1 Jacksonville 7 8 9 10 11 12 Deaths with Oxvcoclene in Oon"tbinati()n with:et.Jeath,s w!th 9xv~odone Of!Jy Cause Tallahassee Leesburg . 10taJ 2 5 6 . Totall)eat_hs with Oxy:codor.ie 5 0 0 1 103 1 0 59 34 16 39 14 4 35 19 7 7 21 14 6 5 Page 16 Oxycodone Deaths by Age January- December 2015 Ol50 21 8 0 1 2 11 1 0 1 0 3 7. 1 0 0 1 1 10 18 2 0 0 2 4 Area of Florida 1 Pensacola ~4 2 3 Tallahassee Live Oak 15 10 4 5 6 Jacksonville 83 45 Leesburg 42 f 06 32 22 St. Petersburg ; Tota{ 7 Daytona Beach 8 9 Gainesville 10 Lakeland 11 Miami 12 13 14 Sarasota Tampa 47 7@ Panama City 15 West Palm Beach 16 Florida Keys ~~;· 2$ 72 42 78 60 17 28 19 18 0 2 1 5 5 0 1 2 6 0 31 0 3 2 8 18•25 26-34 35•50 >SO 7 i3 0 1 3 4 5 1 2 7 3 0 0 1 1 0 6 3 16 32 6 10 20 4 14 4 16 9 2 1 19 35 46 0 0 0 0 0 0 3 1 7 7 31 0 0 1 7 6 2 3 2 2 3 1 8 3 17 0 3 4 6 10 2 7 22 0 3 1 9 2 8 10 13 1 3 3 8 2 1 1 6 3 7 11 15 1 5 2 2 0 1 9 16 2 3 8 7 13 1 3 3 3 274 5 6 14 0 7 6 4 14 8 0 10 44 23 6 6 14 12 13 ko 10 20 34 $ 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 9 0 1 47 27 0 0 1 1 1 5 ~o 0 0 0 2 5 80 47 0 6 8 16 17 13 33 20 5 0 0 1 4 0 15 8 6 14 21 18 18 17 2.9 17 Ft Lauderdale 61 44 0 4 Melbourne 76 47 1 1 19 20 Ft. Pierce .&3 0 21 Ft. Myers 20 39 22 Port Charlotte 21 23 24 St. Augustine 11 32 13 13 7 6 Sanford 14 1,081 5 0 0 0 1 1 0 2 0 2 565 4 Statewide Totals Tota.I <18 36 7 18 Naples A9e.of Decedent < 18 District Orlando Q~Y,¢tld0fl.~ ;fr~se,.nt' at ·Death' ·.· .. Ag_e of Decedent 2015 Medical Examiners Commission Drug Report 0 2 12 17 2 3 8 31 7 3 4 4 26 1 3 2 3 1 14 1 1 0 33 86 0 198 3 244 s16 1 0 0 2 0 22 2 75 2 11 22 9 13 26 11 144 7 Page 17 Oxycodone Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 15.00 - 19.99 Broward 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report Page 18 Hydrocodone Deaths January - December 2015 Medfuai . e~:ar.nhler District an~, Areaof Florid~ Total Deatbswith··Hydroce~one Deaths wi:t h f1.ydrocodane Only . ·.• Area ofHorida ·rota.1 Cause · Present Total Pensacola Tallahassee 45 10 13 3 Live Oak 12 Jacksonville 72 27 65 4 21 12 28 31 9 8 Daytona Beach Gainesville 32 7 8 51 15 37 22 1~ 4 9 9 Orlando 59 13 10 Lakeland 35 10 11 Miami 34 10 12 Sarasota 28 11 l3 Tampa 4§ 14 Panama City 16 4 16 2 12 21 6 6 4 2 4 5 2~6 46 25 24 17 30 14 7 3 2 5 3 7 2 5 19 3 2 1 5 District 1 2 3 4 5 Leesburg 6 7 St. Petersburg :).5 West Palm Beach 18 26 16 Florida Keys 9 17 Ft. Lauderdale 21; 18 Melbourne 39 19 Ft. Pierce -20 Naples 21 22 23 24 Ft. Myers 21 15 17 Port Charlotte 5 St. Augustine Sanford 13 Statewide Tota1s .. 19 680 2015 Medical Examiners Commission Drug Report 3 10 3 7 2 3 1 9 18 15 9 13 3 9 14 444 2 4 6 0 5 1 94 v Deaths wit h Hydrocodone in CombiA;ltion With Other Drugs Total Cause Present tause Present 1 1 6 38 2 2 5 3 7 10 67 24 58 29 0 0 0 1 0 0 1 0 0 0 0 0 0 6 2 5 18 3 2 1 5 3 0 3 2 0 3 0 0 0 1 1 2 4 5 0 2 0 7 0 3 1 87 8 40 32 32 27 41 15 23 7 18 38 19 12 2 4 21 12 27 9 4 12 10 10 11 16 4 16 2 12 26 5 6 46 12 31 20 4 28 22 22 16 25 11 7 5 6 21 17 13 5 8 3 8 6 6 3 2 2 18 586 5 229 13 357 ll 11 5 6 Page 19 Hydrocodone Deaths by Age January - December 2015 Medidene CaV$eEI Death Age of Decedent 18 ~25 < 18 26c34 35-50 0 1 3 2 0 0 0 2 0 0 0 3 3 3 5 0 0 0 0 5 4 1 0 9 1 1 0 2 0 0 0 1 2 0 0 3 0 0 2 2 1 2 0 3 0 0 0 5 0 0 3 5 0 0 0 2 0 4 0 0 0 0 2 0 0 0 1 s 2 0 0 10 0 1 1 1 0 0 1 1 0 0 2 0 0 0 0 1 0 0 0 2 0 0 1 1 1 7 28 76 li}';~oted,.()9~ Pr~$ent a:t · Death Age of Decedent >50 7 1 1 10 7 14 5 3 8 6 4 6 Tdt~i 32 8 30 14 <18 18~2s 26-34 35"50 >50 4 0 0 2 1 1 1 0 0 1 0 0 3 0 7 9 12 1 1 6 1 2 1 0 3 1 3 4 3 2 1 0 1 0 1 4 2 12 0 6 10 9 18 3 4 15 2 13 1 2 3 9 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 3 14 124 444 2 7 8 51 15 31 22 9 46 25 24 .. 17 7 9 9 0 0 0 1 1 0 2 5 16 27 s 8 26 10 8 8 10 1 33 10 9 8 5 7 2 5 14 13 8 17 10 3 6 1 1 5 6 4 7 12 7 0 0 0 0 0 1 6 0 1 0 0 2 3 9 1 15 41 128 2$9 0 5 7 3 7 Page 20 Hydrocodone Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 I 0.00 - 14.99 15 .00 - 19.99 Collier Broward 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report r !) r:t#g:P Page 21 Methadone Deaths January - December 2015 Medfoal;E:xaminerDistrkt · · af.1~: Area Qt.f:J6rid~ · District .· Are·a of Flo(lda 1 2 3 4 . 5 6 ·7 Pensacola Tallahassee 5 Live Oak 6 3Z 33 Jacksonville Leesburg St. Petersburg Daytona Beach Gainesville 9 Orlando 10 Lakeland 11 Miami 12 13 14 15 16 17 . 18 Sarasota Tampa Panama City West Palm Beach Florida Keys Ft. Lauderdale Melbourne 19 20 21 22 Port Charlotte 23 St. Augustine Ft. Pierce ···- Naples Ft. Myers Sanford Statewide T~tals 56 12 15 40 14 12. 25 42 5 15 4 15 23 21 5 19 5 4 , · Cat1se 18 3 3 21 17 47 14 10 20 10 4 17 32 1 13 1 12 13 9 lQ 4 8 3 3 7 45-3 290 201 5 Medical Examiners Commission Drug Report .Present 11 C(l)m~!nat!~ Vitith ()thel Dr4gs itJtal 3 Tota! Cause 26 4 14 16 2 3 19 16 40 12 8 20 10 4 16 26 1 12 3 1 14 22 12 13 8 4 7 3 3 6 15 9 3 4 17 4 8 7 5 3 2 2 2 9 9 1 10 2 0 2 262 138 2 3 1 11 3 2 7 3 16 9 4 5 20 4 8 8 10 4 2 3 3 1 3 3 0 0 2 11 1 1 1 1 10 1 12 1 4 0 11 2 1 3 163 Death~ with Methadone ·jn DeathS wi~h Methadc>oe Only ·' Total 2H 8 24 l)>tal 1Peraths with··ri;,'Iethadone 4 .· 0 1 4 !iii Cause 2 1 0 2 1 7 2 2 0 0 0 1 6 0 1 0 0 0 1 0 1 0 0 1 28 Present 1 0 1 1 1 0 1 1 3 0 0 1 5 1 0 1 1 1 3 0 1 0 1 1 2'5 4 5 29 31, 49' 15 12 37 14 12 i$ 3,1 Ji 5 17 5 3 8 400. Present 10 2 2 10 Page 22 Methadone Deaths by Age January - December 2015 Area of floriaa 1 Pensacola 2 Tallahassee Total 29 5 3 Live Oak 6 3 4 Jacksonville 32 21 5 Leesburg 3:3 17 6 7 8 St. Petersburg Daytona Beach 56 1$ Gainesville 15 47 14 10 9 Orlando 40 2c:l 10 Lakeland 10 District Total <18 18 0 3 0 0 1 0 0 0 0 0 7 6 11 2 5 4 1 2 0 0 0 2 0 0 2 0 2 1 . 3 6 8 1 4 1 5 4 9 16 6 11 16 0 0 1 6 3 15 9· 0 0 5 4 0 2 2 0 2 5 0 6 io 1 9 2 4 3 4 4 4 0 3 0 9 8 8 8 0 11 13 10 0 1 4 6 1 5 2 0 3 3 1 4 5 3 0 5 5 2 4 3 1Q· 12 0 0 3 1 0 0 0 0 0 0 0 1 0 0 0 0 1 1 2 1 2 3 1 2 1 0 0 2 1 0 5 102 4 0 0 0 1 5 1 1 11 2 4 6 8 0 0 0 2 4 1 0 7 0 0 0 8 3 0 0 0 2 0 0 1 0 0 10 7 0 1 0 1 1 0 0 1 0 453 290 2 17 53 116 Miami 2,5 1,3 Tampa 42 17 32 14 15 Panama City 5 i West Palm Beach 15 1'3 16 Florida Keys 4 1 17 Ft. Lauderdale n 0 1$ Melbourne n .1 9 Ft. Pierce 15 23 21 0 0 20 2.1 22 23 Naples 5 Ft. Myers HJ Port Charlotte 5. Statewide Tetals 18-25 0 Sarasota Sanford <18 1 11 4 9 4 3 . 4 20 I 5 Medical Examiners Commission Drug Report 1 0 1 " TotaJ 0 12 Meth,ad~me ~res_ent at · [)~atl\l Age of Decedent >SO 35-50 0 0 0 0 0 0 0 St. Augustine 18~25 26-34 14 12 24 . Meth.:~uilene Caused·!~eatJ:a Age of DecedSO 2 4 0 2 11 0 4 1 3 6 4 5 2 0 1 0 1 2 1 1 2 1 1 4 4 0 5 6 0 0 0 0 0 0 0 0 0 3 0 0 2 163 1 6 23 1 7 0 0 1 63 11 0 0 0 ' ' .. ' 0 0 0 1 0 1 1 1 4 0 4 2 1 0 70 Page 23 Methadone Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 15.00 - 19.99 Collier Broward 20.00 - 24.99 > 25 .00 2015 Medical &aminers Commission Drug Report !) r&riP Page 24 Occurrences of Hydrocodone, Oxycodone, and Methadone (Present and Cause) 2006 to 2015 --------·-·-····--------··-·-------------··------------ ···---·--·-···---·---····-·-------·---····--··-····---·-··-·--·--··--·-·---- ----------·--·--------------, 3000 2500 i 1 ------9---~·--,----------~----·----,-·-·-------------------~-·-~------··------ 2000 _,____ _ _ VI Q) u c ~ ._ :::i u u 0 1500 -! ~ ~ I 1000 I ~---------·--------- ;#'= I 'O .• ·-- ,. . -1·----;~_:,...-- -·----- ---- -- - - - ---- -- - 500 - -·----,-------.:A.::" ---------- - --- --------- ---- ~-- ,.----...._ ... ~ .... I -·-Ii ...,... i 4- .... 2014 2015 ---------·----··----·------------------··--·----------------------·---·----------------- ·- -----,------.-------..------7 0 2006 2007 IL_ 2008 2009 ...,_Hydrocodone 2010 2011 ~Oxycodone 2012 ' 2013 Methadone --------------·--------· 2015 Medical Examiners Commission Drug Report Page 25 Deaths Caused by Hydrocodone, O:xycodone, and Methadone 2006 to 2015 1600 I -----------· 1400 - - - - -·····-·---·-·-·······---·-···------·-·-·-··-·-·-······-··--------# -·-·······---··-···-·-' --··-·-··-·--··----·---····-·-·--·-····-·-··----··---·-·-·--·-·-·----··--·--·-·---··-··-·--·-·-·--·····---··-·-·--------··--····-·--·-·····-----·-······- 1200 ' ec 1000 VI ---------·····---·---··--------·---------·-·--- QI t: ::J u u ------ ------ 0 ...._ 0 ._ QI _o _a::=____________=:A___ _ ~ E ::J z 400 200 0 -1- -- l 2006 -. 2007 2008 2009 2010 2011 ...._Hydrocodone r .;fEJQxycodone I______ _ 2012 2013 ·----~------- , 2014 2015 Methadone ' ··-----------·-·--·---------·-·----·---------------------------·--------------------------·---·-···-~-·----~ 20 I 5 Medical Examiners Commission Drug Report Page 26 Morphine Deaths January - December 2015 MedicatlE~all'!in~r C>lstrict ~nd )\re{} of'FIO,rj(la · . Total Deat-hs wtth Morphine q:~aths wit~-M.orphime Qnly· ~; ' Qistrict Area of Florida Total Cause Present Total Cause 1 Pensacola 64 2 Tallahassee 9 Live Oak 5 Jacksonville 100 Leesburg 41 Iii St. Petersburg +s 7. 8 Daytona Beach 118 4:S 21 8 3 29 18 58 5 2 3 4 5 17 4 9 Orlando 10 Lakeland 5-0 i1 Miami 12 13 14 15 16 17. Sarasota 43 1 2 71 23 60 31 8 128 21 94 53 58 4 48 5 1 0 1 0 2 3 2 1 2 1 0 2 4 1 4 1 8 2 1 0 0 0 0 1 Gainesville 25 194 Tampa 157 122 99 Panama City 15 West Palm Beach 64 Florida Keys lS Melbourne 7 96 63 19 20 Ft. Pierce 3.8 Naples 21 Ft. Myers 22 Port Charlotte 23 24 St. Augustine 28 66 25 14 44 23 21 46 5 7 35 1,483 895 Ft. Lauderdale Sanford Statewide Totals 2015 Medical Examiners Commission Drug Report 77 22 17 66 29 63 69 41 11 16 2 19 19 15 7 20 20 7 13 588 2 4 3 5 14 9 4 10 12 4 6 l 11 s 1 1 0 3 1 3 125 37 Prese:nt 4 2 1 4 1 12 2 4 12 8 4 8 8 3 2 0 3 3 0 1 0 neath~ wt~l1 M50 Total <18 1&-25 26-34 35-50 43 1 14 9 21 4 1 8 1 1 6 5 2 3 0 2 1 Jacksonville 100 71 0 22 5 41 i3 0 3 5 6 St. Petersburg 118 7 Daytona Beach 4'8 60 31 0 0 8 Gainesville 25 9 Orlando 194 8 128 0 1 10 18 32 10 Lakeland so . 21 11 Miami 1$7 .. 94 0 1 Sarasota 122 53 7 8 16 5 12 20 16 40 i2 13 14 Tampa 58 3 10 Panama City 99 15 2 2 15 16. West Palm Beach 64. 1 5 Florida Keys 7 5 17 Ft. Lauderdale 96 77 0 2 1 13 1 15 8 5 0 3 0 11 3 1 2 7 5 4 3 1 11 5 19 8 7 12 Leesburg 0 0 32 7 19 13 3 52 8 38 17 22 0 18 3 32 18 5 4 10 3 4 1 0 0 1 0 5 0 1 5 1 2 10 1 0 2 0 0 1 1 2 2 1 1 3 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 13 0 5 0 0 6 14 1 2 0 3 1 38 Dtstrict 4 48 18 Melbourne 63 44 19 Ft. Pierce 38 23 20 Naples 28 21 46 S. 7 21 Ft. Myers 66 22 23 24 Port Charlotte 25 St. Augustine 14 Sanford 35 22 i,483 895 Statewide Totals 2015 Medical Examiners Commission Drug Report 0 0 0 0 0 0 1 1 0 0 1 0 0 0 6 0 2 4 9l 9 6 0 35 3 28 16 15 0 6 1 10 4 9 8 12 1 0 7 211 9 331 11 29 8 18 32 10 58 4 17 27 66 9 29 17 12 63 12 69 41 16 4 11 21 1 16 2 23 19 18 19 15 8 7 1 1 7 20 20 7 2 2$5 588 16 13 >50 8 30 6 8 1 1 22 27 7 8 0 3 s 11 3 4 11 0 1 2 1 0 5 1 9 3 10 6 2 16 1 5 3 3 93 160 6 294 Page 28 Morphine Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 Broward 15.00 - 19.99 20.00 - 24.99 > 25.00 20/ 5 Medical Examiners Commission Drug Report !) rdtiP Page 29 Fentanyl Deaths January - December 2015 rviedb:~ .Exa~ine17 i;)istrict .· .' a!l4 Area of ·~JJ?ri~a Tl)tal Death,wlth F~taavt . District Area of Florida Total Cause 1 Pensacola 30 2 Tallahassee 27 1 1 48 3 Live Oak 5, 1 4 5 Jacksonville 56 Leesburg 6 St. Petersburg 7 8 Daytona Beach 9 Orlando 10 59 26 12 105 10 11 12 Lakeland li Miami 102 Sarasota 13 Tampa Panama City 122 24 10 West Palm Beach 103 14 15 16 17 18 19 20 21 22 23 24 Gainesville ' ·Deaths wltb fentany~ ~ Total cause Present Total ca1;1se Present ,Q 0 0 3{) 27 3 4 0 8 1 0 8 0 0 0 1 0 4 3 6 2 0 0 1 1 4'8 7 3 10 9 3 8 1 3 67 14 82 111 15 9 90 38 13 3 20 3 4 0 2 5 2 1 11 14 13 9 1 3 1 2 13 0 9 2 8 Florida Keys 3 3 82 77 Melbourne 26 Ft. Pierce 40 25 Naples 10 Ft. Myers 31 15 8 c;i\>,m:~rnatio~ \yJ~n· O~!:l~i Dpllg~ Present 3 49 14 Ft. Lauderdale , Deaths with Fentanyf if\ Only 12 5 14 17 3 12 0 8 8 92 1 3 1 2 0 1 0 14 1 1 42 7 41 14 7 62 12 9a 81 108 98 14 1 . 10 Sl 25 9 21 8 94 3 0 0 11 10 1 71 6 1 1 3 3 1 1 34 s 25 15 0 0 1 0 0 24 7 82 3 67 23 8 7 18 0 6 3 10 11 2 30 2 17 10 7 1 12 0 4 11 16 2 St. Augustine 8 7 19 7 3 6 3 15 11 3 0 1 2 Sanford 5 4 8 3 2 10 2 911 705 2:06 99 63 36 12 812 642 171) Port Charlotte Statewide Tetals 2015 Medical Examiners Commission Drug Report 8 0 0 2 9 7 7 Page 30 Fentanyl Deaths by Age January - December 2015 MediGale~tiiit'ler DiS:trict .and Area,of.florkla • F.entan\4 Caus~d Death·· - -.. '' ~." •' ·.<" ' • ' • • : ~ 1 ,, .Fentanyl.Pres~n'.t at Q~~th, • t' .., .,. Age ofDecedent Age of Decedent District Area ofFloricia Total Total <18 18-25 26c34 35-50 >50 Totad <18 18-25 26c34 35-50 >50 1 2 Pensacola 30 5 27 0 0 4 6 0 0 11 6 1 0 12 2 18 5 2 16 3 10 21 3 4 1 0 0 0 1 1 3 0 g 0 0 0 0 Tallahassee 1 3 Live Oak 1 4 Jacksonville 56 5 6 Leesburg :10 1 48 7 St. Petersburg 59 4:9 7 8· 9 Daytona Beach 26 14 West Palm Beach 10 103 1.5 9 90 Florida Keys 3 3 Ft. Lauderdale &2 77 Melbourne 40 26 Ft. Pierce 8. 7 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 Gainesville 12 9 Orlando 105 67 10 Lakeland 11 Miami 12 Sarasota 17 102 122 24 82 111 13 Tampa 14: Panama City 15 16 17 18 19 " 14- 20 Naples 25 10 21 Ft. Myers 31 19 22 Port Charlotte 15 7 0 23 st: Augustine 8 3 24 Sanford 15 911 11 0 0 3 Stat-e-wide totals 705 2015 Medical Examiners Commission Drug Report 0 0 7 1 3 2 1 4 1 8 16 0 1 11 0 11 2 0 2 1 0 0 3 78 10 2 14 2 2 22 7 29 34 1 0 37 2 24 0 1 19 2 14 5 4 25 3 34 39 8 4 33 1 28 6 11 1 0 2 1 4 4 10 4 1 4 207 6 3 9 0 14 7 3 1 6 -~ 0 i6 0 0 0 0 1 1 12. 0 2 3 0 5 0 2 1 1 3 0 1 0 2 0 1 0 0 0 0 0 0 0 d $~ 3 20 1,1 9 1 13 0 5 14 17 ·. 0 1 1 1 4 1 5 0 3 0 2 2 2 3 0 10 1 1 2 4 0 1 3 0 1 1 0 5 0 2 5 7 2 2 0 2 1 1 2 0 1 1 1 0 2 0 0 1 3 0 6 3 2 17 2 12 4 6 0 5 0 1 7 12 0 2 8 0 1 0 4 2 0 4 0 1 0 0 0 0 0 0 7 1 8 6 3 4 268 149 lQ6 s 20 34 46 101 5 Page 31 Fentanyl Deaths by County 2015 Occurrences Per I 00,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 Collier Broward 15.00-19.99 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report r !) c)ttP Page 32 Historical Overview of Fentanyl Occurr~nces 1 (Present and Cause) 2003 to 2015 r ooI - ·--------·-··-------------------------····---· ..-·-·-·--·--·······--·--···-·--------·-··-····-····-·-···-----------....----·····--··-·-·-··---·-·----------··-·-····-····-·--·---------------·-···-····-·······-·---------·-·--·-------------·-·-···- -·-··-·-·-···· i - 900 800 700 -~--- VI Q.J 16°0 1 0 '+- 500 0 Qi _() E 400 ::J z ---------- 300 200 100 0 -------·-·- ----------·--·-----------~----··-·--·--·------·-··-·---------·---------------------------------- ..,_~~~~~~ 2003 2004 l 2005 2006 ---------r 2007 2008 , -~- 2009 2010 2011 2012 2013 2014 2015 -..Fentanyl Related Deaths 1 The number of fentany/ occurrences indicated includes occurrences offentanyl analogs. 20 I 5 Medical Examiners Commission Drug Report Page 33 Frequency of Occurrence of Fentanyl Analogs Total Occurrences =96 January - December 2015 Butyryl Fentanyl 13 1"3°% Note: While not officially tracked in 2015, several medical examiner offices voluntarily reported data for occurrences of illicit fentanyl analogs. 2015 Medical Examiners Commission Drug Report Page 34 Prescription Drugs in Medical Examiner Deaths 2014 versus 2015 Medit~l -£>taroiRer Dis~rict . ,and Area ofFlPiida Total Prescription orug Qeaths i.n ME·Dea.ths t"rese11~ ~n~ ea1;1s*H District Area of Florida 2014 1 2 Pensacola 150 69 36 306 239 479 162 97 506 185 389 217 305 84 350 27 256 211 213 73 203 70 83 64 4:;174 Tallahassee 3 Live Oak 4 Jacksonville $ Leesburg 6 St. Petersburg 7 Daytona Beach 8 Gainesville 9 Orlando 10 11 12 Lakeland 13 Tampa 14 15 16 17 1$ Miami Sarasota Panama City West Palm Beach Florida Keys Ft. Lauderdale Melbourne 19 Ft. Pierce 20 Naples - 2.1 22 23 24 Ft. Myers Port Charlotte St. Augustine Sanford s:tatf?wlde Totals These tables are based on prescription drugs tracked by the Medical Examiners Commission and reported by Florido Medico/ Examiners. Do not odd ocrass columns. 2015 Medic al I 2015 208 51 36 355 191 472 174 106 518 199 541 332 360 89 394 52 292 271 197 87 207 70 69 93 S,364 I PFesqtip~ion Dru~ ~Pr~~~'tand (;au~el .• Percent Clll'ai'.lg§! ~~. 7% .,.z~~i~ 0.-0% . i1?1P% -~(;>.1,% -LS.% 7.4% ~.3% 4,43 7.6% ,3~,1% SJ;(,)% . 1~.-0%. G,0% 12,6% ''9:2.6% · H.1% 28.4% . -7..5$. 1fil.i % 4•.0% 0~0% -16.~% 45 .3~ . 12.4~ These individuals died with one or more prescription drugs in their system. The drugs were identified as either the cause of death or merely present in the decedent and also may have been mixed with illicit drugs and/or alcohol. Examiners Commission Drug Report Acdde~ilta[P~ths wi.th · 2014 85 34 16 187 137 277 70 33 272 100 174 126 159 40 201 13 167 115 100 45 101 35 43 38 2,568 I 2015 128 22 22 220 103 278 97 51 307 96 288 224 188 43 251 21 220 161 107 49 118 36 30 44 3,,];04 I Percent Change 50.6% ~3J»3% 37.5% '17.6% -2/l.8~ Q.4% 3'8.f?% 54.5% 12:9% -4-0% 15:55% ]7;8% 18> .;2z% 7.$% i4:su 91.s% · 3·4j% f,Q,9% 7.0% 8'9% i6;8% 2.9,% -30.2% t:>.&% 29,;!}% The manner of death for these decedents was reported as accidental. These individuals died with one or more prescription drugs in their system. The drugs were identified as either the cause of death or merely present in the decedent and also may have been mixed with illicit drugs and/or alcohol. A¢¢;~~htafDeaths Caused by. .Pr~scriptioo prug$ 2014 62 20 10 134 84 226 43 18 176 48 90 105 114 24 155 9 136 76 64 37 57 12 21 31 1,152 I 2015 91 14 15 161 63 212 69 30 219 58 166 176 134 23 182 12 194 114 69 39 77 19 19 35 2,191 Percent Clllange 46 ..~% :-:30;Q% so.0% ' 40~ 1% -2',5.0%' -6.2% ~0-?~f 66,,7% . 24.4% tO.$% "MA~- 97.~% . 1q'.s% -4.;z% 1%4% 3:i.3% 42.()% so:oM) 1;8% SA% 35,1% · 58:3% -'9.5% ..12:9% 2s.i% The manner of death far these decedents was reported as occidental. These individuals died with at least one prescription drug in their system that was identified as causing or contributing to the death. These drugs may also have been mixed with illicit drugs and/or alcohol. Page 35 Cocaine Deaths January- December 2015 MedicalEXarttln'erJ)is·tdct ·· .and Area ~fP-iwtd·a District Area of Florida TQ,ta1 ;Oeat~s witb Co~aine · · Cause J>r~sent Total Cause Present Ta.taJ Cause Present 31 6 1 64 30 63 17 20 124 20 49 12 4 82 24 38 20 14 ·2 1 25 10 79 32 41 11 4 69 21 34 14 5 63 13 6 174 45 56 12 64 44· 1:1. 8 1 0 13 3 4 6 6 16 2 27 6 14 4 66 11 6 1 1 9 12 10 1 4 16 4 17 .:to 5 3 l..57 8 Pensacola 80 2 3 Tallahassee :J.8 Live Oak 4 Jacksonville 5 14'6 Leesburg 6 St. Petersburg 7 8 9 10 Daytona Beach Gainesville 54 101 37 31 ,·" Orlando 203 Lakeland 3~ 11 Miami 28~ 115 12 13 Sarasota 134 i4 15 Panama City 16 17 18 19 2021 22 23 24 Florida Keys 13 Ft. Lauderdale Naples 152 86 49 23 89 28 3 109 4 113 53 26 14 Ft. Myers 71 22 Port Charlotte 12 St. Augustine 9 16 1,834 3 1 11 967 Tampa West Palm Beach Melbourne Ft. Pierce Sanford Stat¢wide Totals C.:l.tnbination .Vifith.·.~herQrug' · · Tot.al 1 5 .Deaths with.Cotaine tn Deaths w.ith .Cocaine'Qnly 84 15 173 . 2015 Medical Examiners Commission Drug Report 9 39 33 23 9 49 9 8 22 15 14 7 21 s 16 5 20 12 6 6 4 5 2 2 3 867 289 5 7 1 11 2 16 6 1 4 1 0 0 2 137 4 6 5 L 3 2 2 1 143 16 5 4 1,24 0 3'9 18 87 53 30 16 16 108 16 98 84 21 171 27 245· i~3 63 :r-:. 55 132 74 43 21 2 98 2 97 47 25 17 lei 67 7 13 21 3 1 9 1,ss4 8~0 10 11 147 39 42 8 59 6 35 27 18 7 46 7 6 4 724 Page 36 Cocaine Deaths by Age January - December 2015 ,. Medi¢~1 E~a:mlner O:istr:kt llf>ld Area .of Ffprida District Area of Florida .1 Pensacola ·Co<;~·in~ C?Ju~ed c <18 18-25 26-34 35c50 >50 Total <18 18-25 26-34 35-50 >50 3i 0 0 0 0 0 0 0 0 1 0 0 1 2 0 0 7 5 5 1 5 7 0 0 16 3 15 3 1 28 6 25 19 2 0 36 0 20 13 4'~ . 4 0 17 8 20 4 5 31 10 34 23 12 4 7 3 1 19 6 16 4 0 24 7 16 14 6 33 3 55 18 18 2 2 27 5 6 10 1 0 0 0 0 0 0 0 0 0 2 0 1 0 1 0 1 0 2 7 10 9 2 1 24 14 23 9 9 53 3 41 40 7 2 42 4 38 25 5 3 4 0 0 3 7 1 0 6 373 2 Tallahassee ::1;8 .