PERMEATING BORDERS

OVERDOSE PREVENTION Summer Conference 2014

July 24, 2014

ACOPCAllegheny County Overdose Prevention Coalition

Presents

District Attorney’sCrime Prevention Strategy

as it relates to Substance Abuse

Kevin McCarthyAssistant District Attorney

Allegheny County

Notice

This presentation includes information on pending legislation.

This presentation is only intended to inform the community as of the date it was presented in late July 2014.  

Until legislation is approved, if approved, the content may undergo many revisions. Please refer to http://www.legis.state.pa.us/ for updates to these bills.”

Assistant District Attorney

Kevin McCarthy

Senate Bill 1180

Why Address Prescription Drug Abuse?

80% of recent heroin users started by abusing prescription pain medication

Why Address Prescription Drug Abuse?

Pennsylvania’s Statistics:– Fourteenth in the country for drug overdose mortality

Why Address Prescription Drug Abuse?

Pennsylvania’s Statistics:– Third highest rate of heroin abuse in the country

Why Address Prescription Drug Abuse?

Pennsylvania’s Statistics:– Heroin-related deaths have doubled between 2009-2012

Why Address Prescription Drug Abuse?

Pennsylvania’s Statistics:– Drug-related deaths outnumber death by motor vehicles

Why Address Prescription Drug Abuse?

Pennsylvania’s Statistics:– In 2012, deaths by heroin outnumbered deaths by gunshot in

Philadelphia

Prescription Drug Monitoring Saves Lives and Reduces Addiction

One of the most effective ways of combatting prescription drug abuse is through the operation of a robust prescription drug monitoring program

Prescription Drug Monitoring Saves Lives and Reduces Addiction

These programs help identify major sources of prescription drug diversion such as:– Prescription Fraud,– Forgeries,– Doctor Shopping, and – Improper prescribing and dispensing

Prescription Drug Monitoring Saves Lives and Reduces Addiction

In Pennsylvania, only Schedule II drugs are permitted to be collected

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Almost every other state authorizes the collection of at least Schedule II, III, and IV substances

Prescription Drug Monitoring Saves Lives and Reduces Addiction

SB 1180 remedies these defects in Pennsylvania law by:– Increasing the types of controlled substances collected; and– Ensuring appropriate access for those who can identify, stop, and

address prescription drug abuse

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Prescription drug monitoring programs work– After the inception of Florida’s prescription drug monitoring program

doctor shopping declined 35% during the FY 2012

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Prescription drug monitoring programs work– A survey of prescribers in Oklahoma revealed that 63% of

respondents reported that its program helped them identify patients abusing prescription medications

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Prescription drug monitoring programs work– In Kentucky, 70% of respondents found its program very or

somewhat important in helping them decide what drug to prescribe a patient

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Prescription drug monitoring programs work– In Maine, 97% of surveyed prescribers and pharmacies found its

program useful in monitoring prescriptions and controlling doctor shopping

Prescription Drug Monitoring Saves Lives and Reduces Addiction

Prescription drug monitoring programs work– According to a 2010 study, when program data was used in an

emergency room: 41% of cases had altered prescribing after the clinician reviewed the data, With 61% of patients receiving fewer or no opiod pain medications than had

been originally planned by the physician, and 30% receiving more than previously planned because the physician was able

to confirm the patient did not have history of drug abuse

SB 1180 is Constitutional

SB 1180 balances privacy interests and appropriate access to information by law enforcement

Balancing Privacy Interests and Appropriate Access to Information by Law Enforcement

Law enforcement can only access such information if we obtain a court order

Must prove by a preponderance of the evidence:– There is reasonable suspicion that criminal activity occurred, and– This information is relevant to an active investigation

Balancing Privacy Interests and Appropriate Access to Information by Law Enforcement

Whether a search warrant should be required to access the database is a policy question, and not a legal issue

Balancing Privacy Interests and Appropriate Access to Information by Law Enforcement

SB 1180 mandates that controlled substances entered into it cannot be accessed by law enforcement unless a judge concludes that there is reasonable suspicion related to an active investigation of illegal activity

Balancing Privacy Interests and Appropriate Access to Information by Law Enforcement

