rx abuse: the scope of the problem 2010

8/8/2019 Rx Abuse: The Scope of the Problem 2010

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Rx Abuse: The Scope of theRx Abuse: The Scope of the

Problem 2010Problem 2010

Ohio Attorney General LawOhio Attorney General LawEnforcement ConferenceEnforcement Conference

September 14, 2010September 14, 2010


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WARREN COUNTY DRUG TASK FORCE

JOHN BURKE, COMMANDER

P.O. BOX 898LEBANON, OHIO 45036

PHONE: (513) 336-0070CELL: (513)-623-3278

FAX: (513) 336-9097

E MAIL:

[email protected]


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PHARMACEUTICAL DIVERSIONPHARMACEUTICAL DIVERSION

Commander, Warren County, Ohio,Drug Task Forc e

Command er- Southwestern Ohio HIDTA Ma jor Case &Interd ic tion Initia tives

President-Nationa l Assoc ia tion of Drug Diversion

Investiga tors (NADDI)

32 years Cinc inna ti Polic e Division

Commander Pharmac eutic a l Diversion Squad

Six investiga tors, one sec reta ry


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PHARMACEUTICAL DIVERSIONPHARMACEUTICAL DIVERSION

DEFINITION?DEFINITION?

Any criminal act involving a prescription drugAny criminal act involving a prescription drug

Illegal manipulation of a prescription drugIllegal manipulation of a prescription drug

Illegal removal of a prescription drug at anyIllegal removal of a prescription drug at anypoint in its path from manufacturer topoint in its path from manufacturer to

patientpatient


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SOURCE OF DIVERTED DRUGSSOURCE OF DIVERTED DRUGS

Forged and Altered PrescriptionsForged and Altered Prescriptions

Doctor ShoppersDoctor Shoppers

Prescribers/Dispensers of Rx DrugsPrescribers/Dispensers of Rx Drugs

Theft (Health Facility and Other)Theft (Health Facility and Other)

Package theft/diversion (UPS, DHL, Fed X)Package theft/diversion (UPS, DHL, Fed X)

InternetInternet Pharmacy Robbery & BurglaryPharmacy Robbery & Burglary

International SmugglingInternational Smuggling


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INTERNATIONAL SMUGGLINGINTERNATIONAL SMUGGLING

Alprazolam with roots in MexicoAlprazolam with roots in Mexico

Not dispensed in the United StatesNot dispensed in the United States Delivered to Southwest Ohio 200,000Delivered to Southwest Ohio 200,000

dosage units a month for 3.5 yearsdosage units a month for 3.5 years 100% profit made on each load100% profit made on each load

Arrests made and over 100,000 dosageArrests made and over 100,000 dosageunits confiscatedunits confiscated

Miami nightclub sceneMiami nightclub scene

Activity continuesActivity continues


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PHARMACY BURGLARIESPHARMACY BURGLARIES

Involve the afterInvolve the after--hours entry of a pharmacyhours entry of a pharmacy

Smash and grab likely addicted perpetratorSmash and grab likely addicted perpetrator Usually planned criminal enterprisesUsually planned criminal enterprises

Entry through the roofEntry through the roof--adjoining businessadjoining business

Alarm disabledAlarm disabled

Possible entry into safePossible entry into safe

Hundreds of thousands of dollars street value RxHundreds of thousands of dollars street value Rxdrugs often removeddrugs often removed

Rx Patrol should be utilizedRx Patrol should be utilized


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Rx PatrolRx Patrol

Funded by Purdue PharmaFunded by Purdue Pharma

Reports of pharmacy robberyReports of pharmacy robbery Reports of pharmacy burglaryReports of pharmacy burglary

Reports of major pharmacy crimeReports of major pharmacy crime Database for law enforcementDatabase for law enforcement

Only as good as the information provided by LEOnly as good as the information provided by LE

and pharmacy personneland pharmacy personnel

Reporting can be done onlineReporting can be done online www.rxpatrol.orgwww.rxpatrol.org
http://www.rxpatrol.org/http://www.rxpatrol.org/http://www.rxpatrol.org/


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Rx CounterfeitingRx Counterfeiting

Huge problem in the United StatesHuge problem in the United States

NCS high $$ targeted usuallyNCS high $$ targeted usually Appearance of pills and packaging almostAppearance of pills and packaging almost

identicalidentical Requires testing from the manufacturerRequires testing from the manufacturer

Can be integrated into the retail drug supplyCan be integrated into the retail drug supply

Terrorism (Financing and Creating)Terrorism (Financing and Creating)

RFID &/or Serialized pills possible solutionRFID &/or Serialized pills possible solution