(S Live Oak s 1 4, Jacksonville 146 64 Leesburg 54 3·0 St. Petersburg 6:1} 17 6 7 ·8 Daytona Beach 101 37 Gainesville 31 io 9 Orlando 124 . 10 Lakeland 103 33 11 12 Miami 115 Sarasota i3 Tampa 14 Panama City 289 134 84 15 is West Palm Beach 16 Florida Keys u Ft. Lauderdale' 173 13 152 109 '4 11;3 20 89 ZR 19 Ft. Pierce 49 ' l .{; 2o 2i Naples 23 14 Ft. Myers n 22 22 Port Charlotte 12 3 23 24 St. Augustine 9 Sanford i6 1 11 0 0 0 0 0 0 1 1 1 0 0 0 1,834 967 s Melbourne Statewide Totals Cocalne Pf¢$ept.at O,~tlh Af!.e of Decedent _.1 Tot~I 3 18 .. - Age of pecedent fatal 80 .. 5' pea,i:. 3 5~ 86 . 2015 Medical Examiners Commission Drug Report 11 1 15 6 4 0 10 0 18 1 2 1 4 0 0 0 98 209 15 1 21 0 37 17 7 4 6 2 1 2 : 2·82 82 24 3·8 20 11 19 13 174 45 5.6 12 64 9 39 33· 23 9 49 9 8 5 867 ' 0 0 0 0 0 8 3 1 12 6 1 2 1 10 5 32 3 2 0 16 1 6 4 2 1 4 0 2 1 12.2 11 1 1 14 3 36 14 7 3 17 5 9 11 5 2 21 7 19 1 12 9 5 10 3 3 22 2 49 10 25 2 11 2 11 9 9 1 0 1 3 19 3 5 3 3 13 5 1 0 190 ~03 l44 13 Page 37 Cocaine Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 Brtiwa(d 15.00 - 19.99 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report ~ I ~arf' Page 38 Cocaine Related Deaths by Medical Examiner District (Present and Cause) 2001 to 2015 '• .. ... l?lstrict Are,._ ·of Plot:@~ ·,2.gq1 .;z002 200~ 20Q4 ~-005 1 2 Pensacola Tallahassee 23 46 28 37 33 59 38 69 58 3 live Oak Jac;kspnville 8 108 7 13 148 184 Leesburg St. Petersburg 38 47 56 22 205 69 16 246 21 81 89 116 150 19 195 60 138 35 15 77 48 116 30 42 45 124 43 43 43 Lakeland IViiarni 37 12 94 33 149 136 46 165 75 151 189 162 39 56 20 46 79 14 Sarasota Tampa Pam1mactty 15 16 17 West Palm Beach Florida Keys Ft. Lauderdale 125 113 83 81 31 147 160 69 108 22 64 47 178 53 182 14 94 16 121 138 l,8 Melbourne Ft. Pierce-· Nap·les Ft. Myers 35 39 17 48 33 66 33 23 15 43 21 27 55 68 Port Charlotte 6 3 St. Au ~ustine Sanford 7 15 5 23 24 20 13 1,614 11 22 1,702 1,943 4 5 6 7 g 9 10 11 12 13 19 20 2i 22 23 24 Daytona Beach Gainesville Odal'1do Statewide Total 1,105 24 13 1,307 2015 Medical Examiners Commission Drug Report 43 11 2006 78 51 185 2.0.07 76 40 10 6 s 107 146 57 62 98 54 113 2011 ·34 36 8 248 45 173 13 165 67 16 125 56 9 115 52 154 139 134 112 125 100 84 42 51 32 44 39 179 40 43 34 124 29 36 30 120 27 37 190 41 58 39 145 35 155 184 54 201 75 146 191 168 18 16 136 84 58 24 150 80 45 34 84 78 96 79 10 14 24 14 19 17 20 33 35 2,052 Z,179 10 120 62 10 119 48 13 119 46 36 25 281 151 31 23 56 27 33 30 105 24 197 2013 34 25 2009 106 130 32 83 115 2010 2012 2008 17 143 59 54 20 126 27 157 62 46 15 146 14 135 68 47 29 15 67 59 35 21 158 31 198 57 83 9 106 96 9 182 11 7 127 49 2015 80 18 20 34 30 101 37 198 29 137 37 226 181 33 234 60 59 60 74 84 65 134 10 11 13 87 105 143 15 173 13 129 52 4 6 13 102 99 60 50 29 152 86 49 23 20 115 38 40 13 23 24 16 53 34 10 31 203 33 289 84 53 73 56 51 63 71 5 23 7 15 20 2 11 14 12 9 24 9 11 19 10 1 26 9 19 32 24 16 1,791 1,462 1;4.02 1,444 1,318 1,337 1,508 1,834 14 27 48 128 42 2014 56 Page 39 Historical Overview of Cocaine Occurrences (Present and Cause) 2001 to 2015 --------- ---------------------------·- -··-------- 2500 ~- 2000 ' ------------------· ' __________,,,.,._,_________ -------- ·-- - - - - ---------· ~ - - 4- 0 Qi .0 E 1000 ::l z 500 I I l I' o , . ---- --- - ·- +-------~-- --------·------ ---------- l l ! ' I II I I 2001 2002 2003 2004 2005 2006 2001 2oos II I ---, 2009 ..._Cocaine Related Deaths 2010 2011 2012 2013 2014 201s I --·----- - - - - - - - - - ---------------------·---·--------------------------------------------J 2015 Medical Examiners Commission Drug Report Page 40 Heroin Deaths January- December 2015 ~dic:al E~'50 TotSO 1 0 1 0 0 0 0 2 0 0 1 0 1 0 0 1 0 0 1 0 2 0 0 0 0 1 0 0 0 0 2 0 5 3 1 0 3 0 1 1 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 4 0 1 0 0 0 1 0 0 0 1 0 0 1 0 0 11 18 19 Page 42 Heroin Deaths by County 2015 Occurrences Per 100,000 Population 0 0.01 - 4.99 5.00 - 9.99 10.00 - 14.99 15 .00 - 19.99 Collier Broward 20.00 - 24.99 > 25.00 2015 Medical Examiners Commission Drug Report Page 43 Heroin Related Deaths by Medical Examiner District1 (Present and Cause) 2001 to 2015 District 2Q01 ioo2 2·0.os 2004 :2!}QS 2006 2.ob1 200$' 2009 201-0 2011 2012 2.013 ~.014 2015 1 0 0 0 0 1 0 1 2 0 0 1 3 12 28 0 0 0 0 0 0 0 1 0 1 2 0 0 0 0 0 0 0 1 0 1 8 3 4 1 3 14 15 16 45 1 Area of Florida Pensacola 2 Tallahass~e 1 0 1 3 Live Oak Jacksonville 0 0 0 0 0 0 13 17 7 5 5 4 Leesburg St. Petersburg 1 s 2 1 0 0 0 0 1 3 2 16 8 33 23 14 13 7 12 s s 1 32 9 3 1 1 4 7 14 2 s 6 4 2 1 2 0 3 1 0 1 3 4 20 0 0 0 0 0 0 0 0 0 0 0 2 1 2 3 47 33 38 22 15 7 16 16 24 10 18 26 41 83 108 4 s 6 > 10 Daytona Beach Gainesville Orlando Lakeland 1 2 0 3 2 2 0 0 2 1 0 1 4 7 10 11 Miami 39 46 32 18 22 20 26 38 30 26 15 33 40 60 92 12 Sarasota Tampa Panama City s 5 20 15 9 14 4 19 4 2 2 8 19 SS 68 34 34 19 14 6 7 11 s 2 1 2 2 3 22 35 0 0 0 0 0 0 1 0 0 1 0 0 2 2 4 West Palm Beach Florida Ke.ys 68 41 28 29 19 8 10 7 7 4 12 6 20 51 165 4 5 0 1 0 1 0 1 1 0 0 1 1 0 1 Ft. Lauderdale Melbourne 53 50 49 35 17 13 4 17 8 s 3 9 11 28 80 6 9 10 3 2 1 1 1 2 0 0 0 2 7 12 Ft. Pierce Naples ·. Ft. Myers 3 4 3 3 1 3 3 3 1 1 1 2 3 7 8 7 8 9 13 14 15 16 17 18 19 20 21 Port Charlotte 23 St. Augustine 24 Sanford Statewide Totals 22 7 17 3 4 1 4 1 1 0 0 0 0 2 14 11 s 11 13 4 1 2 4 7 9 0 1 4 12 30 43 0 s 0 1 3 1 0 0 1 0 0 1 1 3 2 0 1 0 0 0 0 0 0 0 1 0 1 1 1 2 6 3 7 4 4 0 7 3 1 1 2 1 7 18 19 328 326 261 180 122 96 110 132 111 58 62 117 199 447 779 1 Prior to 2013, only deaths caused by heroin were provided in this chart. The chart has been updated to reflect deaths in which heroin was the cause of deoth or merely present at the time of death . 2015 Medical Examiners Commission Drug Report Page 44 Historical Overview of Heroin Occurrencesl (Present and Cause) 2001 to 2015 ·-·-.. --·-·-·-..-·-·----·-·--·--·-·----·----- . . . ·--·- --··---.. . --·-··-..·--.. ....-........._.__,·-·-·--···--·-............______________________._._.______. . ._--···· __. . ______...__.__, ____ -· . --........--..-- _.,_,,____ ,,. .l ::r i ------·----~-----·------·---·~·- ·- ·----··--- -· · ---~·------------··---,------------ ·------------·--·--------- ____. ---------------·- ---- ----------------------- 700 - - - -- -·--- - 600 ··--- "'u QJ c QJ ~ 500 u u 0 4- 0 Cu ..c 400 -l--- ---··----·---- - - -· E ::i z 300 ! 200 ~· · 100 - ~ I .__._ """-.. 0 ,- - - --r---~ 2001 2002 - - .. ! --- -"'lllira;.---·----------- - - -- -------- -- ------ -- ----- ---------- -- - -------- ---------- ---- _________.._____________...,.._ ___.__ ..... _________ ..____ .. __,,____ i --,---.-------.---2003 2004 2005 2006 .... ........~ --..,---- 2007 2008 . ' 2009 -------,I ------.-2010 2011 2012 2013 2014 2015 -C-Heroin Related Deaths l ·---- ------------------------------------·-- - ----------·---------------------~-·---------------1 1 Prior to 2013, only deaths caused by heroin were provided in this graph. The graph has been updated to reflect deaths in which heroin was the cause of death or merely present at the time of death. 2015 Medical Examiners Commission Drug Reporl Page 45 Drug Detected at Death: Cause vs. Present Diazepam Deaths Total Occurrences= 604 Alprazolam Deaths Total Occurrences 1,439 = ,- 2015 Medical Examiners Commission Drug Report -----~~~~~-~--~~-~ ----· Morphine Deaths Total Occurrences= 1,483 I i Page 46 Drug Detected at Death: Cause vs. Present - - - - - - - - - - -- - --·-----·-·--·--·--·-·--·---··--·----·----· Oxycodone Deaths Total Occurrences = 1,081 Hydrocodone Deaths Total Occurrences = 680 I I [_____ _ I I I! --···-··---·-------·------·-·.,.·--·-···-·-··~-··J ~ --- ~ -- - - - · · - - -I --i Methadone Deaths Total Occurrences= 453 I I IL _ _ 2015 Medical Examiners Commission Drug Report Page ./7 Drug Detected at Death: Cause vs. Present -·-···---·--·--··--······-··-·····-·-----·---····-····-·-··--·-·- ..; r-- Cocaine Deaths Total Occurrences = 1,834 I I -1 Heroin Deaths Total Occurrences= 779 Present 46 6% ________ _j ·---------···-·-----------------------------------------------·--·------····--·------··- ! I i i FentanylDeaths Total Occurrences = 911 I I I I I II 2015 Medical Examiners Commission Drug Report Page 48 Manner of Death for Cases Reported (Accidental, Homicide, Natural, Suicide, or Undetermined) ..----·-·----; Diazepam Deaths Alprazolam Deaths Natural r ./ Undetermined 2% 12%"' IHomicide ' 3% I Morphine Deaths 2% 2015 Medical Examiners Commission Drug Report Page 49 Manner of Death for Cases Reported (Accidental, Homicide, Natural, Suicide, or Undetermined) Hydrocodone Deaths Oxycodone Deaths Undetermined 1% Homicide 3% I 3% --------------------------------·------·------------·~------' ----~-I Methadone Deaths I I Homicide, 2% I ~-- · ---- 2015 Medical Examiners Commission Drug Report Page 50 Manner of Death for Cases Reported (Accidental, Homicide, Natural, Suicide, or Undetermined) ,1 ,~s~:=-----Heroin Deaths Coca ine Deaths 3% Undetermined 1% - Undetermined Natural \ 1% ~ Homicide 1% ------------- · Fentanyl Deaths Natural 5%/ 2015 Medical Examiners Commission Drug Report Page 51 Glossary Amphetamines -A group of synthetic psychoactive drugs called central nervous system (CNS) stimulants. The collective group of amphetamines includes amphetamine, dextroamphetamine, and methamphetamine. Methamphetamine is also known as "meth," "crank," "speed," and "tina." Methamphetamine is metabolized to amphetamine, and thus, occurrences of amphetamine may represent methamphetamine ingestion rather than amphetamine ingestion. Benzodiazepines -A family of sedative-hypnotic drugs indicated for the treatment of stress, anxiety, seizures, and alcohol withdrawal. Benzodiazepines are often referred to as "minor tranquilizers." Xanax (alprazolam) and Valium (diazepam) are the most commonly prescribed drugs in this drug class. Many benzodiazepines are interconverted to one another, making occurrences of these drugs difficult to interpret. Exceptions include alprazolam, clonazepam, lorazepam, and midazolam. Buprenorphine -A semi-synthetic opioid known as Buprenex, Suboxone, and Subutex indicated for the treatment of opioid addiction and moderate to severe pain. Cannabinoids -A series of compounds found in the marijuana plant, the most psychoactive of which is THC, a strong, illicit hallucinogen. Street names for this drug are often associated with a geographic area from which it came but also include generic names like "ganja," "MJ," "ragweed," "reefer," and "grass." Carisoprodol - Muscle relaxant indicated for the treatment of pain, muscle spasms, and limited mobility. It is often abused in conjunction with analgesics for enhanced euphoric effect. It is marketed as Soma. Cathinones -A family of drugs containing one or more synthetic chemicals related to cathinone, an amphetamine-like stimulant found naturally in the Khat plant. They are 'cousins' of the amphetamine family of drugs, which includes amphetamine, methamphetamine, and MDMA (ecstasy). It often goes by the street name of "Molly." Cocaine -An illicit stimulant. Powdered cocaine goes by many street names including "C," "blow," "snow," and "nose candy," while freebase cocaine is mostly commonly known as "crack." Ethanol - Ethyl alcohol. Fentanyl - Synthetic opioid analgesic supplied in transdermal patches and also available for oral, nasal, intravenous, and spinal administration. Fentanyl is also produced illicitly, and currently many fentanyl occurrences represent the ingestion of illicit fentanyl rather than pharmaceuticallymanufactured fentanyl. 2015 Medical Examiners Commission Drug Report Page 52 Glossary(Continued) Flunitrazepam (Rohypnol) - Commonly referred to as a "date rape" drug. It is a sedative-hypnotic drug in the benzodiazepine class. It often goes by the street name "roofies." Gamma-Hydroxybutyric Acid (GHB}-A depressant, also known as a "date rape" drug. GHB often goes by the street name "easy lay," "scoop," "liquid X," "Georgia home boy," and "grievous bodily harm." Hallucinogenic Phenethylamines/Piperazines- Includes such drugs as MDMA (Ecstasy, a hallucinogen}, MDA (a psychedelic), MDEA (a psychedelic hallucinogenic}, and piperazine derivatives. Ecstasy has multiple street names including "E," "XTC," "love drug," and "clarity." MDMA is often also known by a large variety of embossed logos on the pills such as "Mitsubishis" and "Killer Bees." Hallucinogenic Tryptamines - Natural tryptamines are commonly available in preparations of dried or brewed mushrooms, while tryptamine derivatives are sold in capsule, tablet, powder, or liquid forms. Street names include "Foxy-Methoxy," "alpha-0," and "5-MEO." Halogenated Inhalants - Includes, but are not limited to, halogenated hydrocarbons, such as Freon, and similar halogenated substances typically used illicitly as inhalants. Heroin -An illicit narcotic derivative. It is a semi-synthetic product of opium. Heroin also has multiple street names including "H," "hombre," and "smack." Hydrocarbon Inhalants - Includes toluene, benzene, components of gasoline, and other similar hydrocarbons typically used illicitly as inhalants. Hydrocodone -A narcotic analgesic (pain killer}. Vicodin and Lortab are two common drugs containing hydrocodone. Hydromorphone -A narcotic analgesic (pain killer} used to treat moderate to severe pain. Marketed under the trade name Dilaudid, it is two to eight times more potent than morphine. Commonly used by abusers as a substitute for heroin. Ketamine -An animal tranquilizer and a chemical relative of PCP. Street names for this drug include "special K," "vitamin K," and "cat valium." Meperidine -A synthetic narcotic analgesic (pain killer) sold under the trade name Demerol, it is used for pre-anesthesia and the relief of moderate to severe pain. Methadone -A synthetic narcotic analgesic (pain killer) commonly associated with heroin detoxification and maintenance programs but it is also prescribed to treat severe pain. It has been increasingly prescribed in place of oxycodone for pain management. Dolophine is one form of methadone. 2015 Medical Examiners Commission Drug Report Page 53 Glossary (Continued) Morphine -A narcotic analgesic (pain killer) used to treat moderate to severe pain. MS (Morphine Sulfate), Kadian, and MS-Contin are the tablet forms; Roxanol is the liquid form. Heroin is metabolized to morphine, and thus, occurrences of morphine may represent heroin ingestion rather than morphine ingestion. Nitrous Oxide (N20) - Also known as "laughing gas," this is an inhalant (gas) that produces light anesthesia and analgesia. "Whippets" are a common form of nitrous oxide. Oxycodone -A narcotic analgesic (pain killer}. OxyContin is one form of this drug and goes by the street name "OC." Percocet, Percodan, Roxicet, Tylox, and Roxicodone also contain oxycodone. Oxymorphone -A narcotic analgesic (pain killer) that is often prescribed as Opana, Numorphan, and Numorphone. Phencyclidine (PCP) -An illicit, dissociative anesthetic/hallucinogen. Common street names for this drug include "angel dust," "ace," "DOA," and "wack." Sympathomimetic Amines ...,-A group of stimulants including phentermine (an appetite suppressant} and other sympathomimetic amines not tracked elsewhere in this report. Synthetic Cannabinoids - Synthetic cannabinoids are man-made chemicals that are applied (often sprayed} onto plant material to mimic the effect of delta-9-tetrahydrocannabinol (THC), the psychoactive ingredient in the naturally grown marijuana plant {cannabis sativa). Synthetic cannabinoids, commonly known as "synthetic marijuana," "Spice," or "K2," are often sold in retail outlets as "herbal incense" or "potpourri" and are labeled "not for human consumption." Tramadol -A synthetic narcotic analgesic sold under the trade name Ultram and Ultracet. Indications include the treatment of moderate to severe pain. It is a chemical analogue to codeine. Not currently a scheduled drug. Zolpidem -A prescription medication used for the short-term treatment of insomnia; it is commonly known as Ambien. 2015 Medical Examiners Commission Drug Report Page 54 APPENDIX B - Heroin Overdose Cases YTD 2016 Average Deaths Per Month = 6 Average Revives Per Month= 22 Average Total Cases Per Month= 28 Total Cases YTD 220 District 14 - City of Lake Worth Total Overdose Cases 01/01/16-08/31/16 = 70 60 I . I I ; I fll ~ fll ~ 50 ~ +o u 0 '-4 ~ ' I l I I ; \ 5'4 l I 30 .J_ 20 l : 10 0 Ii i ; - ! ,.Q a z::s : rt 3S I : 1'4 : ( -1 6 I !..--~ .,.. __;_~ ---;Jan 2016 . : + 14 ' Feb 2016 5 ··.--~· 22 l 19 l ~ I 11 I j : ; J ~ 7 H Apr 2016 May2016 I Mar 2016 ·1 -7 Jun 2016 Month U Overdose Deaths ' U Overdose Revives ---: 8 i Jul 2016 Aug 2016 NARR SUPPORT LEVELS FARR does not offer a rating scale that measures the efficacy or valuation of any individual Certified Residence. Our mission is to ensure the availability of housing that is: 1. safe and dignified 2. alcohol and drug free 3. a peer supportive environment 4. a good neighbor and responsible citizen FARR Standards and the FARR Code of Ethics serve as guides for how best to achieve these four goals and provide a basis for service provider accountabUity to an independent, non-profit organization dedicated to upholding the resident's right to access high quality, recovery-oriented housing. Some support levels are more organically 'peer-supportive' than others and, when selecting a program, individual residents are 'best' served by first gaining a deeper appreciation of defining criteria for each level. FARR recognizes four distinct support levels under the singular term Recovery Residence. One level is not better or more advanced than the others, but instead offers a unique service structure most appropriate for a particular resident. By way of example, Level l residences are perhaps best exemplified by the Oxford House model. This non-profit SOlc (3) program operates nationwide, supports over 1,200 recovery homes that serve more than 24,000 residents annually. Highly regarded by clinicians, peer specialists and SAMHSA alike, the Oxford House program is documented by evidencedbased studies demonstrating consistently positive outcomes. Many people achieve sustainable recovery while residing in level 1 residences. Visit ~Y:l,Q.l5fordhouse . org to learn more about this program. During the first year of my recovery, I resided in a residence that excelled at the aforementioned core goals. The apartment I occupied was safe and modestly appQinted, dean and adequate to my needs. I could rely on management to screen anyone whom they, or we residents, suspected was using arid to immediately and responsibly remove active users from our community. AH my housemates were in recovery and once weekly we convened as a community for a 12 step meeting on property. We were expected t.o attend meetings throughout the remalnder of the week, work with our 12 step sponsor and take full ownership of our recovery program. This is a basic description of a FARR Le~l 2 residence. The Social Model might have been embraced more thoroughly to further empower that particular community. However; an argument is just as easily made that the maintenance and development of future resident leadership is primarily the responsibility of the residents themselves. Management was attentive to neighbor concerns regarding parking, noise and general resident behavior. Having established good relations, residents took pride in caring for the upkei!p of the property. It was one of the nicest homes on the block, complete with the proverbial white picket fence. The home supported eleven residents