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TRANSCRIPT
Pharmacy Burglary,Robbery and Diversion
Presenters:• Tara O’Connor Shelley, PhD, Associate Professor, Center for
the Study of Crime and Justice, Colorado State University• Cheri Atwood, Director of Compliance, Mississippi Board of
Pharmacy• John Harless, Lieutenant, Mississippi Bureau of Narcotics
Pharmacy Track
Moderator: Chad C. Corum, PharmD, Co-Owner and Pharmacist, Corum Family Pharmacy, and Member, Operation UNITE Board of Directors
Disclosures
Cheri Atwood; John Harless; Tara O’Connor Shelley, PhD; and Chad C. Corum, PharmD, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.
Disclosures
• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.
• The following planners/managers have the following to disclose:– John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest:
Starfish Health (spouse)– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center
Learning Objectives
1. Explain the trends in diverting pharmaceuticals, particularly in the form of pharmacy robbery and burglary.
2. Identify preventative measures to enhance security of pharmacies and the safety of their staff and customers.
3. Outline strategies to reduce pharmacy burglaries and robberies.
4. Provide accurate and appropriate counsel as part of the treatment team.
Pharmacy Robbery & Burglary: The Offender Perspective
Learning Objectives1. Explain the trends in diverting pharmaceuticals,
particularly in the form of pharmacy robbery and burglary.
2. Identify preventative measures to enhance security of pharmacies and the safety of their staff and customers.
3. Outline strategies to reduce pharmacy burglaries and robberies.
4. Provide accurate and appropriate counsel as part of the treatment team.
US Opioid Prescriptions Dispensed by US Pharmacies (NIDA, 2014)
Diversion• Definition: When legitimately manufactured
controlled substances are diverted from their lawful purpose to an illicit purpose (DEA, 2013).
• Trend: Diversion of prescription drugs on the rise since the 2000’s (most common type=pain relievers) (NDIC, 2011).
• Examples: Robbery/Burglary of Pharmacies; Fraud; Cargo Theft; Giving/Selling Drugs to Family/Friends.
• Data: “…data on pharmaceutical abuse and diversion are not reliable, comprehensive or timely.” (US GAO, 2003)
Data Sources on Pharmaceutical Diversion
• RxPatrol – Proprietary industry data;
law enforcement• National Incident Based
Reporting System (NIBRS)– Law enforcement;
publically available• DEA Form 106 data– Law enforcement
sensitive; DEA registrants
• National Drug Intelligence Center (NDIC) – Law enforcement
survey; discontinued• National Survey of Drug
Use and Health (NSDUH)
• Monitoring the Future Survey
Pharmacy Robberies for CPDs2006-2014
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140
100
200
300
400
500
600
700
800
900
Rx PatrolDEANIBRS
Pharmacy Burglaries for CPDs 2006-2014
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140
200
400
600
800
1000
1200
Rx PatrolDEANIBRS
Research Goals1. Understand the nature & extent of pharmaceutical
diversion that occurs as a result of robbery or burglary of retail pharmacies.
2. Interview convicted offenders to document their perspective about pharmacy crime.
3. Collect information to help prevent pharmacy crime & enhance pharmacy safety.
4. Explore relevance of criminological theories.a. Routine Activities Theory
Routine Activities Theory
• Cohen & Felson (1979); Felson (1994)
Suitable Target Desirable, Accessible,
Visible, Valuable, Vulnerable
Absence of Capable
GuardianPeople or official
social control agents
Motivated Offender
Those w/Criminal Inclinations
CRIME
Methodology
• Semi-Structured Interviews w/48 Convicted Offenders in Two Hot Spot Locations – Ohio (32) & Florida (16)
• Interviews were transcribed verbatim & loaded into NVivo for analysis of open ended responses.
• Coded for general theoretical concepts associated w/Criminology and relied on an open coding strategy to identify other emergent themes.
