Transcript Doctor`s Office Prevention

“Drug Diversion-The Scope of
the Problem”
Teleconference
Commander John J. Burke
PHARMACEUTICAL
DIVERSION
• Commander, Warren County Drug TF
•
•
•
•
•
(1999-Present)
Coordinator- Southern Ohio HIDTA
Pharmaceutical Diversion Initiative
Vice President- National Association of
Drug Diversion Investigators (NADDI)(1996Present)
President- PDE Inc. (1995-Present)
32 years Cincinnati Police Division (19681999)
Commander Pharmaceutical Diversion
Squad (1990-1999)
PHARMACEUTICAL DIVERSION
• 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 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 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
16
14
Marijuana
Most Abused Drugs
12
Cocaine or Crack
10
millions
Prescription Drugs
8
6
Ecstasy
4
Inhalants
2
Heroin
0
LSD
Methamphetamine
1
Source: U.S. Substance Abuse and Mental Health Services
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?

Andrew Cunanan - pain medication

Nevada Casino Incident - Dexedrine

HP Abuse/Patient Care - pain
medication
TOP 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 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 PROBLEMS
1. Stadol Nasal Spray
2. Proventil
3. Ultram
4. Methadone
5. Fentanyl patches
DRUG DIVERSION SOURCES

Forged/Altered Prescriptions

“Doctor Shopping”

Other Rx Scams

Internet
DRUG DIVERSION SOURCES

Reverse Distributors

Health Professional Diversion

Package Interdiction

International Smuggling
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
PRESCRIPTIONS
• Alteration of prescription
• Changing doses, refills or strength
• White out
FORGED AND ALTERED
PRESCRIPTIONS
• Nail polish remover
• Photocopying
• Computer generated prescriptions
DECEPTIONS
• Doctor shopping/ER shopping
• Phony call-ins
• After hours patient scam
• Employee of health professionals
WHAT CONSTITUTES
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 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
COLLABORATION

Communicate regularly with local
physicians

Understand and discuss your
concerns

Encourage doctors to make you
part of the pain management team
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 Patrol
Nationwide Law Enforcement
Database
 Invented & Funded by Purdue
Pharma
 Pharmacy Robbery & Burglary
Offenses
 Networking Opportunities for LE

Rx 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
Reporting necessary by LE &/or
pharmacists
 www.rxpatrol.org
 Database compares like/similar
offenses
 LE agencies contacted if possible
match occurs

PRESCRIBING PRACTICES

This program is NOT intended to
discourage the dispensing of
appropriate medication for
legitimate medical purposes
PRESCRIBING 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 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
THE RETAIL PHARMACY
Methamphetamine
• Schedule II. Current accepted medical
use, high potential for abuse.
• Can be manufactured using material
bought in Wal-Mart.
• National rapidly emerging drug problem.
• Methods of use:
• Snorting
• Smoking
• Injecting
• Eating
• Drinking
Methamphetamine
Effects:
• Increased heart rate
• Irregular heartbeat
• Increased blood
pressure
• Irreversible damage to
blood vessels in the
brain, producing
strokes.
• Respiratory problems
• Anorexia
• Cardiovascular
collapse
• Death
Central Nervous System
Effects:
• Irritability
• Confusion
• Paranoia
• Convulsions
• Hyperthermia
• Insomnia
• Tremors
• Aggressiveness
• Anxiety
• Convulsions
Methamphetamine
Indications of Meth Lab
Activity





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
Activity

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 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 Made
Methanol/Alcohol (Gasoline
Additives-Heet)
 Salt
 Lithium (batteries)

* Hundreds of recipes on internet
How 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:

Mason Jars and Pyrex dishes

Bottles, funnels, coffee filters

Blenders, hot plates, rubber gloves
PHARMACEUTICAL DIVERSION
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: [email protected]
Questions
?