in four attached units. While that community, like so many others, experienced the typical ebb and flow of casual, short-timers who were uncommitted, I personally know of at least six housemates who remain clean and sober today. By my unscientific, outcome measurement, this rates a batting average above .500, which in this world, is a 'hall of fame' performance by most standards. I l l t llPage Ii 1fli:rt=ARR ... ....... .. ' ,., ' ~·: .,..,.., Thousands of Floridians achieve long-term recovery while residing in level 2 residences ewry year. level 1 & 2 residences require residents adhere to a published set of house rules and consequences, however; it is generally level 3 residences who offer 24/365 supervision, often by credentialed staff, such as behavioral techs. recovery coaches and/or peer specialists to ensure resident accountability. Recovery Residence By design, Level 3 recovery residences are vested in delivery of only peer-support services. No clinical {medical) services are performed directly within or by a FARR Certified Level 3 residence. These services often includes life skitl mentoring, assistance with crafting an individual resident's recovery plan, communal meal preparation and dining, group transportation to self~~lp meetings and access to recovery coaches. This support is generally more + + appropriate for resldents who require a structured environment during early recovery from addiction. Conversely; it is most likely inappropriate for a resident who has already achieved a solid footing and demonstrates a personal commitment to their recovery. Residents of a level 3 residence often independently elect to participate in external clinical services such as attending an outpatient groups of their choice and/or engaging a private therapist for one-on-one counseling. "Independently elect" is a very important distinction. Many factors, induding some that meet licensing thresholds, influence the distinction between a Level 3 and level 4 recovery residence. level 4 residences incorporate the Medical Model (licensable clinical services) into the Social Mode1 to varying degrees. In Florida, by virtue of state statute 65.397, Level 4 residences are required to obtain and maintain appropriate licensure from the Department of Children & Family Services - Substance Abuse (OCF). "Florido Moder programs are defined as Partial Hospitalization Programs (PHP) wtt:h day/night community housing.. In Def licensing parlance, these are generally Residential '3 service providers, In turn, these programs fall under the FARR definition of a Level 4 residence. DCF Residential 4 & 5 programs also meet FARR level 4 criteria. Each of these classiflcations offer varying degrees of cltnlcal service, provided by credentialed staff, along with a recovery-oriented hoo$ing component. At first glance, the DCF licensing requ irement coupled with FARR Certification may appear redundant. Nothing could be farther from the truth . OCF is our state licensing authority. The Department is tasked with determlning the successful completion of application documentation as it is submitted by substance abuse disorder treatment programs throughout the state. DCF does not have the funding, staff, Infrastructure or appetite to measure service provider compliance to Standards established to promote high-quality, recoveryoriented housing. This is not a job function the Department considers to fall under their legislative mandate. Their report to the Florida Senate Appropriations Committee published October 2013 made this fact ab5olutely clear. To download a copy of this study, visit httE.f./www . dcf. state.fl.us/proP,rams/samh[c;f..Q.S~L?.Q(?erHomesPR / DCFPrg~i§,Q.15.P.!:So~rHomes . pdf 21 Page l I ~~·~· .. ·· "\faJFARR ··.··'•"'··········· .. ... .. ., _.,_ r As the Florida Affiliate of the National Alliance of Recovery Residences (NARR), FARR offers Level 4 Recovery Residences the opportunity to voluntarily submit for certification to our Standards and Code of Ethics. This opportunity directly addresses issues of import to the entire continuum. Persons seeking long-term, residential care and transitional support for themselves or a family member gain free, reliable access to a published list of programs who have voluntarily sought and secured certification. This voluntary approach provides a constructive and desirable path to establishing a mechanism for accountability without running afoul of FHAA and ADA protections. The current NIMBY climate, that attempts to utilize municipal zoning as an alternative path, amounts to an irresponsible waste of tax payer dotlars, further dividing communities at a time when there is an ever-increasing need to foster local resources that address what has now risen to the level of "An Amerlcah Epidemic". FARR does not measure or evaluate the quality of clinical care. This is outside of our mission and expertise. Instead, FARR measures accountability to standards designed to ensure the delivery of those four core goals referenced at the onset of this publication. Peer Support, provided through varying degrees of Social Model implementation within the residential component of a Level 4 residence is the guiding consideration. To learn more regarding the Social Model and how this structure is best embedded ln recovery housing, please visit htto:L(narronline.org/wpcontent/uploads/2014/09/,Maximizing-Social-Model·Principles-ln-Residential-Recovery -Settings. pdf The entire continuum of care recognizes an important truth: that the Acute Care model of "28 days treatment" followed by a graduation ~ebration and the abrupt return of the graduate to the same environment from which they originated has proven far less effectiVe than has the long-term, tra nsitiona I approach that gradually "steps the dient up" towards assuming responsibility for their own chronic disease management. When framed positively, many refer to this achievement as 'Recovery'. FARR Certified Residences receive our seal of approval. The FARR certification process is rigorous and subsequent grievances related to mm-compliance are taken very seriously. Our raison d'etre is to ensure residents have aq:ess to quality, peer--supportive, recovery-oriented housing to assist them along their journey to secure lastin~ freedom from the bondage of addiction. For further information, please visit http;LL:fu.rr.q_nline.org/ standards-ethics/ support-levels/, 3I Page I I [ I FARR C'...ertification & Compliance Agreement 04/2016 NARR Core Principle: Operate with Integrity I attest and affirm that our organization is .in compliance v.'ith NARR Quality Standards through 05 in their entirety and will remain compliant with same. 01 I attest and affirm that the submission of this application for voluntary certification of compliance with NARR Quality Standards for Recoveiy Residence.s, NARR Code of Ethics arid other criteria as specified by F.S 397,487 truthfully represents full disclosure of facts pertaini11g to ownership, management and staffing of all recovery residence locations operated by our program and that all policies, procedures, and protocols documented by this submission accurately describe the operational practices of our organization, management, staff and volunteers. II I I r r J l attest and affirm that, should the FARR Certification Administrator, Compliance Administrator and/or Field Assessor request an opportunity to revie'"" partially or in their entirety, financial records pertaining to the operation of the residence seeking voluntary certification for compliance verification purposes, the requested documents vviH be provided upon request without cost or delay. I understand and agree that should it be assessed by the FARR Compliance Committee, in their sole determination, that this application does not truthfully and accurately represent full disclosure of facts and operational practices of our organization, sanctions will be applied '"'ithout further recourse which may include immediate revocation of our organization's Certificate of Compliance. NARR Core Principle: Uphold Resident Rights 1 l understand and agree that should it. be assessed by the FARR Compliance Committee, in their sole determination, that this application does not truthfully and accurately represent full disclosure of facts and operational practices of our organization, sanctions will be applied ·without further recourse which may include immediate revocation of our organization's Certificate of Compliance. I I 1 I I I affirm and attest that our organization's ovmership, management, staff and volunteers uphold the rights of residents as referenced throughout NARR Quality Standards, NARR Code of Ethics and F.S 397-487, placing the rights ofresidents and the rights of the resident community chief among organii.ationa1 priorities. J attest and affirm that our organizati.on does not subscribe to the "another head to fill a bed" intake philosophy and agree to screen applicants for residency, mindfol of the needs and sensithities of our priority populatfon, to ensure our community is appropriate for the applicant and that the applicant is appropriate for our community. Ir I I attest and affit·m to thoroughly orient new residents to our community> fully disclosing house rules and consequences, resident right') and responsibilities, phasing and discharge protocols, and all fees and financial commitments, billed directly or indirectly, for 'vhich the resident may potentially become legally accountable as a result of policies, procedures or protocols practiced in the operation of our program. NARR Core Prindple: Are Recovery Oriented I attest and affirm that our organization is in compliance \\~th NARR Quality Standards 10 and II in their entirety and will remain compliant with same. J atte!>'t and affirm that our organization is a recovery-oriented housing provider rather than a "boarding house for persons who do not drink and/or use illicit drugs" and that we take deliberate and intentional steps to encourage and mentor resident participation in a self-directed recovery plan. NARR Core Principle: Are Peer Staffed and Governed I attest and affirm that our organization is in compliance with NARR Quality Standards 12 through 17 in their entirety and will remain compliant with same. I atte.st and affirm that our organization values the resident voice and encourages peer leadership and accountability by nurturing a community culture that relies on and empowers peers to actively pa1ticipate in community governance. NARR Core Principle: Promote Health I t I I attest and affirm that our organization is in compliance with NARR Quality Standards 18 through 23 in their entirety and wi11 remain compliant with same. l attest and affirm that our organfaation is a transitional support program for persons in recovery from a substance use disorder and that our primary purpose is to deliver recovery-oriented housing that provides residents with encouragement and support to further develop recovery management skills and recovery capital. j I I f I attest and affirm our organization's appreciation and understanding that under state law, support levels l 1 II and III are prohibited from directly offe1i.ng clinkal services that require licensure. NARR Support level IV is required by state law to be appropriately licensed by the Department of Children and Families (DCF) Substance Abuse to provide clinical services in accordance with F.S. Chapter 397 and DCF Rule 65D-30. NARR Core Principle: Provide a Home I I I I I attest and affirm that our organization is in compliance ·with NARR Quality Standards 24 through 26 in their entirety and will remain compliant with same. I attest and affirm that our organi7...ation maintains an alcohol and drug-free environment by means of written policies and procedures that are consistent vdth federal and state law. I attest and affirm that our organization represents a structured home-like environment by means of set parameters that promote acoountability, consideration of others and peer support. I attest and affirm that our organi7..ation maintains a recovery oriented home-like env;ronment to prote,ct the well-being of the residents, staff and community. I I t f NARR Core Principle: Inspire Purpose I attest and affirm that our organization is in compliance with NARR Quality Standard 27 in its entirety and will remain compliant ·with same. I attest and affirm that our organization is operating a recovery oriented. home with acc~ss to re(•overy programming both inside and outside of the recovery residence. l f ! II I attest and affirm that our organization provides resources for each resident's individual recovery and promotes the individual responsibility of developing recovery capital through measures in compliance with NARR Quality Standard 27. NARR Core Purpose: Cultivate Community I attest and affirm that our organization is in compliance with NARR Quality Standards 28 through 30 in their entirety and v.111 remain compliant; including at least 50% of the sub-standards associatt:,'<.l with NARR Quality Standard 28. I attest and affirm that our organization organizes routine meetings and/or activities that by definition promote a community environment functioning as a family. I attest and affirm that our organization hosts social activities within the residence and/or ·withjn the broader recovery community that encourage and facilitate resident bonding and mutual recovery support. I attest and affirm that the FARR Certification Administrator, Compliance Administrator and/or Field AsseSb'Or is granted a provision may result in immediate suspension and/or revocation of our Certificate of Complian<.~e. l attest and affirm that our organization appreciates that residence staff promote recovery through informal and formal intera(,'tions with residents. Peers, including staff, model recovery principles in an interactions with other members of the community. Our organi7.ation attests that all relationships between residents and staff rf'Jlect ethical principles reflected in the Code of Ethics. I II I NARR Core Principle~ Promote Recovery I attest and affirm that our organization is in compliance ,,..;th NARR Quality Standards 31 and 32 in their entirety and will remain compliant "'"ith same. I attc;>.st and affirm that our organization appreciates that ovt~rcrowding can negatively impact tJie objectives sought through communal living and commits to provide a safe, dignified living environment to each of our residents that indudeA" adequate storage for I I I I I 1 I I j personal belongings, clean and fully functional bathrooms, ldtchen and laundry facilities. I J attest and affirm that our organization fosters peer leadership within our community to model behaviors that promote orderliness and cleanliness by all residents at all times. Peers hold one another accountable to properly maintain the exterior and interior of the residence. Community pride is promoted and encouraged during scheduled house meetings. NARR Core Principle: Prolnote Safety I attest and affirm that our organization is in comp!ian o o II ! o Criminal charges alleging felony mis<.-onduct by any Owner, Manager or Staff o Criminal charges alleging felony misconduct by a qualifying Recovery Residence Administrator Criminal charges alleging felony misconduct by a current resident Constitutes an event of non-compliance and may result in suspension and/or revocation of the provider's Certificate of Compliance. 6. Refer grievances filed by stakeholders to external agencies, as determined by the Compliance Audit Administrator, including, but not limited to: Department of Children and Families - Substance Abuse Li censure Division o Florida Attorney G-eneral's Office of Consumer Protection o Florida Department of Lav•.r Enforcement ~1 Local Law Enforcement o Local Zoning Code Enforcement Depmtments o Representations and Indemnification ·TI1e undersigned represents and warrants that (a) they have the right and authority to enter into this Agreement and to perform their respective obligations as herein provided, and (b) their officers, dfrectors, employees and agents will comply \vith all applicable federa.l, state and local laws, codes, rules and regulations. The undersigned ·will indemnify, defend and save harmless FARR arid its respective partners, trustees, beneficiaries, directors, officers, employees, affiliates and agents from and against any and all claims, loss, damage, liability, and expenses (including reasonable attorneys' foes), occasioned by, or arising out of directly or indirectly this Agreement or the breach by the undersigned of any representation or warranty contained in this Agreement, or any act or failure to act by the undersigned in compliance ·witJ1 this Agreement. Relationship of the Parties Nothfog in this Agreement shall be construed in any manner to create any of the relationships of employer and employee, principal and agent, joint ·v enturers or pa11ners benveen FARR, on the one hand, and the undersigned, on the other. Effect and A111endment This Agreement shall be deemed to supersede and replace any previous documents, correspondence, conversations or other written or oral understandings b(.'1:ween the partie,s hereto related to the subj€.ct matter hereof. No waiver by either party of any breach hereunder shall be deemed a waiver of any other breach. This Agreement cannot he assigned, altered, amended, changed or modified in any respect unless each such assignment, alteration, amendment, change or modification is agreed to in writing, signed and delivered by each patty hereto. This Agreement shall become effective upon signature by you and acceptance by FARR. Assignment This Agreement vrill be binding upon and inure to the benefit of you and FARR and their respective successors and assigns; provided, however, that no rights under this Agreement may be assigned by you ";thout the prior written consent of FARR. Choice of Law This Agreement will be governed by and construed under the laws of the State of Florida applicable to agreements executed and petformed entirely within the State of Florida. F..ach party hereto submits to the jurisdiction of the state and federal courts in Palm Beach County, Florida for the purpose of resolving any dispute arising out of or resulting from this Agreement. Headings The headings of articles of this Agreement are for convenience of reference on]y and shall not be construed to be a substantive part of this Agreement. National Recovery Residence Quality Standards ouiy 1s. 201sJ t1.1,'tmini'i!l:illfil n nerate wjtJ1 i ntegdty 01. A!:.~ 1;:uided by a mtjQB anti vision x : -~- ·.·· x . .·x_ ?i_m! 02. /;dhcres to legal and f?lhirn! codes i: ·· . 03 Are financially honeytrnJlfox.tlJrjght ·x 04. .GQJU':O: data for conUmous guaHty improyement ® (!Jl.fil"J)!.i.!miJJ llJ;l!ill.kl_J.:_~sld enujgbt 1k . x i · x ® ~ x -~.. 06. {;.Qmm.Jml~'!t~.. .!.igb.lli~\QJJ'£1Y.i11muumJ11~ for£ ·~ <>rN• in• •. n ts i. x x x :. r·•' S i ., ·n ·~ d 07. PmID()tf! self and ureradyocac,y x IC x x x x· : x x 1'. x x x x x x '< x x x x . 1' ill:.tu~rm:'..eJ:y.::.<:1..JjJillt!:~j x · '~ 10. fufil.e..f_<.H'.fl.r.Y.•. ii.S.rl)1f"JSJ.lJl::s!tiY.C.J1...b_Q]i.s,lli;_an d lift: Iong ~ 8.IT..JW.fJ:...mtlfffu1JlJ:I il!.Q.i:fil.Jllt to ncigl:1h(lr complaint~ t x .. x .x ··· _._. ¥ · x Pr (' pc rt:y :J!I d I[ x; 23. Offer cljnical seryice>ill aci,;w;dm<.:£ with St-0te law 24. Are home-lik~ envh·on111ents x· "x x x Il .. ·············--··-·-··· ··-··-·-·-·--·--·······--····· ··················• ·········· ·-······-·--········-·-·· ······ ·--·--··-·-··-··---·---- ··-- ····---···-···--·------ , I l Adtninistrative and Ope1~ation~l Doniain Core Principle: Operate with integrity NARR L2 As evidenced by: I a A written mission statement that corresponds with NARR's core principles a A vision statement that corresponds wjth NARR's core principles .02 as stated in this document .01 NARR LOS& 1.03 Applied to Levels Are guided by a mission and vision 01. I II III rv ./ ./ ./ ./ ./ ./ ./ ./ .. 