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Rx CounterfeitingRx Counterfeiting

New case (November 2009)New case (November 2009)

Local dealer making alprazolam (Xanax)Local dealer making alprazolam (Xanax)

Crushing legitimate pills with blenderCrushing legitimate pills with blender

AddingAdding cuttingcutting materialmaterial

Using basic pill press to produce 4Using basic pill press to produce 4--5X5X

1 mg blue Xanax tablets produced1 mg blue Xanax tablets produced Seized 12,000 pillsSeized 12,000 pills

Seized multiple pounds ofSeized multiple pounds of cuttingcutting materialmaterial


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INTERNET DIVERSIONINTERNET DIVERSION

According to ONDCPAccording to ONDCP-- Identified 34 rogueIdentified 34 rogue

Internet pharmacies in 2006Internet pharmacies in 2006

Dispensed over 98 million dosages ofDispensed over 98 million dosages ofhydrocodonehydrocodone

Would take 1,118 average pharmacies toWould take 1,118 average pharmacies toequal amount dispensed by the 34 illegalequal amount dispensed by the 34 illegal

Internet apothecariesInternet apothecaries


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Rx Drugged DrivingRx Drugged Driving

Little known about the overall prevalenceLittle known about the overall prevalence

DUI offenders tested for alcohol on street orDUI offenders tested for alcohol on street orlablab

Once legal limit is surpassedOnce legal limit is surpassed-- testing stopstesting stops Unknown if Rx drugs also presentUnknown if Rx drugs also present

Combination of Rx drugs, marijuana, and/orCombination of Rx drugs, marijuana, and/oralcohol can produce increased impairmentalcohol can produce increased impairment


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Rx Drugged DrivingRx Drugged Driving

Mixture of various Rx drugs in systemMixture of various Rx drugs in system

Impairment on legitimately prescribed drugsImpairment on legitimately prescribed drugsno defense for DUIno defense for DUI

More intense study neededMore intense study needed DRE possibly coming to OhioDRE possibly coming to Ohio

Dr. Robert DuPont to address nationalDr. Robert DuPont to address nationalNADDI conference on topic in IndyNADDI conference on topic in Indy


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WHATS THE BIG DEAL?

THEYRE JUST PRESCRIPTION DRUGS!

Elvis Presley - pa in/ sleep ing med ic a tion

Heath Ledger- pa in and sleep ing meds

Mic hael Jac kson-pa in/ sleep ing meds

Anna Nic hole Smith- pa in med ic a tion


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Message to Parents/Family MembersMessage to Parents/Family Members

EducateEducateyourself about the medications young peopleyourself about the medications young people

abuseabuse

CommunicateCommunicatewith your kids/grandkids to dispel the notion thatwith your kids/grandkids to dispel the notion thatthese medicines can be safely abusedthese medicines can be safely abused

SafeguardSafeguardLOCK YOUR MEDSLOCK YOUR MEDS

Limit accessLimit access

Keep track of the quantities in your homeKeep track of the quantities in your home


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Lock Your MedsLock Your Meds


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Available at: www.nfp.org/PDFs/HomeMedInventoryCard.pdf


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TOP Rx DRUGS OF ABUSETOP Rx DRUGS OF ABUSE

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

OXYCODONE(Percocet, Percodan, Tylox) $6 - $8(OxyContin- $.50-1.00 mg.)

METHADONE ($10-$40 per dose)

DIAZEPAM(Valium) $1 - $2

PROPOXYPHENE(Darvon, Darvocet) $2 - $4


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TOP Rx DRUGS OF ABUSETOP Rx DRUGS OF ABUSE

CARISOPRODOL (Soma) $3 - $4

ALPRAZOLAM(Xanax) $3 - $4

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

METHYLPHENIDATE(Ritalin) $10 - $12

HYDROMORPHONE(Dilaud id ) 4mg - $60


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OTHER SIGNIFICANT PROBLEMSOTHER SIGNIFICANT PROBLEMS

Stadol Nasal Spray

Tramadol (Ultram) ($1-$2)

Phentermine (Adipex) ($3-$6)

Fentanyl patches (Duragesic / Ac tiq) ($8-$40)


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Oxycodone ExpressOxycodone Express

Almost 200Almost 200 Pain ManagementPain Management practices inpractices in

Broward Co. Florida (Ft. Lauderdale)Broward Co. Florida (Ft. Lauderdale) Long lines obtaining oxycodone IRLong lines obtaining oxycodone IR

