Steven Smith Group Supervisor. Oakland Tactical Diversion Squad

Transcription

1 Steven Smith Group Supervisor Oakland Tactical Diversion Squad

2 Alabama/Birmingham Atlanta Atlanta/Nashville Atlanta/Savannah Boston Boston/Worcester Chicago Dallas Denver Denver/Billings Denver/Salt Lake City Detroit Detroit/Cleveland Detroit/Columbus Detroit/Lexington El Paso El Paso/Albuquerque Houston Houston/Austin Houston/Beaumont Los Angeles Los Angeles/Honolulu Los Angeles/Las Vegas Miami Miami/Orlando Miami/Tampa Newark Newark/ Camden New Orleans New Orleans/Baton Rouge New Orleans/ Jackson New Orleans/Little Rock New York New York/Albany New York/Long Island Philadelphia Philadelphia/Pittsburgh Phoenix Phoenix/Tucson San Diego San Francisco/Oakland San Francisco/Sacramento San Juan San Juan/Ponce Seattle Seattle/Portland Seattle/Boise St. Louis St. Louis/Kansas City Washington Washington/Baltimore Washington/Charleston

3 Personnel Group Supervisor Special Agents Task Force Officers o o San Ramon Police Department Marin County Sheriff s Office Diversion Investigator Intelligence Analyst Data Analyst

4 Alameda Contra Costa Del Norte Humboldt Lake Marin Mendocino Monterey Napa San Benito San Francisco San Mateo Santa Clara Santa Cruz Sonoma Napa Marin Contra Costa San Francisco San Mateo Santa Cruz

5 Prescription Drug Abuse An American Epidemic

6 National Overdose Deaths Number of Deaths from Prescription Drugs 30,000 Total Female Male 25,000 20,000 15,000 10,000 5,000 0 Source: National Center for Health Statistics, CDC Wonder

7 Number of Drug Induced Deaths Compared to the Number of Motor Vehicle and Firearm Deaths,

8 More deadly to its population Source: CDC, National Center for Health Statistics

9 1. CDC Wonder, 2015; 2. SAMHSA, NSDUH, 2015;3. Rabiner et al., 2009; 4. McCabe et al., 2007; 5. Lord et al., 2011;6. SAHMSA, DAWN, 2014; 7. SAMHSA, TEDS, 2015

10 1. CDC Wonder, 2015; 2. SAMHSA, NSDUH, 2015;3. Rabiner et al., 2009; 4. McCabe et al., 2007; 5. Lord et al., 2011;6. SAHMSA, DAWN, 2014; 7. SAMHSA, TEDS, 2015

11 16 Age at Death from Prescription Drugs 2010 (Source: Clark County Coroner's Office) 14 F 12 R E 10 Q U 8 E N 6 C Y AGE OF DECEDANT Clark County Coroner s Office 2010 Average age at Death: years Highest Frequency: 48 years (14 deaths) Range: 16 years 80 years Total Deaths: 289 Deaths

12 In 2013, 43,982 deaths occurred from drug overdoses in the U.S. 22,767 of those were from prescription drugs and 16,235 involved OPIOIDS 1 22,767 Rx related 21,215 Non- Presription 22,767 Prescription 6,532 16,235 Opioid Non-Opioid 16,235 involving OPIOIDS 1CDC: Prescription Drug Overdose in the United States : Fact Sheet updated 2/9/2015

13 Hydrocodone/Norco /Vicodin (Schedule II) OPIOD Oxycodone/OxyContin (Schedule II) OPIOD Oxymorphone/Opana (Schedule II) OPIOD Methadone (Schedule II) OPIOD Fentanyl (Schedule II) OPIOD Alprazolam/Xanax (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS Diazepam/ Valium (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS Carisoprodol/Soma (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS Cough Syrup (Schedule V) DEPRESSANTS/SEDATIVES/TRANQUILIZERS Adderall (Schedule II) STIMULANT

14 National Overdose Deaths Number of Deaths from Prescription Opioid Pain Relievers 20,000 Total Female Male 18,000 16,000 14,000 12,000 10,000 8,000 6,000 4,000 2,000 0 Source: National Center for Health Statistics, CDC Wonder

15 HYDROCODONE/ACETAMINOPHEN Pain Reliever LEVOTHYROXINE Thyroid LISINOPRIL High Blood Pressure METOPROLOL High Blood Pressure 40 SIMVASTATIN High Cholesterol Represented in Millions Source: IMS HEALTH April 2014, Medicine use and shifting costs of healthcare. A review of the use of medicines in the United States.