2. As evi(i~ced by: 0 An affidavit that attests to complying with non-discriminatory state and federal requirements. .02 0 Marketing materials, claims and advertising that are honest and substantiated as opposed to: a. False or misleading statement.-; or unfounded claims or exaggerations; b. Testimonials that do not: really reflect the real opinion of the involved individual; c. Price claims that are misleading; d. Therapeutic strategies for which licensure and/or counseling <:ertificatlons are required but not applicable at the site. e. Misleading representation of outcomes .03 a Prior to the initial acceptance of any funds, the operator must inform applicants of all fees and charges for which they will be, or could potentially be, responsible. This information needs to be in writing and signed by the applicant. .04 0 The operator must maintain accurate and complete records of all resident charges, payments and deposits. A resident must be provided with a statement of his/her personal charge and payment history upon request. .05 a The operator must disclose refund policies to applicants in advance of acceptance into the home, and before accepting any applicant fees. .01 Applied. to Leveis Adheres t:O legal and ethical cocles M ./ m ./ ./ IV ./ ./ ./ ./ ./ J II I lI I ./ ./ ./ ./ ,/ ./ ./ ./ ./ ./ ./ ./ I ( NARR 2.1 .02 .03 NARR 1.1 .04 .05 2 0 .07 0 Staff must never become involved in residents' personal financial affairs, including lending or borrowing money, or other transactions involving property or services, except that the operator may make agreements with residents with respect to payment of fees. Policy and procedure that ensures refunds consistent with the terms of a resident agreement are provided within 10 business days, and preferably upon departure from the home. Applied to Levels 03. Are f"mancially honest and forthright .01 NARR 2.1 .06 As evidenced by: 0 ldentifying the type of accounting system used and its capability to fu1ly document all resident financial transaction, such as foes, payments and deposits 0 Policy and procedure for disclosing to potential residents their financial obligations, including costs for which they might become liable, such as forfeiture of any deposits and fees as a result of prematurely leaving the home 0 Policies about the timing of and requirements for the return of deposit'>, if financial deposits are required 0 The ability to produce clear statements of a resident's financial dealings with the operator (although it's not a requirement that statements be automatically produced) 0 Policie.s and procedures that ensure the follow conditions are met, if the residence provider or a staff member employs, contractors or enters into a paid work agreement with residents: a. Paid work arrangements are completely voluntary. Residents do not suffer consequences for declining work. Residents who accept paid work are not treated more favorably than residents who do not. b. Paid work for the operator or staff does not impair participating residents' progress towards their recovery goals. c. The paid work is treated the same as any other employment situation. d. Wages are commensurate with marketplace value, and at least minimum wage. The arrangements are viewed by the majority of the residents as fair. e. Paid work does not confer special privileges on residents doing the work. Work relationships do not negatively affett the recovery environment or morale of the home. Unsatisfactplled to Levels 16. Ensure staff are trained or credentialed appropriate to their level As evidenced by: .01 Q Written staffing or workforce development plan .02 Q ll ® Certification and verification policies and procedures III ./ JV ./ ./ ./ Appl!~ to Levels 17. Provide supportive staff supervision As evidenced by: I u NARR 1.11 .01 0 Policies and procedures for supervision of staff ® ® 1IJ ./ JV ./ NARR .-02 Q Ongoing skills development, oversight and support policies and ® ® ./ ./ 1.7b procedures appropriate to staff roles and level of support I I ; : Recovery Support Domain ·. Core Principle: Promote health Applied to I.eveJs 18. Encourage residents to own their recovery As evidenced by: NARR 4 .0S SM 2.11 .01 .02 Q Policies and procedures that encourage each resident to develop and 1 u ./ ./ 6 JV ./ participate in their own personalized recovery plan (Person-driven recovery) Q Policies and procedures that encourage residents to make their own outside appointments 19. Inform and encourage residents to participate in a range of community-based supports SM NARR lH ./ As ev.iden-ced by: .01 0 Staff that are knowledgeable aboutlocal community-based resources Applied to Lev(!Js I II m .t ./ ./ IV ./ 4.08 .02 0 Resource directories or similar resources are readily available to residents Applled to Levels 20. Offer recovery support in informal social settings NARR 4.3 .01 As evidenced by: 0 Staffing plan that corresponds to the delivery of this service ./ ./ I II m ./ .,/ ./ 4.7 SM .02 NARR 4.? Traditions. policies or procedures that foster mutually supportive and recovery-oriented relationships between residents and/or staff through peer-based interactions 21. Offers recovery support services in formal settings As evidenced by: .01 4 .14 Q .02 .03 0 ./ ./ ./ Applied to Levels 11 III ./ Weekly schedule ofrecovery support services recognized by the respective NARR Affiliate organization IV ./ l 0 Weekly schedule of recovery-oriented presentations, group exercises, and activities Q Staffing plan that corresponds to the delivery of this service ./ ./ ./ ./ NARR 4.10 SM4.0 22. Offering life skills development services in a formal setting I AppUed to Le'.Ve1s #23 As evidenced by: .01 .02 JI 111 .,/ Weekly schedule of formal life skills development services or classes Q Staffing plan that correspDnds to the delivery of this service 0 ./ IV ./ ./ 4.12 23. Offer cUnJcal services in accordance with State law As evidenced by: .01 0 Weekly schedule of clinical services available to residents across all phases, if multiple phases are used .02 a Staffing plan that corresponds to the delivery of this service Core Principle: Provide a home 7 Applied to Levels u HI IV .,/ ./ ! I I I ----, 24. Provide a physically and emotionally safe, secure and respectful environment narr 4.01 new NARR J..08 As evidenced by: Q Policies and procedures, such as applicant screenings, that establish the home's priority population and cultivate physically and emot1onally safe environments for discussing the needs, feelings and sustaining recovery-supportive connections. .0 3 0 Policies that promote resident determined lengths of stay that support health and safety of the household/community .02 1.16 (4.6) J ./ .01 Q Written and enforced policies and procedures that address: lJ Ill ./ ./ IV ./ ® ® Applied to Levels 25. Provide an alcohol and illicit drug-free environment As evidenced by: NARR Ap.p lied to Uv6s I ./ Il m IV .I .I ./ a. Alcohol and/or other prohibited drug-seeking or use; b. Possession of hazardous and other prohibited items and associated searches; c. Drug-screening and or toxicology prntocols; and d. Prescription and non-prescription medication usage and storage consistent with the Level of Support and relevant state law NARR 4.04 NARR 1.0fl NARR 26. Are cultivated through structure and accountability As evidenced by: .01 0 Written resident rights, requirements, agreements, social covenants 1 16 4 6 · { · ) New and/or "House Rules" .02 0 Requirements and protocols for peer leadership and/or mentoring policies that foster individual and community accountability Core Principle: Inspire purpose New Applied to Levels 2 7. Promote meaningful daily activities As evidenced by: .01 Q A weekly schedule of the typi<:al resident's activities .02 0 Are residents encouraged to (at least one of the following) : a. Work, going to school, or volunteer outside of the residence community (Level 1, 2 and some 3s) b. Participate in mutual aid or caregiving (All Levels) c. Participate in social. physical or creative activities (All Levels) 8 .!' .I II .I .I Ill IV .!' ,/ ./ .I d. Attend daily or weekly programming (All Levels) .03 Q Person-driven recovery planning & peer governance ,/ Core Principle: Cultivate community 28. Creating a "fu.nctionally equivalent family" within the household Applied to Levels Fail" housJns SM 1.00, Z.GO As evidenced by meeting at least 50% of the following: 0 Are residents involved in food preparation? .01 IV .I HI .I .I .I .I .I .I .I I H ,/ .02 0 .03 .04 .05 .06 0 Do residents help maintain and clean the home e.g. chores? ,/ ,/ ,/ 0 Do residents share in household expenses? ,/ ,/ 0 Family or house meetings at least once a week? ,/ ./ .I .I Do residents have control over who they Hve with? 0 Do residents have access to the common areas of the home? ,/ ./ .I .I ,/ ./ SM4.0 #23 SM SM 4.03 29. Foster ethical, peer-based mutually supportive relationships between residents and/or staff As evidenced by: .01 0 Policies and proeedures that encourage residents to engage one another in informal activities and conversation'? .02 0 Polides and procedures that encourage staff to engage residents in informal activities and conversations? Q Policies and procedures that coordinate community gatherings, .03 recreational events and/or other social activities amongst residents and/or staff? Applied to Levels j II m IV .I ,/ ,/ ,/ ./ ./ .I ./ ./ ./ ./ ,/ NARR 4.08 4.06 30. Connect residents to the local (greater) recovery community Applied to Levels SM 6.00 As evidenced by at least 5-0% of the following for levels 2 through 4 and at least 1 for level ls: Q Residents are informed of or Jinked to mutual aid, recovery .01 community centers, recovery ministries recovery·focused leisure activities and recovery advocacy opportunities; Q Mutual aid meetings are hosted on site and there are typically .02 attendees from the greater recovery community 9 l I NARR 4.03 I ./ II m IV ./ ,/ ,/ ./ ./ ./ I L .03 Q The recovery residence helps participants find a recovery mentor or .04 Q .OS Q .06 Q .07 Q mutual aid sponsor if they are having difficulty finding one Participants are encouraged to find a recovery mentor or mutual aid sponsor before leaving the recovery residence Residents are formally linked with the community such as job search, education, family services, health and/or housin.g programs Residents engage Jn community relations and interactions to promote kinship with other recovery communities and goodwill for recovery services Sober social events are regularly scheduled (each participant can attend at least one). J I ./ ./ ./ ./ ./ ./ ./ .I ./ ./ ./ ,/ .I ./ ./ ./ l : : j Property and Architect~re Dp1~ain ' Core Principle: Promote recovery l Applied ro Levels 31. create a home-like environment SM 1.0 .01 SM l .O .02 S.06 .03 5.07 .04 As evidenced by: Q Furnishing are typical of those found in single family homes or apartments as opposed to institutional settings Q Entrances and exits that are home-like (vs institutional or clinical) Q 50+ sq ft per bed per sleeping room 0 One sink, toilet and shower per six residents a Each resident has personal item storage Q Each resident has food storage space Q Laundry services are accessible to all residents I II m ./ ./ ./ ,/ ./ .I ./ ./ ./ ./ ./ ./ ./ ./ .I ./ ./ .I ./ .I ,/ ./ .I ./ IV ./ .I .I ,/ s.z .05 5.2 ,06 5.8 .07 5.11 .08 0 Working appliances ./ ./ ./ ./ 5.lZ .09 0 ./ ./ ./ ,/ A staffing plan that pr-0vides for addressing repairs and maintenance in a timely fashion I l Applied to Levels 32. Promote community 5.tia SMl.O 113 10 .01 As evidenced by: 0 Community room (space) large enough to reasonably accommodate community living and meetings. l n m JV ./ ./ ./ ./ !t NRR5.11 5.1 5.3 5.9 5.5 3.1 Iii-.2 l?l .02 A comfortable group area, a living room or sofas, for participants to informaliy socialize A kitchen and dining area[s} that encourages residents to share meals together Entertainment or recreational areas and or furnishings that. promote social engagement Furniture that is in good condition .03 .04 QDDU \K?x?s Core Principle: Promote health and safety 33. Promote home safety As evideocecl by: .01 Cl Affidavit From the owner or operator attesting that the residence meets nondiscriminatory iocai health and safety codes OR document from government agency or credentialed inspector attesting co the property meeting health and safety standards .02 El Signed and dated safety seliassessmeot checklist which includes a. Functioning smoke detectors in the sleeping rooms Functioning carbon monoxide detectors, if there are gas appliances c. Functic?ming ?re extinguishers in plain sight and/or clearly marked locations interior and exterior of the property is in a functional. safe and clean condition and free of ?re hazards .03 Cl Smoke-free living environment policy and/or designated smoking area outside of the residence. 34. Have an emergency plan As evidenced by: .01 13 Post emergency numbers, procedures and evacuation maps in conspicuous locations .02 13 Collect emergency contact information from residents and orient them to emergency procedures Good Neighbor Domoin m. o/ Appiied to Levels ll Apylied to Levels .~--· -1 l! Core PrincipJe: Are good neighbors s NARR 5.9 Are compatible with the neighborhood 35. As evidenced by: Q If recovery residence is in a residential neighborhood, there are no .01 .02 0 external indications that the property is anything other than a single family household typical of its neighborhood The property and its structures are consistently maintained Applied to Levels rv ./ UI ./ ./ ./ ./ I . n ./ ./ ./ 6.1 Applied to Levels 36. Are responsive to neighbor concerns As evidenced by: Q Policies and procedures that provide neighbors with the responsible person(s) contact information upon request Q Policies and procedures that require Lile responsible person(s) to .02 respond to neighbor's concerns even if it is not possible to resolve the issue Q New resident orientation includes how residents and staff are to greet .03 and interact with neighbors and/or concerned parties .01 6.2 6.3 Ill ./ ./ ./ ./ ./ ./ ./ ./ ./ 1 .02 As evidenced by: Q Policies that are responsive or preemptive to neighbor's reasonable comp1aints regarding a. Smoking b. Loitering c. Parking d. Noise e. Lewd or offensive language f. Cleanliness of public space around the property Q Parking courtesy rules where street parking is scarce ./ Applled to LeYi!ls 37. Rave courtesy rules .01 12 11 ./ IV ./ l u Ill lV ./ ./ ./ ./ ./ ./ ..., ./ f -~ ~OPTUM™ . · -. . . ·...-.. · _ . , ~ 18- to 25-year-olds present a new challenge to a system that is scrambling to meet their needs for mental health and substance use disorder treatment Optum www.optum.com White Pa.per ·___ . : White Paper Young Adults and the Behavioral Health System More than 3 million 18- to 25-year-olds stayed on their parents' health plans as a result of the Affordable Care Ad (ACA). 1 These young adults, as a group, may have fewer medical expenses than older adults. Their behavioral health costs are another matter. Political, social and economic forces in the past several years have altered the mental health landscape and dramatically affected young adults. Today there is an urgent demand for mental health and substance use treatment for young adults - from a system that is frankly strained to provide effective treatment options while managing the costs. In this paper, we explore the events and trends that have created this situation, and we present some ideas for how to address it Young Adults Are Bearing the Brunt and Reaping the Benefits - of Recent History Seminal legislation in health care Two pieces of federal legislation in two years created a very different health care landscape. Since passage in 2008 of the federal Mental Health Parity and Addiction Equity Act, insurers cannot put limits on substance use disorder coverage or require use of in-network behavioral health providers if the plan includes medical out-of-network benefits. Then, two years later, the Affordable Care Act (ACA) made 18- to 25-yearolds eligible for coverage under their parents' employer-sponsored insurance plans. Higher rates of mental health and substance use disorder Many mental health conditions and substance use disorders begin when people are in their teens and 20s.2 At the same time, abuse of prescription medications in the entire population has taken off. The numbers paint a stark picture: -------~---- - -- --- About one in five - or about 6.4 million - young adults had any mental illness (AMI) in the past year. 3 X2 The rate of substance use disorder among people age 18 to 25 is twice that of adults 26 and older.4 There was a 346% • increase in admissions for opioid treatment from 2001to2011 .6 Optum www.optum.com . L i Among 18· to 25-year-olds, • + of those with any • of those with a mental illness severe mental illness · also have a substance use disorder. 5 Page 2 Young Adults and the Behavioral Health System White Paper Health care system caught flat-footed The fact that many young adults may have lacked health insurance in the past led to lower demand for services. As a consequence there has been, in our opinion, little clinical innovation to address substance use disorders among young adults and not enough attention to defining best practices. Among clinicians who are treating substance use disorders, there is wide variation in their approaches to treatment some driven more by philosophy than evidence of effectiveness. There are systemic deficiencies, too. For young adults in treatment, there is a drop-off in available services when they reach their 18th birthdays and become "adults." They may be abruptly transitioned into adult treatment settings, few of which have separate quarters and programs for young adults. MENTAL HEALTH ISSUES OF 18-TO 25-YEAR-OLDS No mental health issue affects as many young adults as substance use disorder. Substance use disorder accounted for the majority of behavioral health claims costs in 2013.12 Fallout from the 'Great Recession' Economic circumstances have left many young adults stranded. Students who graduated from college even after the 2007-2009 recession have a higher unemployment rate 7 and generally lower career prospects, delaying them from moving out of their parents' homes arid into their own. 8 Meanwhile, those who are working may be part of the growing "freelance economy" 9 characterized by short-term contractual or hourly jobs without benefits. For those young adults, staying on parents' plans is an attractive option to paying their own health care premiums, putting pressure on the health care costs of their parents' employers. Significant Increases in Costs for 18- to 25-Year-Olds 6% Optum analyzed our behavioral health claims for 18- to 25-year-olds in 2011 to 2013 and found a: EATING DISORDERS . . 