Transcript Eastern Iowa Heroin Initiative

A National Challenge with a Community Solution
Pat Reinert United States Attorney’s Office NDIA
Officer Al Fear - Eastern Iowa Heroin Initiative
Midwest High Intensity Drug
Trafficking Area
Kevin W. Techau
United States Attorney Northern
District Of Iowa
Chief Wayne Jerman
Cedar Rapids Police
Department
HEROIN INITIATIVE
Prescription Pain Killer and Heroin awareness program
• Community Action Organizational Efforts
• First Responder Training
• Investigative case development to target sources of
supply for federal prosecution
• TOWN HALL MEETINGS
• Public Awareness Campaigns
• Work closely with substance abuse & health care
providers
Prescription Pain Killer & Heroin addiction.
Heroin/Opioid Addiction does not
discriminate
-All Ages
-All Races
-All Economic Classes
This book covered the pain management
movement of the late 20th century, and
how pain management experts grossly
underestimated the risks of prescribing
opioids long-term for chronic pain.
Those experts taught other doctors that
the risk of triggering addiction was almost
zero, and that physicians had an obligation
to relieve pain in their patients.
Pain was described as the “fifth vital sign,”
with the implication that a patient’s
reported pain level was as objective as
their pulse, blood pressure, body
temperature, and heart rate.
Purdue Pharmaceuticals ad
campaign funds several pain
societies, meetings and education
of physicians to treat chronic pain
with Oxycontin
1998
PAIN AS
THE 5TH
VITAL
SIGN
1986 publication by Dr.
Portenoy and Foley note that
cancer patients chronic pain
treated inpatient with opiate,
2/38 considered addicted.
This led to assumption that
opiate was not the problem,
but personality traits of
patient caused addiction
2000’S
PHYSCIANS
RATED ON
PATIENTS
HAVING NO
PAIN
The ad campaign changes
American medicine, leads
to patients demanding
treatment and development
of “Pill Mills”
1986
OPIATES
CLAIMED TO
BE NOT
ADDICTIVE
2010PRESENT
OPIOID
ADDICTION
& HEROIN
EPIDEMIC
• Legitimate Injury
• Neck pain
• Broken bone
• Sore back etc.
• Prescription of Opioid Painkillers
• Hydrocodone
• Oxycodone
• Oxycontin
• Vicodin
• Opioid Painkillers work by binding to opioid receptors
in the brain. They reduce the sending of pain messages
to the brain and reduce feelings of pain
Cedar Rapids Statistics
150% increase in 5 years
1.Usage Increase
2. Change in Personality
3. Social Withdrawal
4. Ongoing Use
5. Time Spent on Obtaining Prescriptions
6. Change in Daily Habits and Appearance
7. Neglects Responsibilities
8. Increased Sensitivity
9. Blackouts and Forgetfulness
10. Defensiveness
ASAC Prescription Pill Statistics
Patient initial consultation: Rank the substance you are abusing
2007
2014
Primary
Secondary
Third
1
3
4
15-19
2
8
20
29
20-24
11
8
20
23
36
25-30
46
41
33
17
10
4
31-40
29
42
30
41-50
5
7
3
41-50
14
16
9
51-60
3
1
0
51-60
5
7
6
60+
0
0
0
60+
0
1
0
Total
39
44
32
Total
123
153
147
Primary
Secondary
Third
10 - 14
15-19
0
0
1
3
8
14
20-24
6
7
25-30
5
31-40
10 - 14
In 7 Years – A 300% Increase In Prescription Pill Abuse
Pharm Parties
• Teenage parties involving prescription
medications
• “Pharm Party”
• “Pill Party”
• “Skittle Parties”
• Everyone brings medications from home and
place them into a bowl. The bowl gets passed
around for everyone to use.
Accessibility Issue
• If someone came to your home, how easy would be
it be to grab one or a few out of the bottle?
• Would you notice that
there is medication missing?
PAIN KILLERS TO HEROIN
-THE LINK-
What is Heroin?
Heroin is 3 times more potent
than morphine
A Depressant
Can be snorted, injected
or smoked
H
Horse
Brown Sugar
Junk
Nod
Smack
Boy
Method of Delivery
• Snorting or smoking heroin
– 10 to 15 minutes for the drug’s full effect
• Injecting heroin is a much faster
– Injection into muscle 5-8 Minutes
– Injection into vein takes 7 to 8 seconds to
take effect.
New problem in 2015
The Effects of Heroin
Once heroin enters the brain, it binds rapidly
to the opioid receptors and releases dopamine.
• warm flushing of the skin
• dry mouth
• heavy feeling in the extremities
• nausea, vomiting, and severe itching.
After the initial effects
• will be drowsy for several hours
• mental function is clouded
• heart function slows
• breathing is also severely slowed, sometimes enough
to be life-threatening. Slowed breathing can also lead
to coma and permanent brain damage.