Pharmaceutical Use• Of those who used pharmaceuticals, 90% were daily
users
• 78% had a prescription for drug of choice at some point
• Reasons for Initial Use
Doctors Seen/Doctor Shopping
• Of those w/Rx, 73% reported seeing more than 1 doctor/healthcare professional
• Reported Range of Doctors seen 1-100
Why They Do It: Pathways to Robbery
Prescription(s) – Legal & Fraudulent
Doctor Shopping & ER Visits
Street Purchases & Sales
Informal Networks (family, friends, acquaintances at clinics to float)
Robbery
Crime Tactics
• 76% Wore Disguise• 30% Jumped Counter • 23% Passed Note• 16% Use Distraction
Techniques• 89% Used or Implied a
Weapon
• Of Those Using Weapon– Gun (56%)– Knife (19%)– Explosive Device (6%)
• 22% Reported Physical Injuries Occurred
Today’s Customer is Tomorrow’s Offender
• 72% of offenders had been to the targeted pharmacy before…almost all to fill prescriptions
• They carefully watch procedures; volume of transactions; product delivery date & timeframes; some examine cars to differentiate between staff & customers
Geographic Tendencies: Commuters or Marauders
• 66% target a pharmacy in home city• Miles from home residence to pharmacy—0 to 120
miles. • 49% traveled 6 or fewer miles
Key for Results
• Red = Discourager/Deterrent
• Green = Encourager
• Blue = Does not Matter–WHY? Too dope sick or will work around it
“Suitable” Targets
Dimensions of Target Suitability Pharmacies are “suitable” targets…they have the
property that the offender desires, they are accessible, and have a high value (e.g., relief, financial).
Type of Pharmacy Targeted
42%
50%
4%4%Local Mom/Pop
National Chain
Grocery
Warehouses
Ideal Pharmacy Location: Stand Alone Parking Lot
9%
55%
36%Discourage
Encourage
Does Not Mat -ter
“
Worst Pharmacy Location: Grocery Store in Shopping Center
78%
2% 20% Discourage
Encourage
Does Not Matter
Pharmacy Counter in Back
31%
36%
33% Discourage
Encourage
Does Not Mat -ter
Time Delay Safes
76%
2%21%
Discourage
Encourage
Does Not Matter
CAPABLE GUARDIANS
Three Staff Members in Pharmacy
67%
8%
25% Discourage
Encourage
Does Not Matter
Staffing in Pharmacy
90%
10%Discourage
Encourage
Does Not Matter
One Staff Member Two Staff Members
12%
50%
38%
Discourage
Encourage
Does Not Matter
Possible Interference from Staff
46%
3%
51%
Discourage
Encourage
Does Not Matter
Possible Interference from Customers
53%
47%
Discourage
Encourage
Does Not Matter
MOTIVATED OFFENDERS
Developing Offender Typology• Pure Addict (46%)
• Few crime skills, don’t want to hurt people, unstable; don’t consider guardianship & target suitability.
• Hybrids (44%)• Criminals who are also abusers (sometimes addicts),
sometimes dealers, willing to harm as a last resort; do consider guardianship & target suitability.
• Entrepreneurs (10%)• Pure business, trafficking, rare for abuse, willing to
harm; meticulously consider guardianship & target suitability.
Addict• General View
• Target Suitability
• Guardianship
Hybrid• General View
• Target Suitability
• Guardianship
Entrepreneur• General View
• Target Suitability
• Guardianship
Concluding Remarks• Reduce Target Suitability
• Increase Guardianship
• Decrease Motivated Offenders
• Not all offenders are one in the same in how they perceive criminal opportunities.– Crime still occurred even when there were capable guardians
in place and/or target suitability was less than ideal.
Questions?
Tara O’Connor Shelley, Ph.D.B 264 Clark
Center for the Study of Crime and Justice Colorado State University
Fort Collins, CO USA80523
Burglary-Robbery-Diversion Prevention
Partners in Prevention
A Long Term Relationship
• MBN and MBP have worked together to prevent diversion since the early 1980’s. This partnership became much more active beginning in 1999 when MBP started registering pharmacy technicians.
• This frequent interaction created the perfect environment to foster a partnership for addressing pharmacy burglaries and robberies.