41 % increase 80% increase ·, .' ' in per-member/ per-month costs per-month costs for substance use disorders10 2% . MOOD DISORDER . ' ' We can point to three trends that we believe are major cost drivers. They are: Optum www.optum.com Page 3 Young Ad ults and t he Behaviora l Hea lth System White Paper Substance Use Treatment Is a Particular Concern Sensing both demand for services and higher rolls of young adults on their parents' insurance, entrepreneurs have opened new centers for treatment of substance use disorders. Many of these are in "destination" locales, in states far from patients' homes. In our estimation, however, those are often not the most appropriate or effective settings for treatment for these reasons: 1. When individuals can be treated for a substance use disorder in or near their home communities, they often stand a better chance of long-term recovery. Their families and close friends can be part of their recovery, and the individuals in treatment learn how to be sober in the surroundings where they will continue their lives. 2. Close analysis of claims from some treatment centers bears witness to questionable practices in treatment protocols and in billing patients, families and their insurance companies.13 A particular area of abuse is in the use of and billing for drug screenings through laboratory tests that are being administered inappropriately, far more frequently than required, at rates well beyond the usual and customary charges. Florida - An Expensive Destination for Substance Use Treatment The climate and natural beauty of Florida make for a prime destination for substance use treatment. When Optum analyzed recent claims for substance use treatment in Florida, however, we found: The costs of treatment in out-of-network facilities were, on average, three times higher than the costs of treating at in-network facilities.14 $ l Nearly 75 percent of the cases of young adults treated in Florida involved individuals who were not residents of that state. 15 Individuals from outside the state treated at out-of-network facilities were readmitted at highe( rates between 11 percent and 40 percent higher, depending on level of care -- than Florida residents who used in-network facilities .;<> CLAIMS COSTS FOR SUBSTANCE USE DISORDER TREATMENT IN FLOFllOA !8- TO 25-~ EAR-OLD DEPENDEfJTS pi?r rne-mber $36,645 Out-of-Network (63% of members) per mernbcir (27% of m~rnbers) ........ ....................•.•..•.............••..................... ....•...•. Nearly 3){ higher cost per member for out-of-network Figure 1: Florida Example17 Optum www.optum.com Page 4 Young Adults and t he Behavioral Health System White Paper Call to Action: A Collective Response It will take action from everyone with a stake in this issue - health plans, employers, the behavioral health community, patients and their families - to create better systems for supporting young people in recovery. We believe this collective response should include: More treatment options within performance-tiered Providers of substance use treatment must be closely evaluated and rated according to their effectiveness, their efficiency and how well they follow evidence-based practices. In addition, those networks must be broad enough to include lower-cost options, such as community-based programs and medication-assisted therapy, to help ensure continuity of care. networks - ·······································~·~······································ Better education, guidance and advocacy - Too often young adults or their families select treatment centers in the heat of a crisis. They may not be equipped to ask probing questions about outcomes or the science of treatment before committing to care. They also may not know what treatment and support systems are available to them in or near their home communities . And during recovery, they need access to advocates and peer support. ..................................... ··....·. ................................... . ' Vigilance to uncover potential fraud and abuse - Benefit plan sponsors and payers should implement drug screening and reimbursement codes that follow the recommended guidelines of the Centers for Medicare and Medicaid Services. ...........••••.............••..•....• .~-· ••• •·.··..••................................... Recommitment to this vulnerable population Two-thirds of young adults with mental illness did not receive mental health services in the past year.18 When they do seek treatment, sometimes it falls well short of evidence-based practices. Young adults can benefit from specialized care management teams of medical staff and behavioral health dinicians to help them navigate their recovery. They need more community-based programs and peer-support networks to support their long-term recovery, too. - - - -·-·- - - - Optum www.optum.com Page 5 Young Adults and the Behavioral Health System White Paper About Optum Optum is a leading information and technology-enabled health services business dedicated to helping the health system work better for everyone. We're a global team of 40,000 people who collaborate to deliver integrated, intelligent solutions designed to modernize the health system and improve the health of individuals and populations. Optum leads the industry with unmatched depth and breadth of capabilities, a diverse portfolio of innovative health services and technologies, and the exceptional experience and talents of our people. Join the Conversation Optum is interested in your thoughts on this subject. Email us at engage@optum.com . Optum Experts in Young Adults and Behavioral Health Irvin "Pete" Brock Ill, MD Senior Vice President, Affordability Optum Behavioral Solutions Irvin "Pete" Brock Ill, MD, is responsible for Optum initiatives to improve affordability of behavioral health care for employers and commercial and government health plans, including Medicare Advantage and Medicaid plans. He is board certified in adult and geriatric psychiatry, and he has nearly 40 years of experience in health care, including 20 years while serving in the U.S. Air Force. He is a recipient of the Bronze Star and is a combat veteran of Operation Iraqi Freedom. Dr. Brock received his medical training at the Uniformed Services University of the Health Sciences, Bethesda, Md., with fellowship training in the dementias of aging at Johns Hopkins University. He joined Optum in 2008. Martin H. Rosenzweig, MD Medical Director Optum Behavioral Solutions Martin H. Rosenzweig, MD, has more than 20 years of experience in behavioral health, and for the past two years he has helped develop the response by Optum to the growing need for substance use treatment and for improving access to quality, evidenced based care for individuals with substance use disorders. Before joining · Optum in 2000, he spent three years as medical director of the counseling program of Pennsylvania Hospital in Philadelphia and six years at the Institute of Pennsylvania Hospital as director of adult treatment services and then director of the mood disorders program. Dr. Rosenzweig is board certified in psychiatry and neurology and is currently a clinical associate in the Department of Psychiatry at the University of Pennsylvania, where he has been on the faculty since 1992. He is a graduate of the University of the Witwatersrand Medical School in Johannesburg, South Africa . Optum www.optum.com Page 6 Young Adults and the Behavioral Health System White Paper Francisca Azocar, PhD Vice President, Research and Evaluation Optum Behavioral Health Sciences Francisca Azocar, PhD, is a licensed clinical psychologist with extensive experience conducting research in such topics as workplace depression; telephonic care management and outreach to depressed, chronically ill medical patients; and the impact of treatment monitoring and clinician feedback reports on treatment outcomes. Before joining Optum, Dr. Azocar was a faculty member in the Department of Psychiatry at the University of California, San Francisco. She received her doctorate from the University of California, Berkeley, and a National Institute of Mental Health Clinical Services Research post-doctoral fellowship at the University of California, San Francisco. Her work has been published in several scientific, peer-reviewed journals. Sources 1. U.S. Department of Health and Human Services. "State-Level Estimates of Gains in Insurance Coverage Among Young Adults," HHS.gov/HealthCare, June 19, 2012, http:// www.hhs.gov/healthcare/facts/factsheets/2012/06/young-adults06192012a.html. 2. Kessler R C, Berglund P, Demler 0, Jin R, Merikangas K R, Walters E E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593-602. 3. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (May 6, 2014). The CBHSG Report: Serious Mental Health Challenges among Older Adolescents and Young Adults. Rockville, MD. 4. In 2012, the rate of substance dependence or abuse among adults ages 18 to 25 was 18.9%, adults ages 26 and older was 7.0%. Source: Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings (HHS Publication No. SMA 13-4795, NSDUH Series H-46). 5. Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of national findings (HHS Publication No. SMA 13-4795, NSDUH Series H-46). 6. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. (2013). Treatment Episode Data Set (TEDS): 2001-2011. 7. Bureau of Labor Statistics, "The job market for recent college graduates in the United States," BLS.gov, April 5, 2013, http://www.bls.gov/opub/ted/2013/ted_20130405.htm. 8. Schawbel, Dan, "The Top 10 Workplace Trends for 2014," Forbes.com, Oct. 24, 2013, http://www.forbes.com/sites/danschawbel/2013/10/24/the-top-1 O-workplace-trendsfor-2014/. 9. Ibid. 10. Optum analysis of behavioral care costs and population increases (comparisons of incurred dates Jan. 1 through Dec. 31, 2011, paid through March 31, 2012 [not including incurred but not reported (IBNR) claims], against Jan. 1 through Dec. 31, 2013, paid through March 31, 2014 [not including IBNR claims)), for dependents ages 18-25 among national, ASO and fully insured, HMO/PPO/POS membership; Massey, Hubbard and Motz, May 2, 2014. Optum www.optum.com Page 7 Young Adults and the Behavioral Health System Sources White Paper Contact Us: 11. Ibid. Call: 866-386-3408 12. Optum analysis of percentage of treatment cost per diagnosis category versus total behavioral treatment incurred Jan. 1 through Dec. 31, 2013 (paid through March 31, 2014 (not including incurred but not reported (IBNR) claims]) for dependents aged 18-25 among national, ASO and fully insured, HMO/PPO/POS membership; Massey, Hubbard and Motz, May 2, 2014. Email: resourcecenter@optum.com 13. Rosenzweig M, Brock I. "Behavioral Solutions: Effectively Managing the Rising Utilization of the 18- to 25-Year-Old Population," May 22, 2014. 14. Optum analysis of behavioral care costs among 18- to 25-year-old members using at least one facility-based service for non-alcohol substance abuse treatment that discharged in 2013. Data includes the complete Book of Business (national, ASO and fully insured). Analysis includes comparisons between in-area (in-state) vs. out-of-area (out-of-state) and in-network vs. out-of-network on cost and readmission rates. Bolstrom, May 12, 2014. 15. Ibid. 16. Ibid. 17. Ibid. 18. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (May 6, 2014). The CBHSG Report: Serious Mental Health Challenges among Older Adolescents and Young Adults. Rockville, MD . ..... -.\.~ OPTUM™ T 800.765 .6619 I www.optum.com 11000 Optum Circle, Eden Prairie, MN 55344 All Optum trademarks and logos are owned by Optum, Inc. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. © 2014 Optum, Inc. All rights reserved. OPTPRJS778 41364-082014 www.optum .com/resourcecenter NARCAN USE 1/1/2016 - 10/24/2016 /I Incident number Date 16020327 16026855 HCD16000751 PBC 16000193 PBC16000243 PBC16000315 PBC16000485 PBC16000504 PBC16000549 PBC16000897 P BC 16000962 PBC16000980 PBC16001034 PBC16001073 PBC16001080 2/22/2016 3/8/2016 7/30/2016 1/1/2016 1/1/2016 1/1/2016 1/2/2016 1/2/2016 1/2/2016 1i3/2016 1/3/2016 1/3/2016 1/3/2016 1/3/2016 1/3/2016 11312016 113/2016 114/2016 1/4/2016 1/5/2016 1/6/2016 1/6/2016 1/7/2016 1/7/2016 1/712016 1/7/2016 11712016 1n12016 11712016 1/8/2016 1/8/2016 1/8/2016 1/9/2016 1/9/2016 1/9/2016 1/9/2016 1/9/2016 1/10/2016 1/10/2016 1/10/2016 1/10/2016 1/11/2016 1/11/2016 1/12/2016 1/1312016 1/13/2016 1/13/2016 1/1312016 1/13/2016 1114/2016 1/14/2016 1/14/2016 1/15/2016 1/15/2016 1/15/2016 1/15/2016 1/1612016 1116/2016 PSC160011~9 PBC16001142 PBC16001261 PBC16001453 PBC16001691 PBC16002133 PBC16002234 PBC16002288 PBC16002365 PBC16002436 PBC16002452 PBC16002526 PBC16002570 PBC16002578 PBC16002700 PBC16002901 PBC16002973 PBC16003116 PBC16003140 PBC16003189 PBC16003229 PBC16003315 PBC16003404 PBC16003607 PBC16003609 PBC16003698 PBC16004030 PBC16004035 PBC16004416 PBC16004607 PBC16004724 PBC16004831 PBC16004850 PBC16004875 PBC16005151 PBC16005203 PBC16005270 PBC16005395 PBC16005593 PBC16005601 PBC16005619 PBC160e>5817 PBC16005855 Dose 1.00 0.50 2.00 0.50 0.50 2.00 2.00 2.00 1.00 2.00 2.00 0.50 2.00 2.00 1.00 2.00 1.00 0.50 2.00 1.00 1.00 0.50 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 2.00 1.00 4.00 2.00 4.00 0.50 4.00 0.50 2.00 2.00 2.00 2.00 2.00 2.00 0.50 4.00 2.00 2.00 2.00 2.00 0.50 0.50 0.50 2.00 0.40 2.00 0.50 2.00 PBC16006038 PBC16006047 PBC16006055 PBC16006099 PBC16006157 PBC16006307 PBC16006463 PBC16006658 PBC16006750 PBC16006935 PBC16006971 PBC16007005 PBC16007030 PBC16007087 PBC16007178 PBC16007404 PBC16007453 PBC16007531 PBC16007550 PBC16007973 PBC16007991 PBC16008085 PBC16008314 PBC16008339 PBC16008353 PBC16008361 PBC16009002 PBC16009003 PBC16009129 PBC 16009185 PBC16009546 PBC16009672 PBC16009834 PBC16009915 PBC16009948 PBC16010029 PBC16010084 PBC16010095 PBC16010236 PBC16010283 PBC16010449 PBC16010527 PBC16010613 PBC16010747 PBC16010856 PBC16010958 PBC16011048 PBC16011054 PBC16011089 PBC16011188 PBC16011272 PBC16011281 PBC16011340 PBC16011447 PBC16011459 PBC16011471 PBC16011504 PBC16011527 PBC16011741 PBC16011807 PBC16011820 1/16/2016 1/16/2016 1/16/2016 1/17/2016 1/17/2016 1/17/2016 1/18/2016 1/18/2016 1/18/2016 1/19/2016 1/19/2016 1/19/2016 1/19/2016 1/19/2016 1/19/2016 1/20/2016 1/20/2016 1/20/2016 1/20/2016 1/22/2016 1/22/2016 1/22/2016 1/22/2016 1/22/2016 1/23/2016 1/23/2016 1/24/2016 1/24/2016 1/25/2016 1/25/2016 1/26/2016 1/26/2016 1/26/2016 1/27/2016 1/27/2016 1/27/2016 1/27/2016 1/27/2016 1/27/2016 1/27/2016 1/28/2016 1/28/2016 1/28/2016 1/29/2016 1/29/2016 1/29/2016 1/29/2016 1/29/2016 1/29/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/30/2016 1/31/2016 1/31/2016 1/31/2016 2.50 2.00 4.00 2.00 0.50 1.00 0.50 4.00 0.50 2.00 2.00 2.00 2.00 1.00 6.00 0.50 4.00 0.50 1.00 0.50 0.50 2.00 2.00 4.00 1.50 2.00 4.00 0.50 0.50 0.50 2.00 2.00 0.50 6.00 2.00 0.40 2.00 0 .50 4.00 4.00 4.00 0.50 2.00 4.00 1.00 2.00 2.00 2.00 0.50 0.50 1.50 2.00 4.00 0.50 4.00 2.00 1.00 0.50 2.00 2.00 2.00 PBC16011846 PBC16011930 PBC16011939 PBC16012029 PBC16012160 PBC16012193 PBC16012254 PBC16012378 PBC16012383 PBC16012388 PBC16012651 PBC16012657 PBC16012697 PBC16012793 PBC16012821 PBC16012830 PBC16013011 PBC16013029 PBC16013088 PBC16013146 PBC16013171 PBC16013183 PBC16013342 PBC16013427 PBC16013512 PBC16013531 PBC16013546 PBC16013561 PBC16013640 PBC16013657 PBC16013828 PBC16014103 PBC16014155 PBC16014253 PBC16014572 PBC16014595 PBC16014612 PBC16014926 PBC16015044 PBC16015066 PBC16015078 PBC16015093 PBC16015526 PBC16015617 PBC16015675 PBC16015688 PBC16015737 PBC16015740 PBC16015811 PBC16015868 PBC16015898 PBC16015913 PBC16016153 PBC16016193 PBC16016359 PBC16016537 PBC16016591 PBC16016609 PBC16016662 PBC16016701 PBC16016725 1/31/2016 1/31/2016 1/31/2016 2/1/2016 2/1/2016 2/1/2016 2/1/2016 2/1/2016 2/1/2016 2/1/2016 2/2/2016 2/2/2016 2/2/2016 2/3/2016 213/2016 2/3/2016 2/3/2016 213/2016 2/3/2016 2/3/2016 2/4/2016 2/4/2016 2/4/2016 2/4/2016 2/4/2016 2/4/2016 2/4/2016 2/5/2016 2/5/2016 2/5/2016 2/5/2016 2/6/2016 2/6/2016 2/6/2016 2/7/2016 2/7/2016 2n12016 2/8/2016 2/8/2016 2/9/2016 2/9/2016 2/9/2016 2/10/2016 2/10/2016 2/10/2016 2/10/2016 2/10/2016 2/10/2016 2/11/2016 2/11/2016 2/11/2016 2/11/2016 2/11/2016 2/11/2016 2/12/2016 2/12/2016 2/12/2016 2/12/2016 2/13/2016 2/13/2016 2/13/2016 2.00 0.50 3.00 2.00 2.00 2.00 2.00 4.00 2.00 2.50 2.00 2.00 0.50 0.50 3.00 0.50 0.50 2.00 3.00 4.00 0.50 4.00 4.00 2.50 4.00 2.00 2.00 4.00 2.00 0.50 2.00 2.00 4.00 2.00 2.00 2.00 2.00 0.50 2.00 2.00 6.00 0.50 2.00 2.00 2.00 1.00 2.00 2.00 2.00 2.00 2.00 0.50 2.50 0.50 2.00 0.50 4.00 0.50 1.00 6.00 1.00 PBC16016937 PBC16016978 PBC16017017 PBC 16017227 PBC16017275 PBC16017519 PBC16017727 PBC16017788 PBC16017838 PBC16018088 PBC16018089 PBC16018156 PBC16018232 PBC16018303 PBC16018349 PBC16018376 PBC16018512 PBC16018591 PBC 16018605 PBC16018616 PBC16018632 PBC16018638 PBC16018643 PBC16018647 PBC16018656 PBC16018704 PBC16018983 PBC16019024 PBC16019095 PBC16019120 PBC16019121 PBC16019152 PBC16019198 PBC16019304 PBC16019305 PBC16019333 PBC16019351 PBC16019357 PBC16019368 PBC16019381 PBC16019440 PBC16019444 PBC16019445 PBC16019489 PBC16019490 PBC16019529 PBC 16019539 PBC16019660 PBC16019677 PBC16019679 PBC16019741 PBC16019750 PBC16019808 PBC16019851 PBC16019898 PBC16019960 PBC16020059 PBC16020085 PBC16020095 PBC16020100 PBC16020138 2/13/2016 2/13/2016 2/14/2016 2/14/2016 2/14/2016 2/15/2016 2/15/2016 2/16/2016 2/16/2016 2/16/2016 2/16/2016 2/16/2016 2/16/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/17/2016 2/18/2016 2/18/2016 2/18/2016 2/18/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/19/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/20/2016 2/21/2016 2/21/2016 2/21/2016 2/21/2016 2/21/2016 2/21/2016 4.00 1.00 1.00 2.00 4.00 2.00 12.00 3.00 0.50 2.00 1.00 2.00 2.00 1.00 2.50 1.00 2.00 2.00 2.50 1.00 2.50 2.00 2.00 5.00 2.50 2.00 2.00 2.00 6.00 1.00 6.00 0.50 0.80 4.00 4.00 0.40 1.00 4.00 2.00 1.00 2.00 0.50 2.00 6.00 0.50 2.00 2.00 0.50 0.50 6.00 0.50 0.50 2.50 1.00 2.00 6.00 2.00 4.00 1.00 0.50 1.00 PBC16020142 PBC16020181 PBC16020244 PBC16020256 PBC16020259 PBC16020287 PBC16020480 PBC16020575 PBC16020586 PBC16020601 PBC16020688 PBC16020702 PBC16020709 PBC16020718 PBC16020730 PBC16020750 PBC16020756 PBC16020773 PBC16020818 PBC16020916 PBC16020957 PBC16021051 PBC16021098 PBC16021131 PBC16021175 PBC16021312 PBC16021319 PBC16021321 PBC16021326 PBC16021413 PBC16021417 PBC16021445 PBC16021450 PBC16021477 PBC16021483 PBC16021519 PBC16021566 PBC16021568 PBC16021577 PBC16021615 PBC16021663 PBC16021984 PBC16022084 PBC16022090 PBC16022168 PBC16022249 PBC16022327 PBC 16022349 PBC16022359 PBC16022361 PBC16022368 PBC16022386 PBC16022406 PBC16022434 PBC16022436 PBC16022450 PBC16022451 PBC16022453 PBC16022473 PBC16022484 PBC16022510 2/21/2016 2/21/2016 2/21/2016 2/21/2016 2/21/2016 2/21/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/22/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/23/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/24/2016 2/25/2016 2/25/2016 2125/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 2/26/2016 212712016 2.00 0.50 2.00 1.50 8.00 2.00 0.50 2.00 5.50 2.00 4.00 2.00 2.00 2.00 0.50 2.00 2.00 4.00 1.00 4.00 2.00 1.00 2.00 8.00 3.00 2.80 0.50 4.00 3.00 4.00 2.00 1.00 2.00 2.00 3.00 0.50 0.80 0.50 0.50 2.00 2.00 4.00 0.50 2.00 4.00 0.50 4.00 1.00 0.50 4.00 2.00 4.00 4.00 1.00 1.50 2.00 2.00 2.00 0.50 4.00 4.00 PBC16022527 PBC16022746 PBC16022765 PBC16022788 PBC16022799 PBC16022810 PBC16022821 PBC16022841 PBC16022880 PBC16022913 PBC16022979 PBC16023023 PBC16023059 PBC16023208 PBC16023329 PBC16023493 PBC16023561 PBC16023831 PBC16023839 PBC16023964 PBC16024052 PBC16024054 PBC16024086 PBC16024205 PBC16024287 PBC16024331 PBC16024345 PBC16024362 PBC16024579 PBC16024651 PBC16024705 PBC16024841 PBC16025041 PBC16025145 PBC16025176 PBC16025252 PBC16025299 PBC16025329 PBC16025493 PBC16025529 PBC16025579 PBC16025582 PBC16025595 PBC16025666 PBC16025682 PBC16025735 PBC16025741 PBC 16025856 PBC16025942 PBC16025973 PBC16025979 PBC16026069 PBC16026328 PBC16026342 PBC16026350 PBC16026443 PBC16026489 PBC16026519 PBC16026587 