(Roxicodone(Roxicodone) at clinics) at clinics Van loads of folks from Midwest going toVan loads of folks from Midwest going to

these clinicsthese clinics

Filling RxFilling Rxs in Florida or other statess in Florida or other states

Mere possession with script not a crimeMere possession with script not a crime


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OxyContinOxyContinExpressExpress

Source city for OxyContinSource city for OxyContin-- Detroit, MIDetroit, MI

April 2010April 2010-- OSP seized 900 (80mg) pillsOSP seized 900 (80mg) pills--street valuestreet value-- $72,000 from Detroit$72,000 from Detroit

20082008-- Undercover purchase of 3,000Undercover purchase of 3,000OxyContin (80mg) for $110,000 inOxyContin (80mg) for $110,000 in

Dearborn, MIDearborn, MI

Follow up investigation indicates massiveFollow up investigation indicates massivedoctor shopping operationsdoctor shopping operations


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Prescription ReformulationsPrescription Reformulations

EMBEDAEMBEDA-- Manufactured by KingManufactured by King

PharmaceuticalsPharmaceuticals Morphine extendedMorphine extended--releaserelease

Also contains naltrexone hydrochlorideAlso contains naltrexone hydrochloride InjectingInjecting--ShootingShooting--Snorting releasesSnorting releases

naltrexonenaltrexone Abuser suffers withdrawal symptomsAbuser suffers withdrawal symptoms


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Prescription ReformulationsPrescription Reformulations

OxyContinOxyContin-- Manufactured by PurdueManufactured by Purdue

PharmaPharma Reformulation approved by FDA April 2010Reformulation approved by FDA April 2010

Extended release oxycodone deliveryExtended release oxycodone deliverysystem stays the samesystem stays the same

Covering of pill has become much moreCovering of pill has become much moredifficult to compromisedifficult to compromise

All strengths will be replaced by July 2010All strengths will be replaced by July 2010


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WHY RxWHY Rx DRUGSDRUGS ??

Less risk of overdose

Easier to ob ta in through lega l sc rip t

Cheaper than coc a ine and heroin

Less risk of detec tion - lac k ofenforcement

FORGED AND ALTEREDFORGED AND ALTERED


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PRESCRIPTIONSPRESCRIPTIONS Alteration of sc ript is a felony in many

states

Chang ing doses, refills or strength

White out



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PRESCRIPTIONSPRESCRIPTIONS Nail polish remover

Photocopying

Computer generated presc riptions


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DECEPTIONSDECEPTIONS

Employee of Hea lth Professiona ls

Phony c a ll-ins

After hours pa tient sc am

Doc tor Shopp ing

ER Shopp ing


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ER DRUG SEEKERSER DRUG SEEKERS Slam c ar doors and trunks on ha ndsSlam c ar doors and trunks on ha nds

Slam windows on ha nds & fingersSlam windows on ha nds & fingers Carry syringes with b lood to squirt inCarry syringes with b lood to squirt in

their mouth to demonstra te b leed ingtheir mouth to demonstra te b leed ing Carry kidney stones in a ja r to ERCarry kidney stones in a ja r to ER

Insert ob jec ts into open woundsInsert ob jec ts into open wounds Delibera tely irrita te root c ana l workDelibera tely irrita te root c ana l work

Bea t on foot w ith 4.5 LB hammerBea t on foot w ith 4.5 LB hammer


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HEALTH CARE FRAUDHEALTH CARE FRAUD

$100 b illion a year

Patient fraud

Fraudulent identific a tion

Doc tor shopp ing


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Provider Fraud

Fa lse insuranc e b illings

up-coding

brand/ generic sc am

Illega l d iet c linic s

Illega l pa in c linic s


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According toAccording to Prescription for PerilPrescription for Peril (Mahon)(Mahon)

Opioid abusers cost health insurers $15,884Opioid abusers cost health insurers $15,884per year per patient (2005)per year per patient (2005)

NonNon--abusers cost insurers $1,830 per yearabusers cost insurers $1,830 per year Over 8X higherOver 8X higher

$72.5 billion in fraud in the abuse of opioids$72.5 billion in fraud in the abuse of opioids Enormous cost for everyoneEnormous cost for everyone

HEALTH PROFESSIONALHEALTH PROFESSIONAL


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INVESTIGATIONSINVESTIGATIONS 30% of PDS a rrests a re hea lth

professionals

Average hea lth p rofessiona l a rrest

every 6 days

Almost 70% of those a rrests a re nurses

Average nurse a rrest every 8 days



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INVESTIGATIONSINVESTIGATIONS Fa lsify d rug doc uments