Teamwork is the Key
• Mississippi utilizes a multi-disciplinary approach to reducing diversion via burglary and robbery
• Partners in this effort include pharmacy owners and employees, regulatory agencies and law enforcement
• These efforts are spearheaded by the Board of Pharmacy and the Bureau of Narcotics
Information Sharing
• Partnering with a law enforcement agency with a broad jurisdiction is important
• These agencies could include DEA Diversion, the state police, a multi-jurisdictional task force or metro departments
• Aligning regulatory agencies and law enforcement provides a united front
What’s our Goal?
• To prevent the illicit diversion of pharmaceuticals by creating a reduction in the burglary and robbery of pharmacies
How will we Accomplish this?
• Gain an increased awareness of current trends in pharmaceutical diversion
• Increase your awareness of how to physically protect your pharmacy and employees
• Enable your staff to decrease the diversion of pharmaceuticals
• Address any concerns you may have• Improve your ability to identify persons that
need substance abuse treatment.
Burglary versus Robbery
• Burglary – “entry into a building illegally with intent to commit a crime, especially theft” – normally a property crime
• Robbery – “taking the property of another, with the intent to permanently deprive the person of that property, by means of force or fear.” – always a violent crime
Burglary
Robbery
Organized Groups Versus Addict Burglars
• Organized groups often operate in multiple states and commit multiple burglaries for profit
• Addict burglaries are typically committed by one or two people for the purpose of feeding a narcotic addiction
Organized Groups
• “Trash Bag Gang,” “Bandana Group,” “Blue Tub Group,” “Interstate Group”
• These groups often commit multiple burglaries with commonalities ie targeting a specific chain
• The crimes typically happen in multiple jurisdictions
• Motive is most often financial
Addict Burglaries
• These are normally less sophisticated and target pharmacies which the addict is familiar with already
• A specific class of drug may be targeted.• Motive is typically addiction• Addict burglars often act in desperation and
act erratically
Internal Diversion or Theft
• This occurs when employees of medical facilities or pharmacies take drugs for distribution or personal consumption.
• Pharmacists, Techs or other employees• Report any suspected theft to the Board
immediately• Do not allow a problem employee to continue
their activities at another pharmacy
• Remember that you have a duty to report any loss to the Board and DEA
• Burglary, robbery or internal loss
• Report may be completed online
Board E-Mail
• LOSSES OF CONTROLLED SUBSTANCES• Article XXV, Paragraph 1., for the Pharmacy Practice
Regulations requires that if a facility has a loss of controlled substances by BURGLARY, that such incident shall be reported directly to the Board IMMEDIATELY. Investigations of these burglaries is a priority of the Mississippi Bureau of Narcotics. Please contact Lieutenant John Harless with MBN IMMEDIATELY ON DISCOVERY at 601-466-5471, day or night.
Board E-Mail continued
• Please contact the Board of Pharmacy as soon as possible at 601-899-8880. This does not preclude reporting of the burglary to your local law enforcement agency.
Responsibility of Pharmacist –In-Charge
• Each Pharmacist while on duty shall be responsible for the security of the Pharmacy, including provisions for effective control against theft or diversion of Drugs and/or Devices.
• The pharmacist-in-charge shall be responsible for adequate security being maintained on drugs in all areas of the permitted facility at all
Mississippi Pharmacy Practice Regulations
Responsibility of Pharmacist –In-Charge continued
• times and is responsible for reporting any loss or suspected loss of controlled substances or legend drugs directly to the Board immediately (this does not relieve any pharmacist who discovers a loss from the requirement of reporting the loss directly to the Board).
Mississippi Pharmacy Practice Regulations
• It is the responsibility of the discovering pharmacist to report losses or suspected losses of controlled substances or prescription drugs directly to the Board.
(601) 899-8880
Mississippi Pharmacy Practice Regulations
ARTICLE VACTION AGAINST PHARMACIST LICENSE
• Termination of employees suspected of theft of pharmaceuticals or merchandise contacting the Board prior to termination
• Failure to report directly to the Board, losses or suspected losses of controlled substances or medical devices from a permitted facility
Mississippi Pharmacy Practice Regulations
ARTICLE V-ACTION AGAINST PHARMACIST LICENSE- CONTINUED
• Knowing or suspecting that a Pharmacist or Pharmacy Intern is incapable of engaging in the Practice of Pharmacy or that a Pharmacy Technician is incapable of assisting in the Practice of Pharmacy, with safety to the public, is diverting or abusing controlled substances or prescription drugs and failing to report any relevant information to the Board of Pharmacy.