PBC16026818 PBC16026830 2/27/2016 2/27/2016 2/27/2016 2/27/2016 2/27/2016 2/27/2016 ·2/27/2016 2/27/2016 2/27/2016 2/28/2016 2/28/2016 2/28/2016 2/28/2016 2/28/2016 2/29/2016 2/29/2016 2/29/2016 3/1/2016 3/1/2016 3/1/2016 3/1/2016 3/1/2016 3/2/2016 3/2/2016 3/2/2016 3/2/2016 3/2/2016 3/2/2016 3/3/2016 3/3/2016 3/3/2016 3/3/2016 3/4/2016 3/4/2016 3/4/2016 3/4/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/5/2016 3/6/2016 3/6/2016 3/6/2016 3/6/2016 3/6/2016 3/6/2016 3/6/2016 3/7/2016 3/7/2016 3/7/2016 3/7/2016 3/7/2016 3/8/2016 3/8/2016 3/8/2016 3/8/2016 4.00 4.00 2.00 0.50 0.50 2.00 6.00 1.00 6.00 2.00 2.00 2.00 2.00 2.00 0.50 2.00 2.00 2.00 2.00 4.00 2.00 2.00 2.00 2.00 2.00 0.50 2.50 0.50 3.00 4.00 0.50 0.50 4.00 4.00 2.00 2.00 0.25 4.00 3.00 0.50 2.00 2.00 4.00 6.00 4.00 4.00 0.50 0.50 2.00 4.00 1.00 1.50 3.00 2:00 2.00 0.50 4.00 2.00 3.00 1.00 1.50 PBC16026867 PBC16026970 PBC16027065 PBC16027106 PBC16027173 PBC16027217 PBC16027218 PBC16027228 PBC 16027240 PBC16027421 PBC16027467 PBC16027492 PBC16027617 PBC16027638 PBC16027660 PBC16027661 PBC16027686 PBC16027822 PBC16027868 PBC16027913 PBC 16027919 PBC16027959 PBC16027976 PBC16027981 PBC16027996 PBC 16028024 PBC16028040 PBC16028080 PBC16028117 PBC16028261 PBC16028269 PBC16028402 PBC16028410 PBC16028451 PBC16028461 PBC16028517 PBC16028529 PBC16028542 PBC16028561 PBC16028603 PBC16028607 PBC16028720 PBC16028791 PBC16028893 PBC16028896 PBC16028906 PBC16029004 PBC16029021 PBC16029166 PBC16029270 PBC16029493 PBC16029496 PBC 16029536 PBC16029610 PBC16029717 PBC16029718 PBC16029721 PBC16029747 PBC16029798 PBC16029888 PBC16029993 3/8/2016 3/9/2016 3/9/2016 3/9/2016 3/9/2016 3/9/2016 3/9/2016 3/912016 3/9/2016 3/10/2016 3/10/2016 3/10/2016 3/10/2016 3/10/2016 3/10/2016 3/10/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/11/2016 3/12/2016 3/12/2016 3/12/2016 3/12/2016 3/12/2016 3/12/2016 3/12/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/13/2016 3/14/2016 3/14/2016 3/14/2016 3/14/2016 3/14/2016 3/14/2016 3/14/2016 3/15/2016 3/15/2016 3/15/2016 3/15/2016 3/15/2016 3/15/2016 3/15/2016 3/16/2016 3/16/2016 3/16/2016 3/16/2016 2.00 2.00 2.00 3.50 3.00 2.50 0.50 4 .00 4.00 1.00 2.00 4.00 2.00 0.50 1.00 2.50 4.50 2.00 4.00 4 .00 3.00 12.00 0.25 4.00 4.00 2.00 2.00 5.50 4.00 2.00 2.00 2.00 1.00 4.00 4.00 2.00 2.00 2.50 4.00 2.00 0.50 2.00 2.00 0.50 4.00 6.00 1.00 6.00 2.50 4.00 4.00 1.00 2.50 0.50 2.00 2.00 4.00 2.00 4.00 0.50 6.00 PBC 16030075 PBC16030141 PBC16030145 PBC16030154 PBC16030211 PBC16030287 PBC16030295 PBC16030308 PBC16030338 PBC16030387 PBC16030394 PBC16030416 PBC16030500 PBC 16030642 PBC16030664 PBC16030835 PBC16030880 PBC16030893 PBC16030904 PBC16030947 PBC16030951 PBC16031007 PBC16031079 PBC16031091 PBC16031104 PBC16031208 PBC16031217 PBC16031240 PBC16031244 PBC16031361 PBC16031487 PBC16031613 PBC16031648 PBC16031906 PBC16032080 PBC16032123 PBC16032124 PBC16032147 PBC16032163 PBC16032214 PBC16032232 PBC16032347 PBC16032374 PBC16032455 PBC16032516 PBC16032556 PBC16032681 PBC16032715 PBC16032770 PBC16032873 PBC16032886 PBC16032889 PBC16032936 PBC16032945 PBC16033133 PBC16033159 PBC16033266 PBC16033276 PBC16033401 PBC16033478 PBC16033548 3/16/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/17/2016 3/18/2016 3/18/2016 3/18/2016 3/18/2016 3/18/2016 3/18/2016 3/18/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/19/2016 3/20/2016 3/20/2016 3/20/2016 3/21/2016 3/21/2016 3/21/2016 3/21/2016 3/21/2016 3/22/2016 3/22/2016 3/22/2016 3/22/2016 3/22/2016 3/22/2016 3/22/2016 3/23/2016 3/23/2016 3/23/2016 3/23/2016 3/23/2016 3/24/2016 3/24/2016 3/24/2016 3/24/2016 3/24/2016 3/24/2016 3/24/2016 3/24/2016 3/25/2016 3/25/2016 3/25/2016 2.00 2.00 4.00 2.00 0.50 2.00 3.00 2.00 4.00 2.00 2.00 4.00 0.50 4.00 2.50 4.00 4.00 2.00 2.00 2.00 4.00 4.00 4.00 1.00 4.50 8.00 2.00 8.00 3.00 2.00 2.00 0.50 0.50 0.50 2.00 0.50 0.50 2.00 2.00 2.00 0.50 2.00 0.50 0.50 0.50 4.00 0.50 3.00 2.00 2.00 7.00 0.50 4.00 3.00 4.00 4.00 4.00 2.00 2.00 4.00 0.50 PBC16033595 PBC16033658 PBC16033694 PBC16033773 PBC16034009 PBC16034064 PBC16034067 PBC16034103 PBC 16034133 PBC16034147 PBC16034155 PBC16034163 PBC16034171 PBC16034225 PBC16034228 PBC16034371 PBC16034441 PBC16034534 PBC16034590 PBC16034671 PBC16034712 PBC16034722 PBC16034779 PBC16034846 PBC16034919 PBC16034965 PBC16034969 PBC16034999 PBC16035103 PBC16035468 PBC16035476 PBC16035582 PBC16035586 PBC16035607 PBC16035702 PBC16035764 PBC16035780 PBC16035911 PBC16035984 PBC16036122 PBC16036125 PBC16036171 PBC16036235 PBC16036269 PBC16036523 PBC16036538 PBC16036622 PBC16036662 PBC16036691 PBC16036752 PBC16036815 PBC16036902 PBC16036919 PBC16036952 PBC16037332 PBC16037361 PBC16037464 PBC16037494 PBC16037503 PBC16037528 PBC16037567 3/25/2016 3/25/2016 3/25/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/26/2016 3/27/2016 3/27/2016 3/27/2016 3/27/2016 3/27/2016 3/27/2016 3/28/2016 3/28/2016 3/28/2016 3/28/2016 3/28/2016 3/28/2016 .3/28/2016 3/29/2016 3/29/2016 3/29/2016 3/29/2016 3/30/2016 3/30/2016 3/30/2016 3/30/2016 3/30/2016 3/30/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 3/31/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/1/2016 4/2/2016 4/2/2016 4/2/2016 4/2/2016 4/2/2016 4/2/2016 4/2/2016 4/3/2016 4/4/2016 4/4/2016 4/4/2016 4/4/2016 4/4/2016 4/4/2016 4/4/2016 1.00 0.50 6.00 2.00 0.50 4.00 4.50 4.00 3.00 8.00 12.00 4.00 2.00 5.00 4.00 4.00 0.50 0.50 4.00 2.00 4.00 6.00 0.50 2.00 4.00 0.50 8.00 2.00 2.00 2.00 0.50 3.00 4.00 4.00 2.00 3.00 2.00 2.00 2.00 2.00 0.25 2.00 2.00 0.50 4.00 4.00 6.00 0.50 3.00 4.00 0.50 1.00 2.00 3.00 2.00 2.00 4.00 2.00 2.00 2.00 2.50 PBC16037624 PBC16037690 PBC16037693 PBC16037816 PBC16037940 PBC16037987 PBC16037994 PBC16038006 PBC16038182 PBC16038432 PBC16038483 PBC16038534 PBC16038547 PBC16038585 PBC16038640 PBC16038662 PBC16038717 PBC16038721 PBC16038784 PBC16038909 PBC16038920 PBC 16038940 PBC16039004 PBC16039008 PBC16039019 PBC16039052 PBC16039079 PBC16039102 PBC16039116 PBC16039119 PBC16039246 PBC16039293 PBC16039341 PBC16039344 PBC16039577 PBC16039591 PBC16039634 PBC16039664 PBC16039795 PBC16039902 PBC16039921 PBC16039989 PBC16040018 PBC16040063 PBC16040121 PBC16040128 PBC16040135 PBC 16040156 PBC16040165 PBC16040381 PBC16040446 PBC16040477 PBC16040511 PBC16040543 PBC16040643 PBC16040769 PBC16040813 PBC16040926 PBC 16040934 PBC16040938 PBC16041237 4/5/2016 4/5/2016 4/5/2016 4/5/2016 4/5/2016 4/5/2016 4/5/2016 4/5/2016 4/6/2016 4/7/2016 417/2016 4/7/2016 4/7/2016 417/2016 4/7/2016 4/7/2016 4/7/2016 417/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/8/2016 4/9/2016 4/9/2016 4/9/2016 4/9/2016 4/10/2016 4/10/2016 4/10/2016 4/10/2016 4/10/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/11/2016 4/12/2016 4/12/2016 4/12/2016 4/12/2016 4/12/2016 4/13/2016 4/13/2016 4/13/2016 4/13/2016 4/13/2016 4/13/2016 4/14/2016 3.00 1.00 2.00 16.00 2.00 1.00 2.00 2.00 2.00 0.50 1.00 4.00 10.00 3.00 6.00 2.00 4.00 2.00 0.50 2.00 2 .00 3.00 3.00 3.50 2.00 4.00 8.00 4.00 0.50 0.50 2 .00 3.0b 1.00 2.50 2.50 2.00 1.00 1.00 2.00 2.00 2.00 4.00 1.00 6 .00 2 .00 2.00 4.00 1.00 4.00 0.50 2.00 4.00 0.50 4.00 2.00 2.00 1.00 2.00 6.00 3.00 3.00 PBC16041255 PBC16041270 PBC16041356 PBC16041545 PBC16041639 PBC16041699 PBC16041716 PBC16041783 PBC16041955 PBC16041971 PBC16041997 PBC16042093 PBC16042168 PBC16042222 PBC16042349 PBC16042354 PBC16042370 PBC16042380 PBC16042522 PBC16042536 PBC16042730 PBC16042758 PBC16042792 PBC16042873 PBC16042907 PBC16042935 PBC16043036 PBC16043090 PBC16043249 PBC16043251 PBC16043253 PBC16043367 PBC16043413 PBC16043439 PBC16043448 PBC16043477 PBC16043490 PBC16043501 PBC16043533 PBC16043749 PBC16043791 PBC16043804 PBC16043957 PBC16044088 PBC16044098 PBC16044195 PBC16044215 PBC16044243 PBC16044295 PBC16044329 PBC16044431 PBC16044507 PBC16044541 PBC16044595 PBC16044643 PBC16044710 PBC16044721 PBC16044771 PBC16044782 PBC16044934 PBC 16045009 4/14/2016 4/14/2016 4/15/2016 4/15/2016 4/15/2016 4/15/2016 4/15/2016 4/16/2016 4/16/2016 4/16/2016 4/16/2016 4/16/2016 4/17/2016 4/17/2016 4/17/2016 4/17/2016 4/17/2016 4/17/2016 4/18/2016 4/18/2016 4/18/2016 4/18/2016 4/18/2016 4/19/2016 4/19/2016 4/19/2016 4/19/2016 4/19/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/20/2016 4/21/2016 4/21/2016 4/21/2016 4/22/2016 4/22/2016 4/22/2016 4/22/2016 4/22/2016 4/22/2016 4/22/2016 4/22/2016 4/23/2016 4/23/2016 4/23/2016 4/23/2016 4/23/2016 4/23/2016 4/24/2016 4/24/2016 4/24/2016 4/24/2016 4/24/2016 0.50 3.00 4.00 2.00 4.00 4.00 1.00 0.50 1.00 2.00 2.00 2.50 1.00 2.00 1.00 2.00 2.00 0.50 2.00 4.00 2.00 3.00 4.00 2.00 0.50 0.50 2.00 4.00 4.00 4.00 2.00 4.50 2.00 4.00 8.00 2.00 4.00 2.00 6.00 2.00 4.00 0.50 4.00 1.00 2.00 4.00 4.00 4.00 10.00 4.00 2.00 2.00 2.00 0.50 0.50 6.00 2.00 0.50 4.00 4.00 PBC16045037 PBC16045084 PBC16045115 PBC16045206 PBC16045261 PBC16045301 PBC16045319 PBC16045331 PBC16045401 PBC16045414 PBC16045430 PBC16045457 PBC16045551 PBC16045596 PBC16045632 PBC16045638 PBC16045693 PBC16045849 PBC16045854 PBC16046038 PBC16046055 PBC16046095 PBC16046105 PBC16046164 PBC16046174 PBC16046322 PBC16046479 PBC16046550 PBC16046591 PBC16046618 PBC 16046639 PBC16046793 PBC16046829 PBC16046878 PBC16046977 PBC16047065 PBC16047117 PBC16047138 PBC16047148 PBC16047150 PBC16047242 PBC16047278 PBC16047307 PBC16047338 PBC16047505 PBC16047622 PBC16047625 PBC16047630 PBC16047632 PBC16047890 PBC16047944 PBC16048038 PBC16048129 PBC16048184 PBC16048225 PBC16048226 PBC16048234 PBC16048257 PBC16048295 PBC16048517 PBC16048530 4/24/2016 4/25/2016 4/25/2016 4/25/2016 4/25/2016 4/25/2016 4/25/2016 4/25/2016 4/25/2016 4/26/2016 4/26/2016 4/26/2016 4/26/2016 4/26/2016 4/26/2016 4/26/2016 4/26/2016 4/27/2016 4/27/2016 4/27/2016 4/27/2016 4/27/2016 4/28/2016 4/28/2016 4/28/2016 4/28/2016 4/29/2016 4/29/2016 4/29/2016 4/29/2016 4/29/2016 4/29/2016 4/29/2016 4/30/2016 4/30/2016 4/30/2Q16 4/30/2016 4/30/2016 4/30/2016 4/30/2016 5/1/2016 5/1/2016 5/1/2016 5/1/2016 5/1/2016 5/2/2016 5/2/2016 5/2/2016 5/2/2016 5/2/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/3/2016 5/4/2016 5/4/2016 2.00 2.00 4.00 2.00 2.00 2.00 2.00 2.00 6.00 0.50 2.00 3.00 1.00 2.00 0.50 2.00 2.00 2.00 1.00 0.50 2.00 4.00 2.00 4.00 2.00 3.00 0.50 2.00 0.50 4.00 2.00 1.00 2.00 6.00 1.00 3.00 2.00 2.00 2.00 0.50 2.00 2.00 2.00 5.00 2.00 2.00 2.00 1.00 0.50 2.00 2.00 4.00 2.00 2.00 2.00 2.00 2.00 2.00 4.00 2.00 3.00 PBC16048531 PBC16048535 PBC16048621 PBC16048630 PBC16048649 PBC16048847 PBC16048928 PBC16048948 PBC16048949 PBC16048976 PBC16048993 PBC16049127 PBC16049213 PBC16049229 PBC16049298 PBC16049313 PBC16049314 PBC16049413 PBC16049523 PBC16049575 PBC16049624 PBC16049693 PBC16049788 PBC16049856 PBC16049907 PBC16049944 PBC16050037 PBC16050114 PBC16050404 PBC16050460 PBC16050690 PBC16050872 PBC16050891 PBC16050919 PBC16050981 PBC16050990 PBC16051069 PBC16051100 PBC16051141 PBC16051228 PBC16051342 PBC16051434 PBC16051455 PBC16051481 PBC16051491 PBC16051507 PBC16051515 PBC16051629 PBC16051668 PBC16051756 PBC16051787 PBC16051810 PBC16051811 PBC16051820 PBC16051828 PBC16051936 PBC16052037 PBC16052049 PBC16052088 PBC16052114 PBC16052191 5/4/2016 5/4/2016 5/4/2016 5/4/2016 5/5/2016 5/5/2016 5/5/2016 5/5/2016 5/5/2016 5/5/2016 5/6/2016 5/6/2016 5/6/2016 5/6/2016 5/6/2016 5/6/2016 5/6/2016 5/7/2016 5/7/2016 5/7/2016 5/7/2016 5/7/2016 5/8/2016 5/8/2016 5/8/2016 5/8/2016 5/9/2016 5/9/2016 5/10/2016 5/10/2016 5/10/2016 5/11/2016 5/11/2016 5/11/2016 5/11/2016 3/22/2016 5/11/2016 5/11/2016 5/12/2016 5/12/2016 5/12/2016 5/12/2016 5/12/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/13/2016 5/14/2016 5/14/2016 5/14/2016 5/14/2016 5/14/2016 5/14/2016 2.00 2.00 4.00 0.50 4.00 4.00 4.00 2.00 2.50 2.00 2.00 2.00 1.00 1.00 2.00 4.00 2.00 0.50 2.00 0.50 6.00 3.00 2.00 2.00 4.00 2.00 0.50 6.00 2.00 0.40 4.00 0.50 6.00 0.50 4.00 2.00 4.00 4.00 2.00 2.00 1.00 2.00 2.00 2.00 2.00 4.00 2.00 0.50 2.50 2.50 2.00 2.00 2.00 4.00 2.00 0.50 2.00 2.00 6.00 1.00 2.00 PBC16052224 PBC16052247 PBC16052248 PBC 16052261 PBC16052304 PBC16052332 PBC16052445 PBC16052564 PBC16052574 PBC16052618 PBC16052660 PBC16052812 PBC16053071 PBC16053108 PBC16053149 PBC16053215 PBC16053264 PBC 16053386 PBC16053466 PBC16053663 PBC16053702 PBC16053745 PBC16054118 PBC16054231 PBC16054302 PBC16054378 PBC16054403 PBC16054418 PBC16054438 PBC16054660 PBC16054818 PBC16054908 PBC16054943 PBC16055137 PBC16055141 PBC16055212 PBC16055239 PBC16055318 PBC16055324 PBC16055421 PBC16055467 PBC16055583 PBC16055669 PBC16055738 PBC16055767 PBC16055778 PBC16055836 PBC16055920 PBC160q6168 PBC16056189 PBC16056216 PBC16056277 PBC16056432 PBC16056479 PBC16056485 PBC16056519 PBC16056562 PBC16056662 PBC16056688 PBC16056810 PBC16056827 5/15/2016 5/15/2016 5/15/2016 5/15/2016 5/15/2016 5/15/2016 5/15/2016 5/16/2016 5/16/2016 5/16/2016 5/16/2016 5/16/2016 5/17/2016 5/17/2016 5/17/2016 5/17/2016 5/17/2016 5/18/2016 5/18/2016 5/18/2016 5/19/2016 5/19/2016 5/20/2016 51201201'6 5/20/2016 3/28/2016 5/20/2016 5/20/2016 5/21/2016 5/21/2016 5/22/2016 5/22/2016 5/22/2016 5/23/2016 5/23/2016 5/23/2016 5/23/2016 5/23/2016 5/23/2016 5/23/2016 5124/2016 5/24/2016 5/24/2016 5/24/2016 5/24/2016 5/24/2016 5/25/2016 5/25/2016 5/25/2016 5/26/2016 5/26/2016 5/26/2016 5/26/2016 5/26/2016 5/26/2016 5/26/2016 5/27/2016 5/27/2016 5/27/2016 5/27/2016 5/27/2016 4.00 2.00 4.00 2.00 2.00 2.00 0.50 2.00 0.50 2.00 0.50 2.50 6.00 6.00 3.00 8.00 2.50 2.00 0.50 0.75 6.00 0.50 3.00 2.00 1.00 4.00 4.50 4.00 2.00 2.50 0.50 1.00 1.00 1.00 1.00 4.00 2.00 4.00 4.00 4 .50 1.00 2.00 4.00 4.00 4.00 2.00 2.00 4.00 2.00 4.00 4.00 1.00 0.50 2.00 1.00 0.50 4.00 0.50 0.50 4.00 2.00 PBC16056856 PBC16056873 PBC16056887 PBC16056907 PBC16057130 PBC16057148 PBC16057151 PBC16057163 PBC16057188 PBC16057197 PBC16057232 PBC16057248 PBC16057349 PBC16057363 PBC16057525 PBC16057526 PBC16057643 PBC16057721 PBC1605777S PBC16057801 PBC16057822 PBC16057912 PBC16058012 PBC16058047 PBC16058199 PBC16058244 PBC16058268 PBC16058284 PBC16058388 PBC16058395 PBC16058533 PBC16058563 PBC16058565 PBC16058596 PBC16058758 PBC16058807 PBC16058842 PBC16058843 PBC16058912 PBC16059033 PBC16059065 PBC16059115 PBC16059135 PBC16059170 PBC16059290 PBC16059335 PBC16059352 PBC16059414 PBC16059425 PBC16059444 PBC16059500 PBC16059951 PBC16059979 PBC16060040 PBC16060075 PBC16060085 PBC16060204 PBC16060228 PBC16060293 PBC16060309 PBC16060320 5/27/2016 5/27/2016 5/27/2016 5/28/2016 5/28/2016 5/28/2016 5/28/2016 5/28/2016 5/28/2016 5/28/2016 5/28/2016 5/29/2016 5/29/2016 5/29/2016 5/29/2016 5/29/2016 5/30/2016 5/30/2016 5/30/2016 5/30/2016 5/30/2016 5/31/2016 5/31/2016 5/31/2016 5/31/2016 5/31/2016 6/1/2016 6/1/2016 6/1/2016 6/1/2016 6/1/2016 6/1/2016 6/1/2016 6/1/2016 6/2/2016 6/2/2016 6/2/2016 6/2/2016 6/2/2016 6/3/2016 6/3/2016 6/3/2016 6/3/2016 6/3/2016 6/3/2016 6/3/2016 6/3/2016 6/4/2016 6/4/2016 6/4/2016 6/4/2016 6/5/2016 6/5/2016 6/5/2016 6/6/2016 6/6/2016 6/6/2016 6/6/2016 6/6/2016 6/6/2016 6/6/2016 2.00 2.00 2.00 2.00 2.00 6.00 2.50 4.00 4.00 3.00 2.00 1.00 2.00 0.50 6.00 2.00 0.50 2.00 1.00 4.00 2.00 4.00 4.00 3.00 3.00 4.50 1.00 4.00 4.00 1.00 0.50 7.00 2.00 3.00 2.40 2.00 4.40 0.50 2.00 4.00 2.00 0.50 0.50 2.00 2.00 4.00 0.50 2.00 2.00 2.00 4.00 2.00 4.00 25.00 2.00 4.00 4.00 2.00 2.00 2.00 0.50 PBC16060370 PBC16060387 PBC16060407 PBC16060482 PBC16060512 PBC16060560 PBC16060724 PBC16060739 PBC16060785 PBC16060825 PBC16061127 PBC16061219 PBC16061394 PBC16061638 PBC16061666 PBC16061721 PBC16061753 PBC16061797 PBC16061813 PBC16061816 PBC16061830 PBC16061838 PBC16061855 PBC16061997 PBC16062018 PBC16062071 PBC 16062179 PBC16062212 PBC16062273 PBC16062469 PBC16062624 PBC16062632 PBC 16062633 PBC16062690 PBC16062766 PBC16062891 PBC16063061 PBC16063084 PBC16063109 PBC16063305 PBC16063352 PBC16063371 PBC16063374 PBC16064091 PBC16064122 PBC16064178 PBC16064413 PBC16064446 PBC16064461 PBC16064537 PBC16064587 PBC16064709 PBC16064745 PBC16064844 PBC16064884 PBC16064929 PBC16065015 PBC16065124 PBC16065148 PBC16065269 PBC16065295 6/6/2016 6/6/2016 6/6/2016 6/7/2016 6/7/2016 6/7/2016 6/7/2016 6/7/2016 6/7/2016 6/8/2016 6/8/2016 6/9/2016 6/9/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/10/2016 6/11/2016 6/11/2016 6/11/2016 6/11/2016 6/11/2016 6/11/2016 6/12/2016 6/12/2016 6/12/2016 6/12/2016 6/13/2016 6/13/2016 6/13/2016 6/13/2016 6/14/2016 6/14/2016 6/14/2016 6/14/2016 6/14/2016 6/14/2016 6/16/2016 6/16/2016 6/17/2016 6/17/2016 6/17/2016 6/17/2016 6/17/2016 6/18/2016 6/18/2016 6/18/2016 6/18/2016 6/18/2016 6/18/2016 6/19/2016 6/19/2016 6/19/2016 6/19/2016 6/20/2016 3.00 2.00 4.00 2.00 3.00 0.50 0.50 1.00 2.00 0.50 2.00 2.00 4.00 2.00 1.00 2.00 10.00 4.00 5.00 2.00 2.50 0.50 4.00 4.00 6.00 2.00 6.00 1.00 4.00 5.00 4.00 0.50 2.00 2.00 1.00 2.00 2.00 0.50 2.00 3.00 2.00 2.00 4.00 1.00 4.00 2.00 2.00 0.50 2.00 3.00 2.00 2.00 2.00 4.00 2.00 2.00 2.00 2.00 2.00 0.50 0.40 PBC16065558 PBC16065590 PBC16065896 PBC16066018 PBC16066149 PBC16066421 PBC16066536 PBC16066569 PBC16066577 PBC16066601 PBC16066690 PBC16066705 PBC16066888 PBC16066971 PBC16066976 PBC16066987 PBC16067064 PBC16067140 PBC16067154 PBC16067195 PBC16067217 PBC 16067256 PBC 16067303 PBC16067326 PBC16067557 PBC16067568 PBC16067619 PBC16067669 PBC16067681 PBC 16067683 PBC16067830 PBC16067867 PBC16067988 PBC16068132 PBC16068195 PBC16068272 PBC16068276 PBC16068299 PBC16068339 PBC16068350 PBC16068476 PBC 16068592 PBC1S068629 PBC16068679 PBC16068682 PBC16068796 PBC16068883 PBC16068976 PBC16068977 PBC16069152 PBC16069200 PBC16069420 PBC16069472 PBC16069659 PBC16069674 PBC16069705 PBC16069723 PBC16069747 PBC16069758 PBC16069803 PBC16069959 6/20/2016 6/20/2016 6/21/2016 6/22/2016 6/22/2016 6/23/2016 6/23/2016 6/23/2016 6/23/2016 6/23/2016 6/24/2016 6/24/2016 6/24/2016 6/24/2016 6/24/2016 6/24/2016 6/25/2016 6/25/2016 6/25/2016 6/25/2016 6/25/2016 6/25/2016 6/25/2016 6/26/2016 6/26/2016 6/26/2016 6/27/2016 6/27/2016 6/27/2016 6/27/2016 6/27/2016 6/27/2016 6/28/2016 6/28/2016 6/28/2016 6/28/2016 6/28/2016 6/28/2016 6/29/2016 6/29/2016 6/29/2016 6/29/2016 6/29/2016 6/29/2016 6/30/2016 6/30/2016 6/30/2016 6/30/2016 6/30/2016 7/1/2016 7/1/2016 7/2/2016 7/2/2016 7/2/2016 7/2/2016 7/2/2016 7/3/2016 7/3/2016 7/3/2016 7/3/2016 7/3/2016 4.00 2.00 2.00 0.50 2.00 2.00 2.00 0.25 0.50 3.50 0.50 0.50 2.00 2.00 1.00 4.00 4.00 1.50 0.50 2.00 1.50 2.00 0.50 2.00 0.50 4.00 2.00 2.00 6.00 1.00 2.00 2.00 3.00 1.00 1.00 4.00 0.50 1.00 4.00 3.00 4.00 2.00 2.00 2.00 4.00 9.50 2.00 4.00 8.00 4.00 8.00 1.00 2.00 4.00 2.00 6 .00 2.00 1.00 2.00 2.00 4.00 PBC16070091 PBC16070096 PBC16070103 PBC16070173 PBC16070198 PBC16070244 PBC16070254 PBC16070363 PBC 16070411 PBC16070423 PBC16070471 PBC16070583 PBC16070653 PBC16070718 PBC16070719 PBC16070753 PBC16070807 PBC16070815 PBC16070825 PBC16070832 PBC16070894 PBC16071037 PBC16071092 PBC16071108 PBC16071166 PBC16071333 PBC16071361 PBC16071404 PBC16071511 PBC16071519 PBC16071524 PBC16071534 PBC16071636 PBC16071679 PBC16071733 PBC16071740 PBC16071759 PBC16071762 PBC16071844 PBC16071848 PBC16071865 PBC16071866 PBC16071880 PBC16071894 PBC16071933 PBC16071995 PBC16072039 PBC16072118 PBC16072208 PBC16072248 PBC16072256 PBC16072355 PBC16072483 PBC16072494 PBC16072499 PBC16072553 PBC16072619 PBC16072660 PBC16072694 PBC16072718 PBC16072735 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/4/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/5/2016 7/6/2016 7/6/2016 7/6/2016 7/6/2016 7/6/2016 7/7/2016 7/7/2016 7/7/2016 7/7/2016 7/7/2016 7/7/2016 7/7/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/8/2016 7/9/2016 7/9/2016 7/9/2016 7/9/2016 7/9/2016 7/10/2016 7/10/2016 7/10/2016 7/10/2016 7/10/2016 7/10/2016 7/11/2016 7/11/2016 7/11/2016 7/11/2016 7/11/2016 7/11/2016 3.00 12.00 2.00 1.00 4.00 6.00 1.00 2.50 4.00 0.50 0.50 6.00 1.00 3.50 2.00 2.00 3.50 2.00 2.00 1.00 1.00 7.00 3.50 4 .00 1.00 0.50 6 .00 0.50 4.00 4.00 4.00 2.00 0.50 