Commander, Warren County, Ohio, Drug Task Force

Coordinator- Southwestern Ohio HIDTA Major Case Initiative

President-National Association of Drug Diversion Investigators (NADDI)

32 years Cincinnati Police Division

Commander Pharmaceutical Diversion Squad

Six investigators, one secretary

DEFINITION?

Criminal deviation or counterfeiting of a prescription drug.

Illegal removal of a prescription drug at any point in its path from manufacturer to patient

Most likely drug to be abused in the workplace

Obtain through insurance

“Only prescription drugs”

SAMHSA SURVEY 2003:

6.2 million people abused Rx drugs

Significant increase in 12-17 YOA in abuse of Rx drugs

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

According to ONDCP- Identified 34 rogue Internet pharmacies in 2006

Dispensed over 98 million dosages of hydrocodone

Would take 1,118 average pharmacies to equal amount dispensed by the 34 illegal Internet apothecaries

Often high-price medications Produced “legally” in India Packaging often made in China Unknown components in drug Often made in unsanitary conditions

Usually addicted individual involved CII’s often the target Weapon or threat of weapon involved Potentially very dangerous situation Cooperate with the offender Remind police to check ER runs Rx Patrol should be utilized

Involve the after-hours entry of a pharmacy Smash and grab likely addicted perpetrator Usually planned criminal enterprises Entry through the roof-adjoining business Alarm disabled Possible entry into safe Hundreds of thousands of dollars street value Rx drugs often removed Rx Patrol should be utilized

Funded by Purdue Pharma Reports of pharmacy robbery Reports of pharmacy burglary Reports of major pharmacy crime Database for law enforcement Only as good as the information provided

by LE and pharmacy personnel Reporting can be done online

www.rxpatrol.org

Alprazolam with roots in Mexico Not dispensed in the United States Delivered to Southwest Ohio 200,000

dosage units a month for 3.5 years 100% profit made on each load Arrests made and over 100,000 dosage

units confiscated Activity continues

Elvis Presley - pain/sleeping medication

Sonny Bono - pain medication

Bret Favre - pain medication

Matthew Perry- pain medication

ONDCP indicates over 2 million teens abused Rx drugs (2007)

Estimates that 2,500 teens per day initiate Rx abuse and now top source of abuse for those 12 & 13 YOA (ONDCP 2007)

Associated Press December 2005- 9.5% of HS Seniors abused hydrocodone

Parents medicine cabinet

Chronic pain patients

Garbage (fentanyl patches)

Product still popular with juveniles 1 in 10 teens have abused (2 million) Large doses consumed at one time Often ends in

vomiting/dizziness/confusion Overdoses Much of it stolen if not behind the

counter “Triple C” currently most popular

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

OXYCODONE (Percocet, Percodan, Tylox) $6 - $8

(OxyContin- $.50-1.00 mg.)

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

DIAZEPAM (Valium) $1 - $2

CARISOPRODOL (Soma) $3 - $4

ALPRAZOLAM (Xanax) $3 - $4

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

METHYLPHENIDATE (Ritalin) $10 - $12

HYDROMORPHONE (Dilaudid) 4mg - $60

Stadol Nasal Spray

Methadone

Tramadol (Ultram)

Phentermine (Adipex)

Fentanyl patches (Duragesic/Actiq)

Less risk of overdose

Easier to obtain through “legal” script

Cheaper than cocaine and heroin

Less risk of detection - lack of enforcement

Alteration of script is a felony in Ohio

Changing doses, refills or strength

White out

Nail polish remover

Photocopying

Computer generated prescriptions

Employee of Health Professionals

Phony call-ins

After hours “patient” scam

Doctor Shopping

Pill Brokers

ER Shopping

• Slam car doors and trunks on hands • Slam windows on hands & fingers• Carry syringes with blood to squirt in

their mouth to demonstrate bleeding• Carry kidney stones in a jar to ER• Insert objects into open wounds• Deliberately irritate root canal work• Beat on foot with 4.5 LB hammer

• 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!

• Not illegal to be scammed!

• Compliments physician• Deliberately mispronounces drug name• Agitated when cut off drugs of choice• Threatens lawsuit• Leaves abruptly when scam does not

work

PERIODIC URINE SCREENS (Include hydrocodone/oxycodone)

PILL COUNTS

CS RX INDICATES OTHER SCRIPTS WRITTEN

CHECK WITH RPH ON FILLING OF NON-CS SCRIPTS

MEDICATION AGREEMENT AND VIOLATIONS

DOCUMENT! DOCUMENT! DOCUMENT!

FAMILY MEMBER/CARE GIVER DIVERSION

LIMIT CS IN HOUSEHOLD

DO NOT POST DATE SCRIPTS

“DO NOT FILL UNTIL” ISSUE (CII)

REMEMBER “3 DAY RULE” FOR ADDICTS

• 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

Diversion negatively impacts legitimate patients

Requires joint effort and balance between HP and LE

Vast majority of patients are legitimate Vast majority of HP’s are legitimate