9/13/2017 DEA WHO WE ARE: Prescription Drug Abuse. American Association of Service Coordinators September 24-27, 2017 Disney s Coronado Springs Resort

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1 DEA FIELD OFFICES IN FLORIDA Miami Divisional Office David Wickey, GS Orlando District Office Linda Stocum, GS Tampa District Office Amie Hickerson, GS Tallahassee/Jacksonville Offices Michael Jones, GS West Palm Beach Office Marsha Ikner, GS Prescription Drug Abuse American Association of Service Coordinators September 24-27, 2017 Disney s Coronado Springs Resort DEA Established in 1973 by President Richard Nixon Only single mission federal drug law enforcement agency (The Controlled Substances Act) 221 Domestic Field Offices 91 Foreign Field Offices in 70 countries Over 10,000 employees worldwide Special Agents Diversion Investigators Chemists Intelligence Analysts Support Staff WHO WE ARE: 1

2 THE CONTROLLED SUBSTANCES ACT (CSA) Sets forth regulations that establish a closed system of distribution requiring all legitimate handlers of controlled substances and listed chemicals, such as importers/exporters, manufacturers, distributors, physicians and pharmacies to be licensed with DEA and to maintain strict accountability of all controlled substance transactions. Drugs are placed into lists or schedules I-V depending on their abuse/addiction potential and accepted medical use DIVERSION CONTROL DIVISION Regulatory Arm of DEA Prevent, Detect and Investigate the Diversion of Controlled Pharmaceuticals from legal channels Ensure an adequate and uninterrupted supply for legitimate purposes Cost covered by registration fees, not taxes What Happened? For a myriad of reasons, we are the most highly medicated society in the world A perfect storm mix of medication and marketing hit in the form of Oxycontin. The drug manufacturer marketed their drug directly to the people who wrote the prescriptions (the ones who decided what drug was best to treat our aches and pains): Doctors Consequently, the most easily abused and addictive drugs were over-prescribed to the most highly medicated society in history Capitalism 101: Nobody asked the maker of Oxycontin to come up with a drug that was 4x, 8x, 16x or 32x stronger than what was already on the market, but they did and they convinced the doctors that it was foolproof and their patients needed it. 2

3 OPIOID CRISIS People trusted their doctors to do the right thing, but the doctors listened to the marketing guys and didn t do what doctors are supposed to do (Dr. Drug Dealer) People trusted their pharmacists to do the right thing, but the pharmacists listened to the doctors and didn t do what pharmacists are supposed to do (question the Dr.) People trusted their neighbors and relatives to ultimately do what was best and quit abusing such readily available drugs, but our neighbors wouldn t (or couldn t) do the right thing because it was too late, they were addicted Doctors and pharmacists continue to give people what they want, in spite of the fact that it is not good for them. It is easier than doing the right thing (and far more profitable) Circle of Addiction Normally starts with a dependence on a low-level narcotic prescription such as Vicodin, Lortab or Lorcet Once dependence, addiction and tolerance occur a stronger narcotic, such as a oxycodone, is necessary to feed the need Eventually an even stronger narcotic is needed. OxyContin (10-80mg) was easily abused by crushing and available at $25- $80 per tablet Eventually, due to the high street cost of OxyContin, heroin became a cheaper alternative, readily available at $10 a bag But Heroin is much less reliable and more dangerous THE SUPPLY AND DEMAND PROBLEM 5% of World Population 85% of Oxycodone Consumed 99% of Hydrocodone Consumed 80% of New Heroin Abusers Start with Controlled Substances 3

4 What Did DEA Do? DEA is not the Board of Medicine. We do not regulate the practice of medicine. We don t tell doctors HOW to be doctors, we only say they have to issue prescriptions in the usual course of professional practice based on a legitimate medical need (a doctor has to do what a doctor is supposed to do). Primary responsibility for that prescription rests on the prescribing practitioner, BUT a CORRESPONDING RESPONSIBILITY rests on the pharmacist filling the prescription. As an Enforcement/Regulatory Agency, DEA took the Criminal, Administrative and Civil steps available to it to prevent diversion and protect the public interest But we don t provide treatment resources for addicts. We regulate those treatment resources Where Do Prescription Drugs Come From? 1) Friends 2) Prescription Fraud (Forged prescriptions) 3) Doctor Shopping 4) Internet 5) Pain Clinics 6) Medicine Cabinets 7) Pharmacy Thefts/Losses 8) Street Dealers 9) Family Doctors 4

5 THE OPIOID CRISIS Every day prescription drugs are abused in the United States at an alarming rate. OVERDOSES: Not all Overdoses are Fatal or Intentional Overdoses involving Fentanyl are Growing in number and are more likely to be fatal. Fentanyl is a pharmaceutical drug, used as a painkiller for Cancer Patients in small doses. Fentanyl Powder is being illegally imported from China and mixed with heroin, cocaine, oxycodone and just about every other abused drug because it s cheap, easily synthesized in a lab, readily available and very potent A lot of people who overdose on Fentanyl don t know that s what they re taking. and a lot just don t care. A lot of people who overdose have gotten clean and go back to abusing drugs at the level they had built up a tolerance to with lethal results DEA Continues to Respond to America s Prescription Drug Abuse Crisis 5

6 What You Can Do? Be Informed, Understand the power and danger of medications you take Ask your doctor, pharmacist about your medications and their potential for addictiveness Empty your medicine cabinet of unused/unneeded meds Read drug labels to understand the effects of the drugs you are prescribed Don t share medications or self-medicate Be responsible for yourself and your family Treatment Options: Narcotic Addicts have limited options Methadone: Clinic based treatment. Incorporates use of long-acting narcotic to fill receptors, thereby blocking withdrawal symptoms Methadone only dispensed from licensed and registered Opioid Treatment Programs, not by prescription. Involves counseling and is not necessarily designed to end. Not usually covered by insurance. Suboxone/Buprenorphine: Approved for Office-Based Opioid Treatment. Certified Physicians can write prescriptions which can be filled at any pharmacy and possibly covered by insurance. Treatment effectiveness depends on both the addict and the treating physician. Not all physicians include counseling and other ancillary treatments. Rapid Detox Addiction/Drug Abuse is a: Healthcare Problem Social Problem Family Problem Educational Problem Financial Problem Personal Problem Crime Problem Problem for All of Us 6

7 James Graumlich Diversion Investigator DEA Orlando District Office Diversion Group 300 International Parkway Suite 424 Heathrow, FL