Mississippi Pharmacy Practice Regulations
Public Education
• The Board of Pharmacy coordinates frequent training for pharmacists, pharmacy technicians and others with a vested interest in reducing diversion
• This training may cover state and federal law, regulatory changes and other subjects applicable to diversion prevention
Building Solutions Together
Burglary Prevention
• Take preventative action:• Cut hedges• Insure external and security lights work• Have the alarm system and all sensors checked –
vertical motion detectors• Utilize a cellular telephone backup for alarm• Insure all cameras are functioning and recording –
be wary of cameras that have been moved• Make sure all doors are secured
Burglary Prevention
• Avoid leaving bottles of popular drugs sitting out (ie 500 oxycodone on the front counter)
• Consider purchasing a gun/fire safe to store controls in overnight
• Verify who your alarm company calls first – preferably law enforcement
• Place height stickers or markers near doors to aid in identifying suspects
Burglary Prevention
• Be aware of unusual behavior of patrons ie “casing” the store
• Be wary of multiple “false” alarms within a few days – checking response time and how alarm works
• Pay attention to any strange questions such as weekend hours, opening or closing times, etc
• If outside workers are present at the pharmacy, request of identities
• If in doubt, contact MBN or other law enforcement to conduct a site visit and make recommendations
What to do if you are burglarized?
• Avoid tampering with any potential evidence – fingerprints, DNA, video
• Contact law enforcement and the Board• Conduct inventory and complete DEA form
106• Be cognizant that burglars will victimize the
same store multiple times if it is an easy target
Why contact MBN if my local law enforcement agency is there?
• MBN maintains information on all reported burglaries not only in Mississippi, but in adjoining states
• MBN analyzes information and looks for trends in burglaries that cross jurisdictional lines
• MBN attempts to identify organized groups and their methods
• MBN attempts to link other law enforcement agencies with each other if there is evidence that burglaries are connected
How to react to a robbery?
• Stay calm and remember that the safety of you, your employees and patrons is the priority
• Provide the perpetrator what he/she wants within reason
• If another employee reacts poorly because of fear, insure the bad guy that you will handle their demands
• Rather than being a hero, focus on being the best witness possible
• Observe and remember physical characteristics such as height, weight, race, gender, hair color, age, voice, mannerisms, etc
• Observe clothing, weapons, what they place the drugs into, anything that they touch
• Observe any vehicles that are used
• Avoid allowing anyone to leave with the suspect if at all possible
• Once the suspect(s) leave, secure the doors and contact law enforcement immediately
• Do not disturb any potential physical evidence• Be willing to provide or undergo any
appropriate follow up counseling
• In cases of addict robbery, do not treat a suspect in a less serious manner because you may be familiar with them from previous contact
• Addicts commit robberies in desperate times and are capable of unexpected actions
• After you have reported the burglary or robbery to local law enforcement, contact MBN Lieutenant John Harless at 601-466-5471.
• Be prepared to provide law enforcement with a copy of any security footage.
The Reality of Diversion
• The pharmacist is the “gate keeper” in the fight against diversion and prescription drug misuse.
• As medical professionals, you have a responsibility to do everything possible to insure that controlled substances are dispensed in the proper manner.
• An inter-disciplinary approach to the prevention of diversion by burglary and robbery can prove to be quite effective
• Law enforcement, regulatory agencies and pharmacy employees must improve communication and interaction to foster these relationships
• Do not be afraid to reach out to other vested partners with questions and ideas
Pharmacy Burglary,Robbery and Diversion
Presenters:• Tara O’Connor Shelley, PhD, Associate Professor, Center for
the Study of Crime and Justice, Colorado State University• Cheri Atwood, Director of Compliance, Mississippi Board of
Pharmacy• John Harless, Lieutenant, Mississippi Bureau of Narcotics
Pharmacy Track
Moderator: Chad C. Corum, PharmD, Co-Owner and Pharmacist, Corum Family Pharmacy, and Member, Operation UNITE Board of Directors