DRUG ABUSE: NATIONAL AND LOCAL PERSPECTIVES · 2018-07-18 · Marijuana threat changed due to legalization efforts New Psychoactive Substances (NPS) ... increasing since at least

DRUG ABUSE: NATIONAL AND LOCAL PERSPECTIVES

Mobile, AlabamaJuly 19, 2018Patrick B. WilsonGroup Supervisor, DEA Mobile Resident Office

2017National Drug Threat Assessment

Available via www.dea.gov

Objectives• Describe national and state-level trends related to

drug misuse and abuse• Compare and contrast drug misuse and abuse across

Alabama regions• Describe national and state efforts to address drug

misuse and abuse

Disclosure• I, Patrick Wilson, have no actual or potential conflicts

of interest related to this program.

Opioid threat increased Controlled Prescription Drugs (CPDs) Heroin Fentanyl

Methamphetamine production primarily Mexico-sourced

Cocaine shows indications of rebounding

Marijuana threat changed due to legalization efforts

New Psychoactive Substances (NPS) marketed to larger user base

U.S. Drug Situation

2016 NDTS Greatest Drug Threat

Source: DEA

Shifting Drug Threats

Source: DEA

Regional Greatest Drug Threat

West Coast:Meth

East Coast:Heroin

Source: DEA

The Southeast Region

Major Causes of Death from Injury

Note: Suicide and homicide include deaths by drug poisoning or firearms.Source: CDC

National Drug Poisoning Deaths

Source: CDC

Num

ber

of D

eath

s

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000Involving All Prescription DrugsInvolving Prescription OpioidsInvolving HeroinInvolving Synthetic Opioids (Fentanyl)Involving CocaineInvolving Psychostimulants (Methamphetamine)

12,989

29,728

5,716

22,598

9,580

6,784

Drug Enforcement Administration/ Diversion Control Division

How Did We Get Here?

Methamphetamine

Methamphetamine UseCurrent (Past-Month) Use Among Persons Aged 12 or Older

Stable use rates 0.2% of the U.S. population

0.2%

0.1%

0.2% 0.2% 0.2% 0.2%

Source: NSDUH

Methamphetamine Purity and Price Domestic purchase data from January 2007 to March 2015 Purity increased 64% Price decreased 57%

Source: DEA

Jan-Mar07

Apr-Jun07

Jul -Sep07

Oct-Dec07

Jan-Mar08

Apr-Jun08

Jul -Sep08

Oct-Dec08

Jan-Mar09

Apr-Jun09

Jul -Sep09

Oct-Dec09

Jan-Mar10

Apr-Jun10

Jul -Sep10

Oct-Dec10

Jan-Mar11

Apr-Jun11

Jul -Sep11

Oct-Dec11

Jan-Mar12

Apr-Jun12

Jul -Sep12

Oct-Dec12

Jan-Mar13

Apr-Jun1

3

Jul-Sep1

3

Oct-Dec13

Jan-Mar14

Apr-Jun1

4

Jul-Sep1

4

Oct-Dec14

Jan-Mar15

PPG Mean $ $152 $217 $276 $293 $234 $234 $190 $172 $181 $132 $134 $122 $121 $107 $100 $94 $100 $89 $97 $82 $84 $77 $83 $85 $71 $71 $66 $69 $59 $75 $59 $65 $66

Purity Mean % 56.4 42.6 38.6 40.3 45.6 52.0 52.9 61.9 63.8 68.5 69.9 72.9 78.1 83.4 83.8 85.5 85.2 87.3 85.4 86.1 87.8 89.0 90.4 88.1 90.8 92.9 92.7 94.3 95.2 92.9 93.2 93.3 92.4

$152

$217

$276$293

$234 $234

$190

$172 $181

$132

$134$122

$121$107 $100

$94

$100

$89

$97

$82

$84

$77

$83$85

$71

$71

$66

$69

$59

$75

$59

$65 $66

56.44

42.6938.67

40.36 45.62

52.05

52.9961.93

63.8468.52

69.9272.95

78.13 83.46 83.81

85.58

85.26

87.38

85.48

86.1387.80

89.04

90.42

88.12

90.8892.99

92.7194.37 95.23

92.99

93.29 93.31

92.47

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

80.00

90.00

100.00

$0

$50

$100

$150

$200

$250

$300

Pric

ePe

r Pur

e G

ram

(PPG

)

Purit

y Pe

rcen

t

Foreign Production

Primary methamphetamine source

Smuggled across SWB

Super laboratories in Mexico

Large kilogram quantities

Difficult to detect

Methamphetamine TraffickingMethamphetamine in solution Easy to conceal Hard to detect

Methamphetamine Southwest Border Seizures

305% increase in total weight from CY 10 to CY 15 27% increase in total weight from CY 14 to CY 15

Heroin

Heroin Seizures Southwest Border 2016(% Change from 2015)

Heroin Drug Poisoning Deaths by State (Rate per 100,000 population)

Source: CDC

Past year heroin use increased 51% from 2009 - 2014

Increasing Users and Deaths

Source: CDC, NSDUH

Heroin-related deaths increased 222% from 2009 to 2014

Explanation of Death Increase

High purity heroin Accidental overdoses

Prescription opioid abusers Dosage amounts Adulterants

Returning to heroin after a period of abstinence Tolerance decreased

Heroin Availability by Type

White Powder

Black Tar &Brown Powder

Source: DEA

Increasing Heroin Production

Source: U.S. Government Estimates

Controlled Prescription Drugs

Opioid Deaths• From 1999-2016, more than 350,000 people died from an overdose

involving any opioid, including prescription and illicit opioids.• This rise in opioid overdose deaths can be outlined in three distinct

waves.• The first wave began with increased prescribing of opioids in the

1990s , with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.