The bill does not create any new crimes related to drug possession or use

Balancing Privacy Interests and Appropriate Access to Information by Law Enforcement

Those most likely to be flagged in the expanded database would be crooked doctors and those who sell controlled substances to others

Senate Bill 1164-proposed

Drug Over Dose Response Immunity

Senate Bill 1164-proposed

Person reported the drug overdose to law enforcement, the 911 system, campus security, or emergency services personnel

The person provided his identification and location

Remained with the person in need

Senate Bill 1164-proposed

Statute would prohibit that person from being charged, prosecuted or violated for a probation or parole offense for the following:

Alteration of a controlled substance, § 113(a)(5); possession of a controlled substance § 113(a)(16); purchase of a controlled substance without

Senate Bill 1164-proposed

(Cont.) authorization; § 113(a)(19); possession small amounts of marijuana authorization; § 113(a)(31); possession of drug paraphernalia authorization; § 113(a)(32); delivery or possession with intent to deliver drug paraphernalia authorization; § 113(a)(33); possession of anabolic steroids authorization; § 113(a)(37)

Senate Bill 1164-proposed

This section would not bar prosecution if:

law enforcement obtains information prior to the call for assistance

Delivery or distribution of a controlled substance, drug-induced homicide, or any other crime not set forth in section B

Allegheny County Drug Court

What is Drug Court?

“A special court given the responsibility to handle cases involving drug-addicted offenders through an

extensive supervision and treatment program." Represents a non-traditional approach to prosecute

offenders who are addicted to drugs. Rather than focusing only on the crime and the

punishment, drug courts attempt to solve some of their underlying problems.

Goals and Objectives

1. Promote community safety and well-being in order to reduce criminal behavior among offenders.

2. Increase the ability of offenders and their dependents to live independently and responsibly.

3. Conserve judicial system resources by reducing direct costs of arrest and incarceration of offenders.

4. Rehabilitate and improve the treatment outcomes for addicted offenders.

5. Assist offenders in regaining their lives and re-uniting with families.

Key Components

1. Drug Courts promote team approaches and collaboration amongst Judges, prosecutors, defense counsel, treatment providers, probation, law enforcement, and the community

2. Use a non-adversarial approach

Key Components

3. Eligible participants are identified early and promptly placed into Drug Court

4. Drug Courts provide access to a continuum of alcohol, drug and other related treatment and rehabilitation services. When treatment doesn’t work…try more treatment

Key Components

5. Frequent Random Observed Urinalysis Testing

6. A coordinated strategy governs Drug Court responses to participants’ compliance. Reinforce the positive responses and sanction the negative

Key Components

7. Ongoing judicial interaction with each Drug Court participant is essential

8. Monitor and evaluate achievement of program goals on a regular basis to gauge effectiveness

Key Components

9. All Drug Court staff should participate in interdisciplinary education and training

10. Forge partnerships among Drug Courts, public agencies, and community-based organizations

www.NDCI.org

Referrals to Drug Court

Can come from: District Attorney’s Office Public Defender’s Office Defense Attorneys Probation Office

All referrals are reviewed by District Attorney’s Office for Sentencing Guideline eligibility and Prohibited Offenses, then sent to Probation for screening.

Offender Eligibility

Consideration for Drug Court begins at the District Attorney’s office. An individual must be a level 3 or 4 offender under state sentencing guidelines and cannot have committed any of the prohibited offenses.

Individuals with drug related offenses who meet the aforesaid criteria

are considered, as well as, those with non-violent offenses associated with drug dependence.

An individual’s case must be past the Formal Arraignment stage before

it can be considered for Drug Court.

After a case is determined to be appropriate, it is then screened by Probation and Justice Related Services.

Sentencing Matrix

What is a level 3 or 4 Offender?