16 WA Hydrocodone Orders 2013 ME MT ND MN OR ID WY SD WI MI 428M NY CA 1.048B AK NV PHARMACIES AND PRACTIONERS AZ UT CO NM NE KS TX 849M HI OK IA MO AR LA IL 330M MS IN 286M TN 425M AL OH 284M KY GA 284M WV SC 257 VA NC FL 377M CALIFORNIA 1,048,899,555 TEXAS 849,374,257 MICHIGAN 428,622,176 TENNESSEE 425,412,142 FLORIDA 377,085,421 ILLINOIS 330,379,629 INDIANA 286,312,679 OHIO 284,657,108 GEORGIA 266,530,942 SOUTH CAROLINA 257,783,878

17 Law Enforcement Sensitive Oakland Tactical Diversion Squad An American Epidemic

18 WA Oxycodone Orders 2013 ME CA 314M AK OR NV PHARMACIES AND PRACTIONERS ID AZ 178M UT MT WY CO NM ND SD NE KS OK TX HI MN IA WI IL MO AR MS LA IN MI TN 166 AL OH 274M KY GA WV SC VA NC 245M FL 319M NY 290M MA 151M NJ 183M PENNSYLVANIA 319,344,791 FLORIDA 317,828,015 CALIFORNIA 314,670,367 NEW YORK 290,087,245 OHIO 274,860,782 NC 245,122,856 NEW JERSEY 183,685,620 ARIZONA 178,537,952 TENNESSEE 166,821,336 MA 151,848,808

19 OXYCODONE SALES CALIFORNIA 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000, MG 30 MG 80 MG 30,000,000 20,000,000 10,000,

20 U.S. Drug Enforcement Administration Office of Diversion Control 20

21 OXYCODONE SALES NEW YORK 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000, MG 30 MG 80 MG 30,000,000 20,000,000 10,000,

22 OXYCODONE SALES FLORIDA 350,000, ,000, ,000, ,000, ,000, MG 30 MG 80 MG 100,000,000 50,000,

23 OXYCODONE SALES 80 mg CA, FL, NY 25,000,000 20,000,000 15,000,000 10,000,000 CA FL NY 5,000,

24 OXYCODONE SALES 30 mg CA, FL, NY 350,000, ,000, ,000, ,000, ,000,000 CA FL NY 100,000,000 50,000,

25 OXYCODONE SALES 10 mg CA, FL, NY 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 50,000,000 40,000,000 CA FL NY 30,000,000 20,000,000 10,000,

26 Oxymorphone/Opana (Schedule II) Methadone (Schedule II) Fentanyl (Schedule II) Brand Names Actiq, Duragesic Fentanyl is 100x more potent than morphine Street prices: $25 to $40 per patch/lollipop

27 Law Enforcement Sensitive Fentanyl Deaths Oakland Tactical Diversion Squad

28 Prescription Painkillers to Heroin Contributing to increased demand for heroin 19x higher among former CPD abusers 80% of new heroin abusers were CPD abusers Elevated risk Reasons Price Availability Tolerance OxyContin reformulation

29 Oxycodone (Percocet, Percodan, Roxicodone ) Hydrocodone (Vicodin, Lortab, Lorcet ) Fentanyl Heroin

30 Oakland Tactical Diversion Squad 30

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32 Law Enforcement Sensitive Oakland Tactical Diversion Squad Overview

33 Alprazolam/ Xanax (Schedule IV) Benzodiazepines Benzos Anti-anxiety/nervous tension Extremely addictive Diazepam /Valium (Schedule IV) Benzodiazepines Benzos Carisoprodol/Soma (Schedule IV) Sedative

34 National Overdose Deaths Number of Deaths from Benzodiazepines 9,000 8,000 7,000 Total Female Male 6,000 5,000 4,000 3,000 2,000 1,000 0 Source: National Center for Health Statistics, CDC Wonder

35 Dirty registrants: e.g. Doctors, Nurses, Pharmacists, etc. Illegal sales of legally obtained pills Doctor shoppers Fraudulent/ forged prescriptions Prescription fraud rings Stolen prescription pads Fake prescriptions - e.g. creating sophisticated fraudulent copies of prescription pads with use of just a scanner and laptop Burglary and robbery of pharmacies, doctors offices, veterinary clinics Internet / out of country purchases

36 Clinic / Office Red Flags Brief, cursory medical exam Brief, minimal follow up visit Cash only practice Prescribing for excessive amounts of money Prescribing multiple drugs within the same drug category Increasing dose or changing to a stronger opiate with no justification or follow up exam

