“Drug Diversion-The Scope of the Problem”

Teleconference

Commander John J. Burke

PHARMACEUTICAL PHARMACEUTICAL DIVERSIONDIVERSION

• Commander, Warren County Drug TF (1999-Present)

• Coordinator- Southern Ohio HIDTA Pharmaceutical Diversion Initiative

• Vice President- National Association of Drug Diversion Investigators (NADDI)(1996-Present)

• President- PDE Inc. (1995-Present) • 32 years Cincinnati Police Division (1968-

1999)• Commander Pharmaceutical Diversion

Squad (1990-1999)

PHARMACEUTICAL PHARMACEUTICAL DIVERSIONDIVERSION

• Developed in 1990

• Average 500 cases a year

• Average 250 arrests a year

• Investigate illegal diversion of Rx drugs

• Investigate health care fraud

SCOPE OF THE PROBLEMSCOPE OF THE PROBLEM

• Almost 30% of the overall drug problem in America

• Ranks second only to marijuana

• #1 drugs of abuse over the last 30 years

SCOPE OF THE PROBLEMSCOPE OF THE PROBLEM

2003 SAMHSA Survey Results:

• 6.2 million people abused Rx drugs in the last year

• Significant rise in Rx abuse for those 12-17 years of age

0

2

4

6

8

10

12

14

16

1

Marijuana

Prescription Drugs

Cocaine or Crack

Ecstasy

Methamphetamine

Inhalants

Heroin

LSD

millions

Source: U.S. Substance Abuse and Mental Health Services

Most Abused Drugs

WHAT’S THE BIG DEAL?THEY’RE JUST PRESCRIPTION

DRUGS!

Elvis Presley - pain/sleeping medication

Sonny Bono - pain medication

Bret Favre - pain medication

Matthew Perry- pain medication

VICTIMLESS CRIME?VICTIMLESS CRIME?

Andrew Cunanan - pain medication

Nevada Casino Incident - Dexedrine

HP Abuse/Patient Care - pain medication

TOP Rx DRUGS OF ABUSETOP Rx DRUGS OF ABUSE

1. HYDROCODONE (Vicodin, Lortab, Lorcet) $6 - $8

2. OXYCODONE (Percocet, Percodan, Tylox) $6- $8 (OxyContin $.50-1.00 mg.)

3. ACETAMINOPHEN WITH CODEINE (Tylenol #3, Tylenol #4) $3 - $5

4. BENZODIAZEPINES (Xanax/Valium) $1 - $4

5. PROPOXYPHENE (Darvon, Darvocet) $2 - $4

TOP Rx DRUGS OF ABUSETOP Rx DRUGS OF ABUSE

6. CARISOPRODOL (Soma) $3 - $4

7. MORPHINE SULFATE (MS Contin) 100mg - $60; 60mg - $45; 30mg - $30

9. MEPERIDINE (Demerol) N/A (H/P Usage)

10. METHYLPHENIDATE (Ritalin) $10 - $12

11. HYDROMORPHONE (Dilaudid) 4mg - $60

OTHER SIGNIFICANT OTHER SIGNIFICANT PROBLEMSPROBLEMS

1. Stadol Nasal Spray

2. Proventil

3. Ultram

4. Methadone

5. Fentanyl patches

DRUG DIVERSION DRUG DIVERSION SOURCESSOURCES

Forged/Altered Prescriptions

“Doctor Shopping”

Other Rx Scams Internet

DRUG DIVERSION DRUG DIVERSION SOURCESSOURCES

Reverse Distributors

Health Professional Diversion

Package Interdiction

International Smuggling

WHY Rx DRUGS ?WHY Rx DRUGS ?

• Less risk of overdose

• Easier to obtain through “legal” script

• Cheaper than cocaine and heroin

• Less risk of detection - lack of enforcement

FORGED AND ALTERED FORGED AND ALTERED PRESCRIPTIONSPRESCRIPTIONS

• Alteration of prescription

• Changing doses, refills or strength

• White out

FORGED AND ALTERED FORGED AND ALTERED PRESCRIPTIONSPRESCRIPTIONS

• Nail polish remover

• Photocopying

• Computer generated prescriptions

DECEPTIONSDECEPTIONS

• Doctor shopping/ER shopping

• Phony call-ins

• After hours patient scam

• Employee of health professionals

WHAT CONSTITUTES WHAT CONSTITUTES DECEPTION ?DECEPTION ?

• Patient gives false name and address to obtain drugs

• Patient gives fictitious story to obtain drugs (out of town)

• Patient lies about ailment or injury

• Patient denies seeing any other doctors and obtaining any other Rx drugs

TYPICAL Rx DRUG SEEKERTYPICAL Rx DRUG SEEKER

• Every bit as addicted as the heroin and cocaine addict

• Spends most of their waking hours planning on how to get their drugs

• Consumes much of their time deciding how to scam YOU!