A level 3 or 4 offender is an offender who is facing a state sentence

Prohibited Offenses 18 Pa. C.S. 2502 (relating to Murder) 18 Pa. C.S. 2503 (relating to Voluntary Manslaughter) 18 Pa. C.S. 2702 (relating to Aggravated Assault) 18 Pa. C.S. 2703 (relating to Assault by Prisoner) 18 Pa. C.S. 2704 (relating to Assault by Life Prisoner) 18 Pa. C.S. 2901 (relating to Kidnapping) 18 Pa. C.S. 3121 (relating to Rape) 18 Pa. C.S. 3122.1 (relating to Statutory Sexual Assault) 18 Pa. C.S. 3123 (relating to Involuntary Deviate Sexual

Intercourse) 18 Pa. C.S. 3124.1 (relating to Sexual Assault) 18 Pa. C.S. 3125 (relating to Aggravated Indecent Assault) 18 Pa. C.S. 3126 (relating to Indecent Assault) 18 Pa. C.S. 3301(relating to Arson and related offenses) 18 Pa. C.S. 3502 (relating to Burglary of the First Degree) 18 Pa. C.S. 3701 (relating to Robbery) 18 Pa. C.S. 3923 (relating to Theft by Extortion) 18 Pa. C.S. 4302 (relating to Incest) 18 Pa. C.S. 5121 (relating to Escape)

Screening Process

Probation screens candidates for the following: Criminal History History of Supervision (potential Probation violations) Warrants

Once an offender is determined to be appropriate by Probation, they are then assessed by Justice Related Services to determine an appropriate level of care.

Assessment

JRS assessment Designed to capture information needed for the

dimensions of the PCPC (Pennsylvania Client Placement Criteria) 1. Acute Intoxication or Withdrawal 2. Biomedical Conditions and Complications 3. Emotional/Behavioral Conditions and Complications 4. Treatment Acceptance/Resistance 5. Relapse Potential 6. Recovery Environment

Plea

Once an offender meets all screening requirements and a level of care is established, the offender is able to voluntarily plea into the program.

If an offender chooses not to plea into Drug Court, the charges proceed in the originally assigned court room as scheduled.

Sentencing

Standard Drug Court sentences include 18 months Intermediate Punishment 12 months consecutive Probation

Sentences can be extended, if needed, to complete the program. Incentives exist to reduce the period of supervision.

Special Conditions

Drug and Alcohol evaluation

Comply with all treatment recommendations

Random urine screens

Complete “Criminality Group”

Supervision

Monthly Reviews- Monthly review hearings before Judge Nauhaus

Reporting- Minimum weekly contact with Probation- Urine testing at each contact

Community Contact- Every individual will maintain contact with the Drug

Court Team while in the community

JRS supports

Housing Services Coordination

Contingency Funds: Clothing, Food, State ID, Vital Records

Transportation assistance

Linking to Benefits: Medical assistance/Social Security/VA

Violations

Positive drug test

Window violations

Treatment non-compliance

Behavioral non-compliance

New arrest

Sanctions

Restriction

Team Intervention

Swift Intervention

Re-evaluation

Formal violation hearing (Gagnon I and II)

Revocation

Graduation Requirements

Complete IP Sentence

Maintain at least one year sobriety after stepping to the period of Probation following the IP sentence

Complete all treatment requirements

Obtain a High School Diploma or equivalent

Maintain independent housing

Sustain employment

Questions?

Assessment Tools and Treatment Programming

JRS Assessment

Previous Residences

Family History

Financial Circumstances

Education

Current and Past legal issues both as a juvenile and an adult

Medical Conditions

Psychiatric History

Substance Abuse History

Interpersonal relations and other social dynamics

Personal Goals

Types of Programming

Mental Health

Drug and Alcohol

Dual Programming

Specialized Supports Parenting Classes LGBTQI Women’s Groups Non-Secular Recovery Groups

The 6 Domains of the PCPC

1. Acute Intoxication and Withdrawal

2. Biomedical Conditions and Complications

3. Emotional/Behavioral Conditions and Complications

4. Treatment Acceptance/Resistance

5. Relapse Potential

6. Recovery Environment

Levels of Care

Level 1 A: Outpatient B: Intensive Outpatient

Level 2 A: Partial Hospitalization B: Halfway House

Level 3 A: Medically Monitored Detox B: Medically Monitored Short-Term Residential C: Medically Monitored long-Term Residential

Level 4 A: Medically Managed Inpatient Detox B: Medically Managed Inpatient Residential

Commonly Used Programs

Greenbriar

Pyramid

Cove Forge

Renewal

Family Links

VA

Gaiser

Sojourner House

Mon Yough Community Services

Mercy Behavioral Health

Alpha House

Questions?