2 .00 2.00 2.00 2.00 0.50 4.00 2.00 4.00 1.50 2.00 2.00 2.00 2.00 4.00 1.00 2.00 2.00 2.00 2.00 1.00 6.00 0.50 12.00 2.00 2.00 2.00 4.00 4.00 PBC16072815 PBC16072851 PBC16072855 PBC16072866 PBC16072872 PBC16073012 PBC16073029 PBC16073104 PBC16073128 PBC16073313 PBC 16073319 PBC16073334 PBC16073356 PBC16073385 PBC16073458 PBC16073464 PBC16073470 PBC16073507 PBC16073519 PBC16073579 PBC16073588 PBC16073611 PBC16073736 PBC16073769 PBC16073791 PBC16073802 PBC16073810 PBC16073828 PBC16073833 PBC16073866 PBC16073873 PBC16073876 PBC16073904 PBC16073907 PBC16073911 PBC16073915 PBC16073935 PBC16073942 PBC16073949 PBC16073952 PBC160739S6 PBC16073980 PBC16074080 PBC16074119 PBC16074121 PBC16074209 PBC16074219 PBC16074223 PBC16074233 PBC16074254 PBC16074290 PBC16074293 PBC16074309 PBC16074314 PBC16074324 PBC16074338 PBC16074532 PBC16074540 PBC16074545 PBC16074555 PBC16074570 7/11/2016 7/11/2016 7/11/2016 7/11/2016 7/11/2016 7/12/2016 7/12/2016 7/12/2016 7/12/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/13/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/14/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/15/2016 7/16/2016 7/16/2016 7/16/2016 7/16/2016 7/16/2016 7/16/2016 7/16/2016 2.00 2.00 2.00 8.00 8.00 2.00 0.50 4.00 2.00 0.50 2.00 2.00 2.00 4.00 0.50 2.00 3.00 2.00 6.00 8.00 4.00 2.00 4.00 8.00 6.00 1.00 14.00 6.00 5.00 5.00 4.00 1.00 2.00 2.00 3.00 3.00 4.00 2.00 4.00 2.50 4.00 4.00 3.00 1.00 2.00 4.00 4.50 6.00 2.00 2.50 4.00 6.00 1.00 6.00 2.00 8.00 2.00 2.00 2.00 4.00 6.00 PBC16074585 PBC16074614 PBC16074618 PBC16074623 PBC16074673 PBC16074678 PBC16074685 PBC16074749 PBC16074824 PBC16074828 PBC16074832 PBC16074867 PBC16074904 PBC16074937 PBC16074980 PBC16075033 PBC16075194 PBC16075196 PBC16075212 PBC16075216 PBC16075259 PBC16075262 PBC16075279 PBC16075301 PBC16075334 PBC16075337 PBC16075340 PBC16075343 PBC16075346 PBC16075347 PBC16075348 PBC16075349 PBC16075354 PBC16075454 PBC16075468 PBC16075512 PBC16075514 PBC16075542 PBC16075551 PBC16075571 PBC16075578 PBC16075597 PBC16075643 PBC16075727 PBC16075845 PBC16075874 · PBC16075882 PBC16075930 PBC16075962 PBC16075982 PBC16075991 PBC16076008 PBC16076029 PBC16076035 PBC16076204 PBC16076285 PBC16076297 PBC16076301 PBC16076337 PBC16076338 PBC16076369 7/16/2016 7/16/2016 7/16/2016 7/16/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/17/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/18/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/19/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/20/2016 7/21/2016 7/21/2016 7/21/2016 7/21/2016 7/21/2016 7/21/2016 7/21/2016 0 .50 12.00 2.50 6.00 4.00 4.00 2.50 4.00 5.00 2.00 2.00 2.00 6.00 1.00 2.00 2.00 4.00 8.00 1.00 4.00 2.00 3.00 4.00 6.00 6.00 4.00 1.00 4.00 1.00 2.00 6.00 6.00 12.00 0.50 4.00 2.50 0.50 0.50 8.00 4.00 2.00 4.00 10.00 2.00 5.00 2.00 1.50 0.25 5.00 2.00 4.00 2.00 3.00 5.00 2.00 2.00 0.50 1.00 4.00 6.00 4.00 PBC16076393 PBC16076424 PBC16076448 PBC16076452 PBC16076461 PBC16076534 PBC16076569 PBC16076575 PBC16076608 PBC16076633 PBC16076655 PBC16076657 PBC16076661 PBC16076680 PBC16076704 PBC 16076717 PBC16076758 PBC16076775 PBC16076780 PBC16076782 PBC16076783 PBC16076794 PBC16076799 PBC16076920 PBC16076931 PBC16076975 PBC16077021 PBC16077031 PBC16077046 PBC16077055 PBC16077068 PBC16077080 PBC16077126 PBC16077131 PBC16077132 PBC16077182 PBC16077207 PBC 16077315 PBC16077346 PBC16077433 PBC16077501 PBC16077503 PBC16077509 PBC16077541 PBC16077548 PBC16077610 PBC16077611 PBC16077651 PBC16077708 PBC16077783 PBC16077801 PBC16077807 PBC16077808 PBC16077811 PBC16077831 PBC16077851 PBC16078009 PBC16078067 PBC16078068 PBC16078144 PBC16078182 7/21/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/22/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/23/2016 7/24/2016 7/24/2016 7/24/2016 7/24/2016 7/24/2016 7/24/2016 7/24/2016 7/24/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/25/2016 7/26/2016 7/26/2016 7/26/2016 7/26/2016 7/26/2016 0.50 4.00 0.50 4.00 4.00 8.00 2.00 0.80 6.00 1.00 8.40 9.00 2.00 4.00 2.00 2.00 6.00 6.00 6.00 2.50 14.00 0.50 2.50 2.00 0.50 1.00 4.50 4.00 0.40 4.00 2.00 4.00 4.00 4.00 4.00 4.00 6.00 3.00 2.00 4.00 2.00 3.00 6.00 2.00 1.00 2.00 0.50 2.00 2.00 0.50 4.00 4.00 2.50 4.00 8.00 4.00 2.00 2.50 2.00 2.00 0.50 PBC16078191 PBC16078355 PBC16078402 PBC16078469 PBC16078503 PBC16078513 PBC16078567 PBC16078580 PBC16078589 PBC16078596 PBC16078634 PBC16078641 PBC16078652 PBC16078661 PBC16078691 PBC16078718 PBC16078728 PBC16078800 PBC16078863 PBC 16078984 PBC16079053 PBC16079146 PBC16079175 PBC16079205 PBC16079236 PBC16079367 PBC16079388 PBC16079400 PBC16079453 PBC16079568 PBC16079630 PBC16079714 PBC16079741 PBC16079772 PBC16079782 PBC16079799 PBC16079853 PBC16079888 PBC16080121 PBC16080153 PBC16080165 PBC16080180 PBC16080208 PBC16080231 PBC16080286 PBC16080294 PBC16080306 PBC16080311 PBC16080321 PBC16080473 PBC 16080503 PBC16080537 PBC16080624 PBC16080655 PBC16080661 PBC16080719 PBC16080725 PBC16080820 PBC16080893 PBC16080923 PBC16080991 7/26/2016 7/27/2016 7/27/2016 7/27/2016 7/27/2016 7/27/2016 7/28/2016 7/2812016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/28/2016 7/29/2016 7/29/2016 7/2912016 7/29/2016 7/2912016 7/29/2016 7/30/2016 7/30/2016 7/30/2016 7/30/2016 7/30/2016 7/30/2016 7/31/2016 7/31/2016 7/31/2016 7/31/2016 7/31/2016 7/31/2016 7/31/2016 7/31/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/1/2016 8/2/2016 8/2/2016 8/2/2016 8/2/2016 8/2/2016 8/2/2016 8/3/2016 8/3/2016 8/3/2016 8/3/2016 8/3/2016 8/312016 3.00 6.00 8.00 4.00 4.00 0.50 6.00 6.00 1.00 0.50 2.00 6.00 4.00 2.00 6.00 2.50 2.00 4.00 4.00 2.50 0.50 2.00 2.00 2.00 0.50 4.00 4.00 2.00 2.00 8.00 3.00 6.00 5.00 6.00 4.00 0.50 4.00 8.00 2.00 0.50 5.00 4.00 2.00 2.00 1.00 2.00 3.00 1.00 0.50 1.00 1.00 3.00 3.00 1.00 10.00 0.50 10.00 2.00 4.00 0.50 0.50 PBC16081019 PBC16081038 PBC16081039 PBC16081130 PBC16081299 PBC16081361 PBC16081389 PBC16081456 PBC16081501 PBC16081505 PBC16081563 PBC16081584 PBC16081593 PBC16081597 PBC16081598 PBC16081652 PBC16081654 PBC16081695 PBC16081743 PBC16081744 PBC16081764 PBC16081867 PBC16081896 PBC16081925 PBC16081980 PBC16082069 PBC16082081 PBC16082085 PBC16082108 PBC16082109 PBC16082123 PBC16082163 PBC16082167 PBC16082172 PBC16082183 PBC16082190 PBC16082216 PBC1608~259 PBC16082284 PBC16082330 PBC16082361 PBC16082399 PBC16082439 PBC16082472 PBC16082553 PBC16082554 PBC16082619 PBC16082626 PBC16082690 PBC16082702 PBC16082709 PBC16082725 PBC16082732 PBC16082771 PBC16082782 PBC16083084 PBC16083131 PBC16083179 PBC16083299 PBC16083469 PBC16083475 8/3/2016 5/12/2016 8/4/2016 8/4/2016 8/4/2016 8/4/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/5/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8/6/2016 8n12015 8n12016 8/7/2016 8/7/2016 8/7/2016 8/7/2016 8n12016 8/7/2016 817/2016 817/2016 8/7/2016 8n12016 8/7/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/8/2016 8/9/2016 8/9/2016 8/9/2016 8/10/2016 8/10/2016 8/10/2016 3.00 0.50 0.50 1.00 4.50 3.00 14.00 1.00 4 .00 4.00 4.00 10.00 3.00 2.00 6.00 8.00 0.50 4.00 8.00 2.00 2.00 2.00 2.00 3.00 0.50 6.00 6.00 12.00 4.00 4 .00 2.00 2.50 4.50 6.00 2.00 1.00 4.00 4.00 4.00 8.00 9.00 4.00 0.50 2.00 1.50 2.00 4.00 2.00 8.00 1.00 2.00 1.00 1.00 4.00 1.00 0.50 2.00 6.00 2.50 4.00 4.00 PBC16083490 PBC16083496 PBC16083498 PBC16083526 PBC16083527 PBC16083589 PBC16083675 PBC16083686 PBC16083783 PBC16083784 PBC16083806 PBC16083825 PBC16083927 PBC16084041 PBC16084064 PBC16084095 PBC16084138 PBC16084148 PBC16084149 PBC16084157 PBC16084169 PBC16084191 PBC16084192 PBC16084219 PBC16084284 PBC16084355 PBC16084390 PBC16084402 PBC16084464 PBC16084467 PBC16084480 PBC16084513 PBC16084518 PBC16084714 PBC16084751 PBC16084821 PBC16084896 PBC 16084945 PBC16085004 PBC16085077 PBC16085134 PBC16085202 PBC16085212 PBC16085234 PBC16085255 PBC16085260 PBC16085276 PBC16085303 PBC16085311 PBC16085324 PBC16085485 PBC16085497 PBC16085504 PBC16085605 PBC16085632 PBC16085634 PBC16085856 PBC16085858 PBC16085883 PBC16085889 PBC 16085904 8/10/2016 8/10/2016 8/10/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/11/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/12/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/13/2016 8/14/2016 8/14/2016 8/14/2016 8/14/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/15/2016 8/16/2016 8/16/2016 8/16/2016 8/16/2016 8/16/2016 8/16/2016 8/16/2016 8/17/2016 8/17/2016 8/17/2016 8/17/2016 8/17/2016 8/17/2016 8/17/2016 2.00 2.00 4.00 2.00 3.00 0.50 4.00 0.50 1.00 2.00 2.00 8.00 4.00 4.00 0.50 10.00 2.00 2.00 0.50 2.00 2.00 6.00 0.50 2.00 4.00 2.00 2.00 3.00 2.00 0.50 0.50 3.00 1.00 1.00 0.50 2.00 4.00 6.00 8.00 2.00 4.00 0.50 4.00 1.00 5.00 0.50 1.00 3.00 4.00 7.20 0.50 6.00 2.00 2.00 1.00 6.00 1.00 2.50 4.00 2.00 2.00 PBC16085905 PBC16085930 PBC16086013 PBC16086035 PBC16086075 PBC16086122 PBC16086238 PBC16086246 PBC16086264 PBC16086267 PBC16086269 PBC16086285 PBC16086352 PBC16086457 PBC16086523 PBC16086531 PBC16086558 PBC16086615 PBC16086628 PBC16086686 PBC16086699 PBC16086704 PBC16086725 PBC16086757 PBC16086829 PBC16086868 PBC16086879 PBC16086890 PBC16086893 PBC16086938 PBC16086984 PBC16087001 PBC16087019 PBC16087039 PBC16087040 PBC16087150 PBC16087170 PBC16087240 PBC16087258 PBC16087275 PBC16087312 PBC16087335 PBC16087412 PBC16087422 PBC16087427 PBC16087459 PBC16087530 PBC16087550 PBC16087653 PBC16087738 PBC16088004 PBC16088060 PBC16088150 PBC16088156 PBC16088200 PBC16088300 PBC16088478 PBC16088489 PBC16088490 PBC16088512 PBC16088525 8/17/2016 8/17/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/18/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/19/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/20/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/21/2016 8/22/2016 8/22/2016 8/22/2016 8/22/2016 8/23/2016 8/23/2016 8/23/2016 8/23/2016 8/24/2016 8/24/2016 8/24/2016 8/24/2016 8/24/2016 8/24/2016 8/25/2016 6.00 2.00 0.80 0.50 2.00 3.00 4.00 2.00 4.00 4.00 6.00 3.00 2.00 2.00 1.50 0.50 3.00 2.00 2.00 6.00 4.00 2.00 6.00 2.00 2.00 2.00 2.00 3.00 4.00 3.00 4.00 6.00 6.00 6.00 8.00 0.50 0.50 0.50 6.00 1.00 8.00 6.00 6.00 10.00 8.00 1.20 0.50 1.00 2.00 2.00 4.00 3.00 4.00 2.00 1.00 2.00 2.50 2.00 6.00 6.00 2.00 PBC16088626 PBC16088640 PBC16088663 PBC16088669 PBC16088707 PBC16088739 PBC16088807 PBC16088808 PBC16088856 PBC 16088884 PBC16088888 PBC16088910 PBC16089048 PBC16089144 PBC16089160 PBC16089186 PBC 16089191 PBC16089203 PBC16089238 PBC16089259 PBC16089263 PBC16089267 PBC16089295 PBC16089349 PBC16089400 PBC16089407 PBC16089420 PBC16089438 PBC16089512 PBC16089574 PBC16089586 PBC16089618 PBC16089666 PBC16089720 PBC 16089738 PBC16089829 PBC16089869 PBC16089931 PBC16089945 PBC16089988 PBC16090053 PBC 16090097 PBC16090268 PBC16090310 PBC16090340 PBC16090342 PBC 16090411 PBC16090425 PBC16090443 PBC16090447 PBC16090506 PBC16090552 PBC16090592 PBC16090625 PBC16090639 PBC16090703 PBC16090762 PBC16090776 PBC16090837 PBC16090850 PBC16090867 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/25/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/26/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/27/2016 8/28/2016 8/28/2016 8/28/2016 8/28/2016 8/28/2016 8/28/2016 8/29/2016 8/29/2016 8/29/2016 8/29/2016 8/29/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/30/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 3.00 1.50 4.00 4 .00 4.00 2.00 3.00 2.50 4.00 4.00 2.00 2.00 4.00 4.00 2.00 4.00 5.50 1.00 8.00 0.50 6.00 4.00 4.00 0.50 2.00 8.00 1.00 2.00 2.00 0.50 5.00 6.00 0.50 6.00 8.00 6.00 3.00 6.00 2.00 1.00 4.00 2.00 4.00 6.00 2.00 1.50 8.00 3.00 2.00 4.00 4.00 1.00 2.00 4.00 2.50 2.00 6.00 2.00 4.00 2.00 4.00 PBC16090870 PBC16090871 PBC16090872 PBC16090939 PBC16090951 PBC16090958 PBC16090965 PBC16090971 PBC16091140 PBC16091142 PBC16091147 PBC16091218 PBC16091283 PBC16091320 PBC16091325 PBC16091332 PBC16091360 PBC16091375 PBC16091442 PBC16091455 PBC16091505 PBC16091533 PBC16091559 PBC16091570 PBC16091575 PBC16091576 PBC16091652 PBC16091655 PBC16091677 PBC16091687 PBC16091698 PBC16091722 PBC16091732 PBC16091822 PBC16091845 PBC16091887 PBC16091888 PBC16091937 PBC16092074 PBC16092123 PBC16092148 PBC16092292 PBC16092322 PBC16092355 PBC16092374 PBC16092523 PBC16092565 PBC16092610 PBC16092636 PBC16092647 PBC16092654 PBC16092699 PBC16092711 PBC16092716 PBC16092730 PBC16092758 PBC16092847 PBC16092903 PBC16092993 PBC16093021 PBC16093066 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 8/31/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/1/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/2/2016 9/3/2016 9/3/2016 9/3/2016 9/3/2016 9/3/2016 9/3/2016 9/4/2016 9/4/2016 9/4/2016 9/4/2016 9/4/2016 9/4/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/5/2016 9/6/2016 9/6/2016 9/6/2016 9/6/2016 9/6/2016 9/6/2016 0.25 3.00 0.50 0.50 6.00 10.00 6.00 2.00 0.50 4.00 0.50 10.00 0.50 0.40 1.00 2.00 1.00 4.00 1.00 2.00 0.50 6.00 2.00 10..00 4.00 2.00 6 .00 6.00 2.00 6.00 6 .00 6.00 4.00 4.00 1.00 4.00 2.00 2.00 2.50 4.00 2.00 4.00 0.50 10.00 2.00 2.00 2.00 2 .00 6 .00 4.00 1.00 2.00 0.50 2 .00 8.00 4.00 2.00 6.00 2.00 2.00 0.50 PBC16093080 PBC16093089 PBC16093200 PBC16093217 PBC16093277 PBC16093345 PBC16093390 PBC16093452 PBC16093621 PBC16093643 PBC16093654 PBC16093657 PBC16093662 PBC16093708 PBC16093715 PBC16093768 PBC16093781 PBC16093912 PBC16093916 PBC16093973 PBC16093987 PBC16093995 PBC16094006 PBC16094012 PBC16094015 PBC16094074 PBC16094075 PBC16094117 PBC16094143 PBC 16094157 PBC16094160 PBC16094262 PBC16094276 PBC16094346 PBC16094422 PBC16094427 PBC16094468 PBC16094524 PBC16094554 PBC16094560 PBC16094580 PBC16094623 PBC16094670 PBC16094739 PBC16094746 PBC16094764 PBC16094831 PBC16094870 PBC16094882 PBC16094885 PBC16094904 PBC16095070 PBC16095074 PBC16095179 PBC16095195 PBC 16095216 PBC16095226 PBC16095238 PBC16095253 PBC16095299 PBC16095445 9/6/2016 9/7/2016 9/7/2016 9/7/2016 9/7/2016 9/7/2016 9/7/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/8/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/9/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/10/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/11/2016 9/12/2016 9/12/2016 9/12/2016 9/12/2016 9/12/2016 9/12/2016 9/12/2016 9/12/2016 9/13/2016 9/13/2016 2.00 2.00 1.00 4.00 6.00 24.00 8.00 3.00 0.50 4.00 4.00 1.55 8.00 4.00 2.00 6.00 2.00 2.00 0.50 2.00 2.50 4.00 4.00 2.00 4.00 2.00 2.00 0.50 8.00 2.00 2.00 4.00 2.00 4.00 4.00 2.00 12.00 2.00 8.00 6.00 2.00 2.00 1.00 2.00 2.00 6.00 0.50 4.00 10.50 10.00 2.00 8.00 2.00 6.00 2.00 4.00 4.00 2.00 2.00 2.00 8.00 PBC16095504 PBC16095553 PBC16095589 PBC16095606 PBC16095620 PBC16095797 PBC16095866 PBC16095868 PBC16095895 PBC16095896 PBC16095920 PBC16095962 PBC16096181 PBC16096189 PBC16096190 PBC16096229 PBC16096231 PBC16096274 PBC16096285 PBC16096359 PBC16096388 PBC16096432 PBC16096436 PBC16096448 PBC16096505 PBC16096539 PBC16096573 PBC16096609 PBC16096630 PBC 16096657 PBC16096668 PBC16096675 PBC16096696 PBC16096716 PBC16096729 PBC16096731 PBC16096755 PBC16096760 PBC16096764 PBC16096773 PBC16096782 PBC16096783 PBC16096796 PBC16096867 PBC16096919 PBC16096949 PBC16096988 PBC16097057 PBC16097125 PBC16097162 PBC16097233 PBC16097245 PBC 16097283 PBC16097298 PBC16097307 PBC16097322 PBC16097375 PBC16097428 PBC1609743D PBC16097443 PBC16097507 9/13/2016 9/13/2016 9/13/2016 9/13/2016 9/14/2016 9/14/2016 9/14/2016 9/14/2016 9/14/2016 9/14/2016 9/14/2016 9/14/2016 9/15/2016 9/15/2016 9/15/2016 9/15/2016 9/15/2016 9/15/2016 9/15/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/16/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/17/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/18/2016 9/19/2016 9/19/2016 9/19/2016 1.00 12.00 8.00 2.00 5.00 3.00 2.50 0.50 2.00 2.00 7.00 8.00 6.00 4.00 2.00 8.00 4.00 0.50 6.00 8.00 6.00 6.00 1.50 2.00 8.00 4.00 4.00 3.00 4.00 6.00 0.50 0.50 2.00 6.00 2.00 2.00 8.00 2.00 4.00 6.00 8.00 10.00 6.00 10.00 8.00 1.00 6.00 4.00 10.00 4.00 6.00 4.00 4.00 4.00 8.00 6.00 2.00 6.00 2.00 4.00 2.00 PBC16097644 PBC16097705 PBC 16097724 PBC16097786 PBC16097906 PBC16098030 PBC16098099 PBC16098137 PBC 16098139 PBC16098149 PBC16098164 PBC16098171 PBC16098179 PBC16098227 PBC16098236 PBC16098282 PBC16098338 PBC16098343 PBC16098420 PBC16098446 PBC16098475 PBC16098477 PBC16098486 PBC16098494 PBC16098516 PBC16098688 PBC16098706 PBC16098724 PBC16098775 PBC16098777 PBC16098806 PBC16098829 PBC16098850 PBC16098854 PBC16098957 PBC16099129 PBC16099149 PBC16099199 PBC16099214 PBC16099226 PBC16099242 PBC16099244 PBC16099272 PBC16099313 PBC16099377 PBC16099467 PBC16099563 PBC16099644 PBC16099666 PBC16099873 PBC16099877 PBC16099888 PBC16099899 PBC16099946 PBC16100134 PBC16100226 PBC16100359 PBC16100410 PBC16100442 PBC16100604 PBC16100605 9/19/2016 9/19/2016 9/19/2016 9/19/2016 9/20/2016 9/20/2016 9/20/2016 9/20/2016 9/20/2016 9/20/2016 9/20/2016 9/20/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 . 