• The second wave began in 2010, with rapid increases in overdose deaths involving heroin.

• The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids – particularly those involving illicitly-manufactured fentanyl.

Opioid Deaths

10 Guatemala 10 kilograms09 India 10 kilograms08 Vietnam 20 kilograms07 China 20 kilograms06 Denmark 25.5 kilograms05 Columbia 30 kilograms04 Syrian Republic 50 kilograms03 Canada 115.5 kilograms02 United Kingdom 200 kilograms01 United States 79,700 kilograms

99.3%Drug Enforcement Administration/ Diversion Control Division


Today

Top 10 CPD Dispensed (in Billions of Dosage Units)

Primary Diversion of CPDs

Source: NSDUH


Forged Prescriptions

Illegally Obtaining Prescription Drugs

Forged Prescriptions• Doctor’s script pads are stolen by employees and

other individuals who may have access such as a cleaning crew

• Scripts are forged using multiple “patients,” who attempt to pass as many as they can in a shotgun method before the theft of the script pad is discovered

• Scripts may have the dates altered then photocopied for continued use

Counterfeit Prescriptions• Individuals craft counterfeit scripts on a laptop

computer using both fictitious doctor names and DEA numbers and sometimes using legit doctor names and DEA numbers

• Have the ability to quickly alter scripts with a new doctor name and DEA number when compromised


Illegally Obtaining Prescription DrugsPharmacy Thefts/Robberies

Pharmacy Burglary• Organized groups target various controlled drugs at

pharmacies; often in rural areas • Utilize sledge hammers to compromise drive-thru

window or make forced entry through front door • Can complete entire burglary within 3 to 5 minutes • Main target is Hydrocodone and “Cocktail drugs”


Street Dealers



Friends



Medicine Cabinets



- More than half of teens (73%) indicate that it’s easy to get prescription drugs from their parent’s medicine cabinet

- Half of parents (55%) say anyone can access their medicine cabinet

- Almost four in 10 teens (38%) who have misused or abused a prescription drug obtained it from their parent’s medicine cabinet

Medicine Cabinets: Easy Access

Counterfeit Pills / Dark Web Distributors

Counterfeit Vicodin pills found in his home after his death were laced with fentanyl and the drug was found in his system

Prince

Schedule II synthetic opioid More potent than heroin

“Synthetic Heroin” Users are often unaware

Sources Mexico: Clandestine fentanyl China: Fentanyl and its analogs Pharmaceutical Diversion: Much smaller scale

Fentanyl Uses, Sources, and Seizures

Fentanyl in New Forms Counterfeit pills for

street sales

Appearance consistent with authentic pills

Over 10,000 pills seized in 2015

Black tar form

Appeared to be black tar heroin

Lab analysis indicated it was fentanyl and no heroin present

Source: DEA

Fentanyl and Precursor Flow

Fentanyl Exhibits by State CY2016

Carfentanil• Schedule II synthetic opioid

• 10,000x more potent than morphine• Used to tranquilize elephants and large wildlife

• July 2016 – at least 236 overdoses & 14 deaths in Ohio• In 2016, 413 samples identified in submitted exhibits

• Confirmed cases• Ohio• Kentucky• Rhode Island• Michigan• Oregon

Carfentanil cases 2016

Cocaine Cultivation and Production

Source: U.S. Government Estimates

Domestic Cocaine Purity and Prices

Marijuana UseCurrent (past month) use among persons aged 12 or older

31.9% increase in use from 2009 to 2014 12% increase in use from 2013 to 2014 8.4 % of the U.S. population

6.7% 6.9% 7.0% 7.3% 7.5%8.4%

Source: NSDUH

Marijuana Trafficking andU.S. Marijuana Markets

Foreign Mexico, Canada, and Caribbean

Domestic West Coast to East Coast

Three Markets 1. Illicit 2. State-approved medical 3. State-approved personal use/recreational

Domestic Production

State-approved producers Illicit producers Large-scale and small-scale U.S. citizens and foreigners West Coast dominate, however production is in all 50 states Indoor and outdoor cultivation

State Approved Marijuana Status As of August 2017

New Psychoactive Substances Substances designed to mimic illicit drugs;

oftentimes unscheduled and unregulated Younger individuals Avoid drug tests

As of December 2015 643 NPS worldwide 250 NPS in the US

Major Categories Synthetic Cannabinoids K2, Spice

Synthetic Cathinones Molly, Flakka, Bath Salts

NPS Production

China Lab Mailed to the U.S.