37 Clinic / Office Red Flags Patient Deaths Patients traveling long distances / out of state Coaching patients to a particular pharmacy Prescribing opiates without requiring an office visit Coaching patients that they wont receive opiates unless they complain of pain

38 Clinic / Office Red Flags Failing to treat patients with anything other than opiates Failing to refer patients to specialists or to drug rehab Coaching patients on what to say Failing to heed warnings in respect to drug seeking patients Lack of diagnostic tests

39 Clinic / Office Red Flags A toxicology test indicates that the patient is taking illegal drugs Failing to touch or examine the patient where they say it hurts The condition, appearance or behavior of the patient would create a reasonable concern Writing to patients who appear to be selling their medications

40 Clinic / Office Red Flags Writing prescriptions to patients who admit buying pills off of the street The doctor tends to increase the dosage or switch to more powerful drugs The vast majority (75% or higher) of the patients are prescribed opiates There are no individual treatment plans

41 Clinic/ Office Red Flags Patients swap services, or sex for opiates Lost medications are frequently replaced Refills before prescriptions should run out There is a correlation between the fee charged and the prescriptions The patient suggests the medications to be prescribed

42 Clinic / Office Red Flags The doctor pre populates his patient charts A toxicology screen shows the patient is not taking the medication prescribed Husbands and wives, or siblings, are prescribed the same medications

43 Clinic / Office Red Flags There are no nurses, only clerical staff Lack of patient files, or prescription records Patients refer to or ask for drugs using street names The doctor writes prescriptions for patients not present Doctor sees multiple patients at one time

44 AK OR CA 60 WA 23 NV ID Oakland Tactical Diversion Squad Pharmacy Armed Robberies VT 2013 AZ 77 UT MT WY NM CO ND SD NE KS HI OK TX 24 MN IA MO AR LA WI IL MS IN 71 MI TN 37 AL OH 28 GA PA 41 NC 33 SC FL 30 ME MD NH MA RI CT NJ DE ARIZONA INDIANA CALIFORNIA PENNSYLVANIA TENNESSEE NORTH CAROLINA MASSACHUSETTS OHIO TEXAS WASHINGTON

45 Oxycodone 30mg- Top Rx $14-$25 Distribution: Local / North West / ND Increase other Schedule II s, III s Hydromorphone Dilaudid (4mg) $9 Oxymorphone Opana (40mg) $30 Methadone (10mg) $7- $10 Hydrocodone (10mg) $3- $5 October 6 th Schedule III to II Increase Alprazolam Xanax $2-5 Increase Carisoprodol Soma

46 Combating the Prescription Drug Problem Education Parents, Youth, Patients, Health Care Providers Enforcement Monitoring Prescription Drug Monitoring Program(PDMP) Proper Medication Disposal DEA National Take Back Initiative (NTBI XI) April 30, 2016 April 30, :00 AM 2:00 PM SOURCE: ONDCP s 2011 Prescription Drug Abuse Prevention Plan released on Tuesday, April 19,

47 Oakland Tactical Diversion Squad 10 th National Take Back Day: September 26, Total Collection Sites: 5, VT NH DC NJ 26 DE 79 MD 17 PR & VI 176 MA 35 RI 66 CT 21 HI & Guam Drug Enforcement Administration Diversion Control Program

48 64,888 2,766 8,934 19,320 Oakland Tactical Diversion Squad 10 th National Take Back Day: September 26, ,547 2,899 4,625 10,601 3,291 HI & GU Total Weight Collected (pounds): 742,771 (371 Tons) 2,746 20,369 6,285 1,495 62,277 1,139 5,600 2,123 11, ,853 6,360 13,245 8,643 40,240 37,890 3,489 47,233 18,400 9,497 17,427 1,800 6,402 24,396 MA 27,192 5,800 VT 15,995 12,014 5,320 10,167 Drug Enforcement Administration Diversion Control Program 30,193 49,567 6,880 27,229 7,767 NH 897 PR & VI 2,883 RI 6,501 CT 14,875 NJ 889 DC 19,760 7,227 DE 7,593 MD

49 Law Enforcement Sensitive Oakland How Are Tactical We Addressing Diversion the Squad Threat? Enhance Data to Identify and Track Problems Prescription Drug Monitoring Program (PDMP), Medical Examiners (ME s) and Other Sources Vigilant Enforcement and Regulation Identify the Threat DEA Registrants Operating Outside the Law Address the Threat Tactical Diversion Squads (TDSs): 80 Nationally Agents, Diversion Investigations, Intel Analysts

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