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/21/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/22/2016 9/23/2016 9/23/2016 9/23/2016 9/23/2016 9/23/2016 9/23/2016 9/23/2016 9/23/2016 9/24/2016 9/24/2016 9/24/2016 9/24/2016 9/24/2016 9/25/2016 9/25/2016 9/25/2016 9/25/2016 9/25/2016 9/25/2016 9/25/2016 9/26/2016 9/26/2016 9/27/2016 9/27/2016 9/27/2016 9/27/2016 9/27/2016 2.00 8.00 2.00 6.00 4.00 4.00 2.00 6.00 2.00 1.00 9.00 8.00 4.00 2.50 10.00 4.00 4.00 2.00 3.50 4.00 2.00 4.00 0.50 0.50 2.00 2.50 4.00 1.00 1.00 2.00 6.00 10.00 10.00 4.00 4.00 0.50 0.50 2.00 4.00 6.00 0.50 6.00 8.00 1.00 1.00 6.00 2.50 4.00 5.00 2.00 1.00 1.00 8.00 6.00 2.00 2.00 2.00 4.00 0.25 18.00 2.00 PBC 16100638 PBC16100645 PBC16100663 PBC16100908 PBC16101044 PBC16101166 PBC16101343 PBC16101350 PBC16101371 PBC16101384 PBC16101417 PBC16101518 PBC16101526 PBC16101703 PBC16101704 PBC16101763 PBC16101785 PBC16101832 PBC16101835 PBC16101867 PBC16101991 PBC16102013 PBC16102101 PBC16102158 PBC16102168 PBC16102178 PBC16102232 PBC16102263 PBC16102272 PBC16102282 PBC16102357 PBC16102419 PBC16102480 PBC16102490 PBC16102509 PBC16102554 PBC16102576 PBC16102673 PBC16102696 PBC16102722 PBC16102737 PBC16102849 PBC16102882 PBC16102938 PBC16102964 PBC16102978 PBC16103140 PBC16103183 PBC16103205 PBC16103259 PBC16103340 PBC16103381 PBC16103393 PBC16103405 PBC16103427 PBC16103445 PBC16103642 PBC16103701 PBC16103731 PBC16103750 PBC16103771 9/27/2016 9/27/2016 9/28/2016 9/28/2016 9/28/2016 9/29/2016 9/29/2016 9/2912016 9/29/2016 9/29/2016 9/30/2016 9/30/2016 9/30/2016 9/30/2016 9/30/2016 9130/2016 9/30/2016 10/1/2016 10/1/2016 10/1/2016 10/1/2016 10/1/2016 10/1/2016 10/1/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/2/2016 10/3/2016 10/3/2016 1013/2016 10/3/2016 10/3/2016 10/3/2016 10/3/2016 10/3/2016 10/4/2016 10/4/2016 10/4/2016 10/4/2016 10/4/2016 10/4/2016 10/4/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 10/5/2016 6.00 2.00 6.00 4.00 4.00 1.00 6.00 2.00 6.00 1.00 6.00 2.00 2.00 4.00 6.00 4.40 4.00 2.00 6.00 0.50 2.00 0.50 2.00 8.00 1.00 1.00 2.00 4.00 2.00 2.00 4.00 2.00 4.00 2.00 2.00 6.00 6.00 2.00 6.00 2.00 2.00 6.00 2.50 6.00 3.00 4.00 4.00 2.00 2.00 4.00 6.00 0.50 0.50 2.00 4.00 2.50 4.00 4.00 4.00 2.00 4.00 PBC16103781 PBC16103794 PBC16103813 PBC16103839 PBC16103901 PBC16103992 PBC16104033 PBC16104059 PBC 16104089 PBC16104167 PBC16104227 PBC 16104253 PBC16104268 PBC16104403 PBC16104440 PBC16104470 PBC16104477 PBC16104512 PBC16104519 PBC16104567 PBC16104569 PBC16104595 PBC16104596 PBC16104616 PBC16104657 PBC16104712 PBC16104749 PBC16104824 PBC16104877 PBC16104911 PBC16104957 PBC16104966 PBC16105001 PBC16105022 PBC16105063 PBC16105083 PBC16105186 PBC16105221 PBC16105250 PBC16105273 PBC16105296 PBC16105304 PBC16105312 PBC16105366 PBC16105395 PBC16105440 PBC16105466 PBC16105526 PBC16105613 PBC16105642 PBC16105759 PBC16105860 PBC16105897 PBC16105986 PBC16105987 PBC16105989 PBC16105990 PBC16106024 PBC16106029 PBC16106070 PBC16106090 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/6/2016 10/7/2016 10/7/2016 10/7/2016 10/7/2016 10/7/2016 1017/2016 10/7/2016 1017/2016 10/7/2016 10/7/2016 10/7/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/8/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/9/2016 10/10/2016 10/10/2016 10/10/2016 10/10/2016 10/10/2016 10/10/2016 10/10/2016 10/11/2016 10/11/2016 10/11/2016 10/11/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 0.50 2.00 4.00 2.50 3.00 4.00 4.00 8.00 6.00 4.00 6.00 2.00 4.00 3.50 2.00 2.00 6.00 4.00 2.50 8.00 6.00 1.00 4.00 8.00 4.00 6.00 2.00 6.00 1.00 2.00 1.00 4.50 4.00 8.00 2.00 5.00 0.50 4.00 2.00 2.00 2.00 1.00 0.50 8.00 4.00 2.00 2.00 0.50 5.00 10.00 6.00 3.00 4.00 2.00 5.00 8.00 0.50 6.00 2.00 4.00 2.00 PBC16106095 PBC16106144 PBC16106193 PBC16106221 PBC16106224 PBC16106233 PBC16106237 PBC16106256 PBC16106276 PBC16106284 PBC16106299 PBC16106307 PBC16106316 PBC16106321 PBC16106326 PBC16106419 PBC16106498 PBC16106512 PBC16106546 PBC16106555 PBC16106575 PBC16106589 PBC16106648 PBC16106659 PBC 16106660 PBC16106687 PBC16106688 PBC16106725 PBC16106748 PBC16106818 PBC16106819 PBC16106901 PBC16106912 PBC16106913 PBC16106917 PBC16106941 PBC 16106979 PBC16106994 PBC16107012 PBC 16107024 PBC16107047 PBC16107049 PBC16107051 PBC16107066 PBC 16107069 PBC16107108 PBC16107116 PBC16107149 PBC16107170 PBC16107263 PBC16107264 PBC16107267 PBC16107309 PBC16107324 PBC16107384 PBC16107414 PBC16107425 PBC16107440 PBC16107441 PBC16107445 PBC16107463 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/12/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/13/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/14/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/15/2016 10/16/2016 2.00 4.00 6.00 2.50 6 .00 1.00 2.00 1.00 4.00 4.00 2.00 2.00 4.00 2.00 6.00 6.00 3.00 6.00 2.00 2.00 4.00 2.00 4.00 8.00 8.00 2.00 8.00 4.00 6.00 4.00 0.50 11.00 6.00 4.00 4.00 4.00 6.00 2.00 3.00 6.00 5.00 6.00 8.00 6.00 3.00 6.00 2.00 4.00 4.00 0.50 2.00 6.00 2.00 2.50 6.00 4.00 4.00 2.50 2.00 4.00 PBC16107537 PBC16107595 PBC16107607 PBC16107635 PBC16107657 PBC16107719 PBC16107769 PBC16107810 PBC16107833 PBC16107910 PBC16107971 PBC16107974 PBC16107994 PBC16108004 PBC16108062 PBC16108094 PBC16108129 PBC16108205 PBC16108207 PBC16108318 PBC16108353 PBC16108435 PBC16108455 PBC16108478 PBC16108549 PBC16108609 PBC16108714 PBC16108783 PBC16108837 PBC16108844 PBC16108856 PBC16108.872 PBC16108922 PBC16108924 PBC16108997 PBC16108999 PBC16109006 PBC16109010 PBC16109076 PBC16109140 PBC16109179 PBC16109236 PBC16109253 PBC16109255 PBC16109270 PBC16109373 PBC16109406 PBC16109435 PBC16109506 PBC16109542 PBC16109554 PBC16109602 PBC16109643 PBC16109646 PBC16109654 PBC16109661 PBC16109710 PBC16109713 PBC16109726 PBC16109843 PBC16109890 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/16/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/17/2016 10/18/2016 10/18/2016 10/18/2016 10/18/2016 10/18/2016 10/18/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/19/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/20/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/21/2016 10/22/2016 10/22/2016 10/22/2016 10/22/2016 10/22/2016 4.00 8.00 6.00 2.00 4.00 2.00 2.50 1.00 6.00 2.50 0.50 4.00 6.00 4.00 2.00 2.00 3.00 4.00 6.00 0.50 0.50 2.00 1.00 2.00 4.00 8.00 0.50 2.00 6.00 6.00 10.00 2.00 4.00 10.00 2.00 4.00 2.00 0.50 9.00 2.00 4.50 6.00 5.00 2.00 6.00 4.00 8.00 2.00 4.00 6.00 1.00 6.00 2.00 6.00 2.00 4.00 4.00 5.00 2.00 6.00 4.00 PBC16109906 PBC16109910 PBC16109958 PBC16110013 PBC16110073 PBC16110092 PBC16110258 PBC16110268 PBC16110310 PBC16110312 PBC16110320 PBC16110325 PBC16110327 PBC16110351 PBC16110373 PBC16110430 PBC16110455 PBC16110463 10/22/2016 10/22/2016 10/22/2016 10/22/2016 10/22/2016 10/22/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/23/2016 10/24/2016 10/24/2016 Total Incidents 2,089 Total mg 5.00 0.50 2.00 4 .00 4.00 4.00 6 .00 8.00 7.00 0.50 2.00 0.50 1.50 4.00 2.00 2.00 10.00 10.00 6,296.35 Addicts say recovery program stole their money I Tampa Bay Times MY EDITION MY EDITION HOME PAGE HOME HOME PAGE Page 1 of 7 Login TODAY'S PAPER Unlimited Access login Activate Subscribe NEWS TOP NEWS FLORIDA BREAKING NEWS NATION/WORLD LIVE BLOG EDUCATION PINELLAS HEALTH HILLSBOROUGH BIZARRE NEWS PASCO TB· TWO HERNANDO Comment Login Register NIE Subscribe WEATHER POLITICS POLITICS ffbBUZZ BLOG BAY BUZZ BLOG POLITIFACT POUT!FACT FLORIDA FLORIDA LEffb&TitUiftECAST Today's Paper l E-Newspaper i Search BUSINESS 7Jo scUl!W.Q8~~T BUCS SPORTS SPORTS HOMETEAM GOLF OUTDOORS RAYS MiWH!NPiur~pai~Ml~tt!PM,~Rdlt}, November 6th, 2016 AUTO RACING ROWDIES STORM ., ~ 1111- -.. ,,...... ~4if;I THJNGS.:mno . ~T~E{l~fiff8slj~PfiMIU.~~Q ~WY~'fl9i FLOft~ttt~{lrt!EVfirov1E i:IM~~L~SIC W~&1iijE#rs SEARfkORIDA Jt~ll.ii:S US/WORLD tfOOD READS EDUCATION Ff'Y;'i'dii211JbMt1EDIA .... ~~Hll§c BLOtJU~N~S STAfil:NELLAS HEALTH FLORIDIAN MAGAZINE ~~al£®~c§a¥sri~c~1Y&{i¥ THE JU!f.:E BLOG R9J VIDEO OPINION FEATURES & MORE . . . . . . . . . . . . . . . . . . . . . . ,. . . , BIZARRE HILLSBOROUGH PASCO HERNANDO BLOGS BAY MAGAZIN.f IRAVlt._ BO.OKS PARENTING QfJ1SIAWss10 e 1ne1r money THE mo BLOG TV LISTINGS MOVIES MOVIE TIMES o .. 23 STUCi\< IN THE 'BOS BLOG BLOGS BL%~xt BAY BUZZ LIGHTNING STRIKES BUCS BEAT THE HEATER DEAL DIVAS THE BUZZ GADGETS & GIZMOS THE FEED GATOR REPORT THE STATE YOU'RE IN THE GRADEBOOK http://www.tampabay.com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 Addicts say recovery program stole their money / Tampa Bay Times Page 2 of7 --M·----·--·-·--·---·--.. 0' ' ' ,' ' ;~ i•' ,, ;. ~ ·· •• •· · : ' -~ •v. /. ' ·• ----··-----~-• 'r ..,· .. ~ .. •~::' Yi~ ' '47thAnnual ·· I · " 41 l~t.iij)ii1tti]i f 705 E. Brandon Blvd., 8randot1 l='estJt,.. . Of Fo.;, fl\c,leS oatl"tes. . ' Next Wectn"sday, HovemJ>er 16 Carnival Gran Cl 01)ol Choir CUQ( FOR COMP.LETE INFO _ SIGN UP FOR DAYSTARTER Today's top headlines delivered to you daily. Second of two parts RELATED NEWSIARCHIVE Yellen says slow recovery confounds economists' expectations 3 Weeks Ago Yahoo says hackers stole data on 500 million users in 2014 1 Month Ago NSA contractor stole equivalent of 500 million pages, prosecutors say 2 Weeks Ago SIGN UP "Come join us in recovery!"~ So urged the Web ads for Peachford House, a halfway house program in Clearwater that promised to help people addicted to drugs and alcohol. Peachford would put them up in nice apartments, find them work and support their recovery with 12-step meetings. ~ It would turn around their lives. ~ Instead, residents say, Peachford employees stole their money, had sex with clients and turned a blind eye to drugs and drinking as all semblance of "sober living" dissolved late last year. The only jobs most residents got were dead-end day labor. Two alcoholics say they were put to work selling beer at Raymond James Stadium. (View our Privucy Policy) ,I TODAY'S TOP STATS Finally, a few days after Christmas, eviction notices went up. Peachford had been cramming http ://www.tampabay.com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 Addicts say recovery program stole their money I Tampa Bay Times Page 3 of7 six people to an apartment, charging each $135 a week for rent and "program fees," but hadn't paid the apartment complex in months. "All Peachford did was provide an over-priced roof over my head," said Anthony DiGregorio, one of 40 people who found themselves on their own when the Clearwater program shut down in January. "It did absolutely nothing to make me a better life." LOADING ... Peachford's parent organization - Sober Living America - continues to run halfway houses in Tampa and Jacksonville. As the Tampa Bay Peachford was started by James deVarennes, a 55-year-old Georgia man who heads the nonprofit Peachford Ministries. More videos: In 2005, deVarerines incorporated a for-profit company- Peachford House Clearwater - and started a recovery program in the MacArthur Park apartments, off U.S. 19. Among the first clients was DiGregorio. At first the program seemed good, he said. Though most of the jobs were day labor, requiring clients to be up at 3 a.m., Peachford allowed them to keep their paychecks. It provided meals. It supported clients' recovery by requiring them to attend Alcoholics or Narcotics Anonymous meetings. DiGregorio, addicted to painkillers, acknowledges he wasn't ready for recovery then. He left the program, spent eight months in state prison for grand theft, then returned to Peachford a year ago. LOADING ... Things were far different. Clients had to get their own food. They had to sign power-of-attorney forms authorizing Peachford to take their paychecks. "I thought that was crazy," DiGregorio said." I never had to sign anything like that before." He was surprised, too, that one of the male directors was having sex with female clients. And unlike his first time at Peachford, Di Gregorio found virtually no emphasis on recovery. http://www.tampabay.com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 Addicts say recovery program stole their money I Tampa Bay Times Page 4of7 "The AA meetings were run by the senior (person) in the apartment, who could have been there two weeks," he said. "It was supposed to be in the AA format but mostly it was people complaining about Peachford and how they didn't have any money." Clients were paying Peachford $172.50 a week - $135 for "program fees," which were supposed to cover rent and support group meetings, and $7.50 a day for van rides to the labor pool. But Di Gregorio said he and others discovered that not all of their payments were being credited to their accounts. Complaints that employees were stealing from clients brought deVarennes, Peachford's founder, down from Atlanta in October 2011. DeVarennes blamed the clients. "He said we should never have given (the program director) money, we trusted a drug addict with our money," DiGregorio said. DeVarennes fired a director. He was replaced a few days later by the van driver, a man who watched gay pornography in the office and offered male residents "money to have sex," Di Gregorio said. Yet Peachford continued to draw clients. A mental hospital in Pasco County referred 31-year-old Briana Newman to Peachford in November. Within two weeks, she was named "intake coordinator," charged vrith soliciting referrals from detox centers and hospitals that needed some place to send patients after they were discharged. Once Newman got a discharge planner on the phone, she followed a script that started like this: Ask this person, 'Have you heard of Peachford Communities?' If the answer is NO, go into the pitch. The pitch touted Peachford's "sober clean living, its employment assistance and the most attractive come-on: "Clients without funds are welcomed." The pitch brought people from as far away as Maine. "I took on a lot of guilt for sending people here who didn't know what they were getting into," Newman said. Mass eviction Three days after Christmas last year, clients were told they had to be out by New Year's Eve. Peachford was supposed to pay MacArthur Park $1,ooo a month per apartment. By putting six people in a unit and charging each $540 a month, Peachford was collecting as much as $3,240 per apartment yet hadn't made its own rent payments in months. http://www.tampabay.com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 Addicts say recovery program stole their money I Tampa Bay Times Page 5of7 With no place to go, many clients relapsed. "People were just getting loaded," said Jeffry Oliver, a recovering alcoholic who had been at Peachford less than three months. "There was a lot of prescription drug abuse, oxycodone, and people were just running around drunkenly." Di Gregorio, trying to stay clean, worked long hours at a St. Petersburg sludge incinerator. "When I got back to Peachford, they wanted those checks," he said. In late December, he left the program and moved in with a friend. Other clients landed in homeless shelters or shabby motels. Some went to other halfway house programs, including This House II in Clearwater. It was run by Mark Samson, a former Peachford manager accused of stealing from clients. Samson denied wrongdoing. "The only thing I'm guilty of is trying to give people there a better life." Allamanno, of the nonprofit Gulfcoast Legal Services, worked with Clearwater detectives to get prosecutors to take action against Peachford. Luring clients to Clearwater with false promises, requiring them to sign over their paychecks - it smacked to Allamanno of human trafficking, but no charges were brought. DeVarennes, Peachford's founder, did not respond to requests for comment for this story. In a Sept. 5, 2012, letter to Allamanno, he blamed the collapse of Peachford Clearwater on the soured economy and a lender's decision to call in a $550,ooo business loan. "For over six years, we faithfully served almost 5,000 families in the Pinellas/Hillsborough area with no means to pay," deVarennes wrote. "Unfortunately, when the economy hit bottom, we were unable to afford to keep these self-supporting facilities in operation." In his letter, deVarennes said he and his wife had recently lost their $450,000 suburban Atlanta home to foreclosure. They still have a $350,000 gulf-front condo in Panama City Beach, records show. DeVarennes' nonprofit ministry, now called Sober Living America, is soliciting donations on its website for programs to help "homeless and destitute" men in Tampa, Jacksonville and Atlanta. In Tampa, the program is called How House: Growth in Recovery, and operates out of several apartments in Ashford Place, a run-down complex near the University of South Florida. On a recent day, a man opened the office door, then quickly slammed it when a reporter asked to speak with him. Outside a few clients milled around the parking lot. They described a familiar -sounding "program:" Seven men crowded into a three-bedroom apartment. Up at 3 a.m. to catch a ride to the labor pool. How House taking their http://www. tampabay .com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 Addicts say recovery program stole their money I Tampa Bay Times Page 6of7 paychecks, leaving them with little or no money to eventually move out on their own. The only difference? The program fees. They're now up to $i45 a week. Times staff writer Lane DeGregory contributed to this story. Susan Taylor Martin can be contacted at susan@tampabay.com. ABC news investigation Tune in tonight to WFfS for ABC Action News at 11 p.m. to see more on this joint investigation into halfway houses. ' .. ... ~ .. Addicts say recovery program stole their money 11118112 !Last modified: Monday, November 19, 2012 10:41am} Photo reprints I Article reprints @ 2016 Tampa Bay Times 0 0 15 0 7 J Important 9 Inspiring ~--~ • Sad 50 4 @)Angry e5 Happy -~ C1Jtnmcnting Guideline~ Ab11.sl:! 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Grants Scholarships TIMES BRAND MERCHANDISE Purchase photos Reprints and licensing Online store Sign up Home © 2016 News Politics Sports Things To Do Video Opinion Classifieds Cars Jobs Homes Legal Ads Shop •All Rights Reserved •Tampa Bay Times• 490 First Avenue South • St. Petersburg. FL 33701 • 727-893-8111 RSS Privacy Policy Standard of Accuracy Terms, Conditions & Copyright Contact Us http://www.tampabay.com/news/addicts-say-recovery-program-stole-their-money/1261911 11/6/2016 10/10/2016 Bay County battles to keep opioid epidemic at bay Bay County battles to keep opioid epidemic at bay Saturday Posted Oct 8, 2016 at 7:05 PM Updated Oct 8, 2016 at 7:05 PM Since March, heroin and fentanyl have claimed the lives of eight people in Bay County alone. By Zack McDonald 1747-5071 I @PCNHzack I zmcdonald@pcnh.com PANAMA CITY - The death toll from overdoses continues to rise in Bay County as the war on opiates rages, according to the Bay County Sheriffs Office. Since more signs of heroin becoming a prevalent drug in Bay County began to emerge at the end of 2014, narcotics officers have made it a priority in their caseloads. Still, the battle against the drug has only increased as more potent forms of opiates, such as fentanyl, find their way into the county and the body count from the drugs increases. Since March, heroin and fentanyl - a synthetic opioid estimated to be about 80 to 100 times more potent than morphine and 40 to 50 times more potent than pharmaceutical-grade, 100 percent pure heroin - have claimed the lives of eight people in Bay County alone, with countless others being rescued from the edge of an overdose by emergency responders armed with anecdotes, officials reported. Despite the growing death toll, though, Lt. Kevin Francis, the head of the narcotics division at BCSO, said the prevalence of the drugs being seen by authorities has leveled out in the recent months. He attributed the stagnation in what had been a blossoming epidemic over the past year to the efforts of narcotics officers. htlf):/twww.newsherald.com/news/20161008/bay-county-battles-tcrkeep-oploid-epidemic-at-bay 1/3 10/10/2016 Bay County battles to keep opioid epidemic at bay 'Just like any of the drugs in our community, you have a couple of people dealing them," Francis said. "We'll knock them down and the supply goes down, but soon enough somebody fills that role and it goes back up." One of the latest developments in the ongoing battle is the appearance of "car fentanyl," Francis said, which is an even more potent opioid than regular fentanyl. Authorities in South Florida are seeing much more of the drug mixed into other narcotics, but BCSO so far only has seized some small amounts. The danger inherent in using the drugs is the unpredictability of their contents because of their clandestine origins, Francis said. "Some of the stuff we're getting, we've seen heroin with car fentanyl laced in it," he said. The gradual creep of opioids into Bay County has been attributed to a few causes - among them the vacuum left behind by pill mills. With the absence of medical opiates and the relatively cheap production costs associated with producing heroin, some have turned to opioids to fill the void of prescription pills. Whatever the cause, in the last decade, heroin abuse has skyrocketed across the country. The rate of heroin-related overdose deaths increased 286 percent between 2002 and 2013, according to figures recently released by the Centers of Disease Control and Prevention. In 2002, 100 people per 100,000 were addicted to heroin, and that number had doubled by 2013. In February of this year, President Barack Obama asked Congress for $1.1 billion in new funding to address the epidemic of prescription opioid and heroin abuse in this country. "More Americans now die every year from drug overdoses than they do in motor vehicle crashes," a White House statement noted at the time. The rise might have been spurred partially by an increase in supply; the amount of heroin seized at the border with Mexico quadrupled by 2013 from the 2000s, making the drug cheaper in the U.S. and more pure. The South and the West, generally, have been relatively immune from fullblown epidemic status, unlike the Northeast and Midwest. Francis said the main focus for BCSO is keeping the drug at bay in the county. http://www.newsherald.com/news/20161008/bay-county-battles-to-keep-opioid-epidemic-at-bay 2/3 10/10/2016 Bay County battles to keep opioid epidemic at bay "We don't want it to get worse," he said. "We have a small heroin problem. Our No. 1 priority is making sure it doesn't get worse." http://www.newsherald.com/news/20161008/bay- county-battles-to-keeiropioid-epidemic-at-bay 313