Heroin/ Opioid Withdrawal
Sweats
Chills
Diarrhea
Vomiting
Insomnia
Restlessness
Tremors
Bone pain
Seizures
2015 Statistics on Heroin
CEDAR RAPIDS METRO AREA
Heroin overdoses - Police Response
61……… Overdose Calls involving Heroin
20……… Deaths - Heroin
Heroin overdoses - Hospital Response
330……..Heroin/Opioid Hospital Admissions
NATIONAL HEROIN DEATHS
BY RACE & AGE
NATIONAL
HEROIN
DEATHS BY
REGION
The Heroin Cycle
First use of opiate (typically prescription drug)
Use becomes more and more regular
Daily use/withdrawals
Treatment
RECOVERY
Death
The Cost of Addiction
• Heroin typically costs about $20-$30 per .1 gram.
• A daily user will use at least .2 to .4 gram of heroin ($50 to $100)
per day and sometimes up to $150 to $200 per day,
– This will depend on the purity of the heroin purchased (lower purity,
may need to use/spend more for the same effect)
• Withdrawals may occur every 6-8 hours, which may necessitate
multiple purchases in a day
• Dealer availability impacts ability to purchase
SO…
• $100 to $200 per day habit = $700 to $1400 spent per week just on
heroin
• Over $36,000 (upwards of $70,000) spent per year to feed the
addiction
Where Does the Money Come From?
•
•
•
•
•
Oftentimes, the user will have a regular job with a paycheck (helps to hide addiction)
Once the addiction progresses to daily use, maintaining a regular job becomes more
difficult
Heroin addiction does not care when bank accounts are depleted
Beg, borrow money and items – pawn shops
Property crimes
–
–
–
–
•
Theft
Forgery
Burglary
Robbery
Other crimes
–
–
–
–
–
Financial fraud
EBT/food stamps fraud
Pseudoephedrine “smurfing”
Drug crimes (middling deals for other users, recruiting other users, giving dealers rides)
Sexual exploitation
Impact on the Family
• User’s Primary focus on supporting a habit can
degrade child care skills
• Child’s exposure to dangerous substances in
the home results in increased risk of poisoning
• Emotional Impact on a child finding a family
member unresponsive or dead
Heroin Harms Children Now And In The Future
• In Iowa, since 2000,
overdose deaths
related to opiates,
opioids, and heroin
have increased by
1000%
FENTANYL
• In early 2015, Cedar Rapids first started seeing heroin
laced with Fentanyl, followed by Fentanyl being sold as
heroin, which is part of a national trend
• Fentanyl is an opiate that is 100 times more
powerful than morphine, and 30 to 50 times more
potent than heroin
When prescribed by a physician, fentanyl is often administered via
injection, transdermal patch, or in lozenge form. However, the type of
fentanyl associated with recent overdoses was produced in clandestine
laboratories and mixed with (or substituted for) heroin in a powder form.
Mixing fentanyl with street-sold heroin markedly amplifies their potency
and potential dangers.
Way Forward
• Physician Challenge
– Over prescribing practices??
– Alternatives to Opioids???
Use of the State Prescription Monitoring Program
(PMP)
– “Doctor Shopping”
– Currently 44% of Doctors registered to PMP
• Up from 32% in 2014
Iowa Prescription Monitoring Program
•
Iowa law was amended a few years ago to permit a prescriber to authorize
licensed, registered, or certified health professionals (i.e. RN, LPN, CMA, etc.) to
register as agents of the prescriber to access the Iowa PMP.
•
The Iowa PMP has currently registered more than 1,000 prescriber agents and
approximately 100 pharmacist agents (pharmacy technicians). A registered
prescriber or pharmacist may authorize as many as three agents to access the
Iowa PMP and obtain patient information on behalf of the prescriber or
pharmacist. A registered agent user may assist an unlimited number of
practitioners to obtain information from the Iowa PMP.
•
ANY pharmacist that is involved in the care and treatment of a patient may register
to use the Iowa PMP. This would include a pharmacist practicing in an emergency
department or other practice setting; it does not limit pharmacist access to a
“traditional” dispensing practice.
•
This legislative session the Board is proposing changes to the PMP authorizing
law that would permit the integration of the Iowa PMP into electronic health and
pharmacy record systems. Such integration would improve authorized
practitioner’s ease of access to PMP information and eliminate, or at least reduce,
the burden of practitioners having to access a separate website and system to
obtain information to aid in determining appropriate patient treatment plans.
Get rid of all unwanted prescription medications!
PUBLIC SERVICE ANNOUNCEMENTS
MARKETING and Community Outreach
We are not here to arrest our
way through the problem
We are here to help those who are suffering from
substance abuse find the road to recovery.
FACEBOOK – Eastern Iowa Heroin Initiative
www.facebook.com/eaterniowaheroininitiative
RECOVERY IS POSSIBLE
• Get rid of your unused prescription medications!
• Identify people in need and encourage treatment
• Share information with law enforcement relating
to drug dealing in your community
• Be suspicious, spot check
• The Eastern Iowa Heroin Initiative on FACEBOOK
• www.facebook.com/easterniowaheroininitiative
Officer Al Fear
Cedar Rapids Police Department
Midwest HIDTA Heroin Initiative
[email protected]
319-432-1492
Patrick Reinert
Assistant United States Attorney
Northern District of Iowa
[email protected]
319-731-4017