Sprayed on Plant

DriedPackaged for SaleTypical Package

Other NPS Forms

Counterfeit Pills Fall 2015 - 214 counterfeit Xanax pills seized in New Jersey Contained no Xanax, but AB-FUBINACA instead AB-FUBINACA has also been disguised as “Molly”

Liquid Synthetic Cannabinoids Used in e-cigarettes/vape pens Hot spots, difficult dosage Hard to detect

NPS Rebranding

Molly or Flakka Decreased popularity of Bath Salts Synthetic cathinones in MDMA

Methylone Synthetic cathinone More profitable than MDMA

Alabama: DEA New Orleans Division

DEA Offices in Birmingham, Huntsville, Mobile, and Montgomery

DEA Demand Reduction Coordinator:George Cazenavette3838 N. Causeway Blvd, Suite 1800Metairie, LA 70002Phone: (504)840-100E-mail: [email protected]

The Southeast Region

Drugs most associated with violent crime in Alabama






Alabama Heroin Deaths 2017


Jefferson County Drug Overdoses Total Deaths:2014 - 2592015 - 2242016 - 2512017 - 267

Heroin:2014 - 1382015 - 972016 - 1002017 - 98


Jefferson County Drug Overdoses

Fentanyl:2014 - 252015 - 492016 - 1052017 - 104

Cocaine:2016 - 55 2017 - 59


Jefferson County Drug Overdoses

Methamphetamine:2016 - 222017 - 35

Prescription Opioids: 2014 - 322015 - 742016 - 222017 - 9

Tackling Drug Abuse

Enforcement Partnership

Diversion Partnership

Community Partnership

The DEA 360 Strategy

• Coordinating and Targeting Enforcement Efforts• Federal, State, and Local Resources• Community Enforcement Efforts

1. Built on local intelligence and experience 2. Coordinating efforts – Task Forces / Initiatives3. Targeting local distribution realities4. “Top Target” Lists5. Death or Serious Bodily Injury Cases

Enforcement Partnerships





Diversion Partnerships

• Enhance Data to Identify and Track Problems• Prescription Drug Monitoring Program (PDMP), Medical

Examiners (MEs), and Other Sources

• Vigilant Enforcement and Regulation• Identify the Threat

• DEA Registrants Operating Outside the Law

• Address the Threat • Tactical Diversion Squads (TDSs)

• Agents, Diversion Investigators, Intel Analysts, Task Force Officers

• Diversion Investigators • Mobile/Regional TDSs


• Education and Outreach• National Strategy - Sustained & Consistent Messaging

• Pharmacist Drug Awareness Conferences • Law Enforcement, Medical Practitioners, Anti-Drug

Organizations• National Drug Take Back Initiative Collection Sites and

Safe Drug Disposal Regulations

• Local Strategy in 360 Strategy Target Areas• Proactive and Robust Community Engagement • Local Practitioners/Community Groups• Local Field Divisions with HQ Support


Save The Date:October 27, 2018

National RX Take Back Day





Community Based

Solution

DEA & Federal Partners

Community Leaders

Community Based

Organizations

Substance Abuse

Professionals

Schools

Faith –BasedOrganizations

State & Local Law

Enforcement Partners

Social Service Organizations

• DEA recognizes we cannot arrest our way out of the drug problem – our goal is lasting success in the communities we serve.

• Education and Prevention are key elements for a true 360 degree strategy.

• Enforcement operations provide an opportunity for community empowerment and a jumping off point for education and prevention efforts.

Community Action Support

FOUR KEY TARGET AUDIENCES:

1) Home (Parents & Caregivers)

2) Educators & The Classroom

3) After School (Athletics, Scouts, Boys & Girls Clubs, 4H, After-School Activities)

4) The Workplace

Community Partnerships

Initial National Partners:

• Department of Justice: Office of Justice Programs (OJP)

and Violence Reduction Network (VRN)

• Substance Abuse and Mental Health Services Administration (HHS-SAMHSA)

• Centers for Disease Control & Prevention (CDC)

• Community Anti-Drug Coalitions of America (CADCA)

• Partnership for Drug-Free Kids (Partnership)

• DEA Educational Foundation

• Benevolent and Protective Order of the Elks

• Boys & Girls Clubs

• Boy Scouts & Girl Scouts of America

• Youth Athletic Associations

• Young Marines


Milwaukee

St. Louis

Pittsburgh

Louisville

Year 1 (2016) Pilot Communities:


Manchester

Albuquerque

Charleston, WV

Dayton

Year 2 (2017) Pilot Communities:


Q&A

Mobile, AlabamaJuly 18 2018Patrick B. WilsonGroup Supervisor, DEA Mobile Resident Office

Documents

DRUG ABUSE: NATIONAL AND LOCAL PERSPECTIVES · 2018-07-18 · Marijuana threat changed due to legalization efforts New Psychoactive Substances (NPS) ... increasing since at least