PHARMACY PHARMACY COLLABORATIONCOLLABORATION

Communicate regularly with local physicians

Understand and discuss your concerns

Encourage doctors to make you part of the pain management team

WHY GET INVOLVED?WHY GET INVOLVED?

• Drug seekers keep you from legitimate patients

• Lack of addressing the issue will increase the problem

• Perpetuates patient’s addiction or trafficking by ignoring the problem

Rx PatrolRx Patrol

Nationwide Law Enforcement Database

Invented & Funded by Purdue Pharma

Pharmacy Robbery & Burglary Offenses

Networking Opportunities for LE

Rx PatrolRx Patrol

RX PATROL PARTNERS National Association of Drug

Diversion Investigators (NADDI) National Community Pharmacist’s

Association (NCPA) National Association of Chain Drug

Stores (NACDS) Pharmaceutical Security Institute

Rx Patrol Rx Patrol

Reporting necessary by LE &/or pharmacists

www.rxpatrol.org Database compares like/similar

offenses LE agencies contacted if possible

match occurs

PRESCRIBING PRACTICESPRESCRIBING PRACTICES

This program is NOT intended to discourage the dispensing of appropriate medication for legitimate medical purposes

PRESCRIBING PRACTICESPRESCRIBING PRACTICES

Legitimate patients with pain should not suffer because health professionals are fearful of law enforcement

Law enforcement is not interested in investigating appropriate dispensing of Rx drugs

PRESCRIBING PRACTICESPRESCRIBING PRACTICES

Its important that none of us allow those who divert prescription drugs to influence the legitimate prescribing and dispensing of controlled substances

METHAMPHETAMINE AND METHAMPHETAMINE AND THE RETAIL PHARMACYTHE RETAIL PHARMACY

MethamphetamineMethamphetamine• Schedule II.Schedule II. Current accepted medical Current accepted medical

use, high potential for abuse.use, high potential for abuse. • Can be manufactured using material Can be manufactured using material

bought in Wal-Mart.bought in Wal-Mart.• National rapidly emerging drug problem.National rapidly emerging drug problem.• Methods of use:Methods of use:

• SnortingSnorting• SmokingSmoking• InjectingInjecting• EatingEating• DrinkingDrinking

MethamphetamineMethamphetamineEffects:Effects:• Increased heart rateIncreased heart rate• Irregular heartbeatIrregular heartbeat• Increased blood Increased blood

pressurepressure• Irreversible damage to Irreversible damage to

blood vessels in the blood vessels in the brain, producing brain, producing strokes.strokes.

• Respiratory problemsRespiratory problems• AnorexiaAnorexia• Cardiovascular Cardiovascular

collapsecollapse• DeathDeath

Central Nervous System Central Nervous System Effects:Effects:

• IrritabilityIrritability• ConfusionConfusion• ParanoiaParanoia• ConvulsionsConvulsions• HyperthermiaHyperthermia• InsomniaInsomnia• TremorsTremors• AggressivenessAggressiveness• AnxietyAnxiety• ConvulsionsConvulsions

MethamphetamineMethamphetamine

Indications of Meth Lab Indications of Meth Lab ActivityActivity

Strong chemical smell (ether/ammonia) Efforts made to cover windows or

reinforce doors Trash never put out; always burned Considerable late night hour traffic Lab materials surrounding property (fuel

cans/chemically stained coffee filters/altered propane tanks)

Indications of Meth Lab Indications of Meth Lab ActivityActivity

Suspicious vehicles arriving with trunks/chemical containers and paraphernalia/rubber tubing, etc.

Occupants always smoking outside

Paranoid behavior of residents or extensive security

How Meth is MadeHow Meth is Made

Made with common household products sold in pharmacies everywhere

Cold tablets containing Ephedrine/Pseudoephedrine

Ether (Starting Fluid) Sulfuric Acid (Drain Cleaner)

How Meth is MadeHow Meth is Made

Methanol/Alcohol (Gasoline Additives-Heet)

Salt Lithium (batteries)

* Hundreds of recipes on internet

How Meth is MadeHow Meth is Made

Anhydrous Ammonia (Farm Fertilizer)

Stolen (farmers, retail distributors)

Stored in altered propane tanks

-bluish color at valve on tank

Equipment used to Manufacture Meth:Equipment used to Manufacture Meth:

Mason Jars and Pyrex dishes

Bottles, funnels, coffee filters

Blenders, hot plates, rubber gloves

PHARMACEUTICAL DIVERSION PHARMACEUTICAL DIVERSION EDUCATION INC. EDUCATION INC.

John J. Burke, President P.O. Box 146

Bethel, Ohio 45106 1-800-566-2049 (Office)1-513-734-1647 (Fax)

www.rxdiversion.com Email: burke@rxdiversion.com

QuestionsQuestions

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