Nurses do not sell their d rugs

Impa ired and use while working

Drug substitution and c ompromises c an be lifethrea tening to pa tients

Rose Med ic a l Center (CO) Diversion

ILLEGAL PRESCRIBERILLEGAL PRESCRIBER


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ILLEGAL PRESCRIBERILLEGAL PRESCRIBER

INVESTIGATIONSINVESTIGATIONS Rx drugs for sexRx drugs for sex

Rx drugs for moneyRx drugs for money Rx drugs for illicit drugsRx drugs for illicit drugs

Health care fraudHealth care fraud Personal or family member impairmentPersonal or family member impairment

Senile practitionerSenile practitioner Requires multiple agency cooperationRequires multiple agency cooperation


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VETERINARIAN INVESTIGATIONSVETERINARIAN INVESTIGATIONS

Can prescribe virtually all Rx drugsCan prescribe virtually all Rx drugs

Pain relieversPain relievers BenzodiazepinesBenzodiazepines

KetamineKetamine Anabolic steroidsAnabolic steroids

Susceptible to breakSusceptible to break--insins Susceptible to employee diversionSusceptible to employee diversion

DENTIST INVESTIGATIONS


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DENTIST INVESTIGATIONSDENTIST INVESTIGATIONS

Issues can be selfIssues can be self--addictionaddiction

Prescribe pain relievers regularlyPrescribe pain relievers regularly Dr. ShoppersDr. Shoppers can victimize dentists ifcan victimize dentists if

necessarynecessary Many addicts have poor dental hygieneMany addicts have poor dental hygiene

May aggravate dental work to get drug ofMay aggravate dental work to get drug ofchoicechoice

PHARMACY INVESTIGATIONSPHARMACY INVESTIGATIONS


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PHARMACY INVESTIGATIONSPHARMACY INVESTIGATIONS

Typically target CIII and CIV drugsTypically target CIII and CIV drugs

No perpetual inventoryNo perpetual inventory RPh/Intern/TechRPh/Intern/Tech

May require covert camerasMay require covert cameras SelfSelf--medicatingmedicating

Personal impairmentPersonal impairment

PRESCRIPTION MONITORINGPRESCRIPTION MONITORING


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PRESCRIPTION MONITORINGPRESCRIPTION MONITORING

PROGRAMS (PMPPROGRAMS (PMPS)S) Enacted by individual states to track theEnacted by individual states to track the

prescribing/dispensing of Rx drugsprescribing/dispensing of Rx drugs

Most involve only controlled substancesMost involve only controlled substances All involve access to health professionalsAll involve access to health professionals

Varied availability for law enforcementVaried availability for law enforcement

Valuable tool for investigators especially if easilyValuable tool for investigators especially if easilyaccessibleaccessible

Electronic databasesElectronic databases

Can identify diversion and reduce health careCan identify diversion and reduce health carefraudfraud

OhioOhios PMPs PMP-- OARRSOARRS


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P j t D DP j t D D


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Project Drug DropProject Drug Drop

www.projectdrugdrop.comwww.projectdrugdrop.com

NADDINADDIs site for Rx take back programs site for Rx take back program Provides Community toolkitProvides Community toolkit

Provides Law Enforcement toolkitProvides Law Enforcement toolkit Provides valuable resourcesProvides valuable resources

Calendar allows for event scheduleCalendar allows for event schedule Stresses law enforcement involvementStresses law enforcement involvement

NADDINADDI
http://www.projectdrugdrop.com/http://www.projectdrugdrop.com/http://www.projectdrugdrop.com/


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NADDINADDI

National Association of Drug DiversionNational Association of Drug Diversion

InvestigatorsInvestigators www.naddi.orgwww.naddi.org

Membership is $50 per yearMembership is $50 per year

Rx list serverRx list server

Ohio state chapterOhio state chapter

NADDI N ti l C fNADDI National Conference
http://www.naddi.org/http://www.naddi.org/http://www.naddi.org/


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Indianapolis, IndianaIndianapolis, Indiana-- Hyatt DowntownHyatt Downtown

November 16November 16--19, 201019, 2010

Registration scholarships may be availableRegistration scholarships may be available

Go toGo to www.naddi.orgwww.naddi.org for more infofor more info

NADDI National ConferenceNADDI National Conference
http://www.naddi.org/http://www.naddi.org/http://www.naddi.org/


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Kash

Kilo


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REMEMBER!REMEMBER!

Law enforcement and regulatorsLaw enforcement and regulators

should strive to pursue thoseshould strive to pursue those

involved in drug diversion withoutinvolved in drug diversion withoutnegatively impacting legitimatenegatively impacting legitimate

patientspatients


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QUESTIONS????QUESTIONS????

rx abuse: the scope of the problem 2010

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