We are not the Boogeyman! Detective A. McMillan Prince William County Police Narcotics Unit

Transcription

1 We are not the Boogeyman! Detective A. McMillan Prince William County Police Narcotics Unit

2 Objectives Provide a background of the law enforcement initiative with the current heroin problem and how we have come to work with medical professionals increase its effectiveness. Provide a law enforcement perspective of patient / prescriber crimes Provide methods to combat the current problems with cooperation between health care entities and law enforcement.

3 Prince William County Prince William County Square Miles Multiple Cities / Townships that vary from rural to suburban Current population - 422, 727 Large commuter population via I95 and I66. Police Department 820 (635 Sworn, 116 civilian, 46 crossing guard, 23 animal control) Special Investigations Bureau 32 (6 supervisors, 26 detectives) Narcotics Unit 12 Detectives Street Crimes Unit 10 Detectives Gang Unit 4 Detectives

4 An Emerging Problem -Increase in availability of opioids -Decrease in price -Significant increase in Overdoses within Prince William County

5 Operation Blue Dragon Dragonslayer Three key areas were addressed simultaneously to try and impact the problem. Enforcement Treatment Education Impact

6 Enforcement Multi-tiered - (Low level, mid level, upper level dealers, as well as doctors.) Large in scope - (keep public interest, keep dealer interest, significant short term impact.) Sustained - (reinforces messaging and disrupts drug flow.) Efficient - (utilize available resources at maximum capacity)

7 Best way to break the revolving door for addicts is to get them well. Partnering with stakeholders in community to address the addiction aspect of the problem. Community Services Board (CSB) Faith based community Medical Community Treatment LE initiated invitation to get treatment During this major life event, or rock bottom event, treatment was made available upon release from booking. CSB provided full support and staffing to accommodate those seeking treatment.

8 EDUCATION Use of media to amplify public awareness. Embedded reporter from Washington Post Large coverage locally and nationally Exposed large segments of county to dangers of pharmaceutical and Heroin abuse. Focus on educating school staff, medical professionals, doctors, EMS, and community services on diverted pharmaceuticals and Heroin. Meeting with any and all civic and community groups that request this kind of training.

9 Why haven t we done this yet? Law enforcement traditionally dedicated solely to enforcement We cannot arrest our way out of this problem. Public pressure to extend beyond simple enforcement. Little training provided to govern interactions with medical community Lack of training with regards to privacy laws :03 Allows for release of certain information but requires in writing and justification. Distrust between medical community and law enforcement Nationally, law enforcement has been seen as self serving and aggressive Us Vs. Them mentality Lack of cooperation breeds mistrust and no confidence in both institutions They just want to arrest everyone and destroy their careers! They just want to protect their own while the patients overdose!

10 Public Pressure

11 Initiative Development Criminal Investigations of doctors stemming from multiple complaints for providing narcotics without performing exams Discovered a law enforcement prescribing spectrum of medical professionals Only had investigative techniques set up with one aspect of spectrum Enforcement Only Problematic because not appropriate in most situations Began non-enforcement communication with medical community Directly with prescribers / office managers in private practice Risk Management for hospitals (learned after repeated failed attempts to speak with hospital staff) Notifications regarding patients Information sharing is a two-way street Began providing information regarding patients with addictions, drug arrests, and diversion. (New PMP access allows LE to identify prescribers to make notifications).

12 Perfect Prescriber No LE action Law Enforcement Prescribing Spectrum Unknowing Prescribers LE to provide missing information to increase patient care ability Uneducated Prescribers Provide addiction/fraud training from LE perspective and experience Criminal Prescribers Clandestine Investigations

13 Problems with Unknowing and Uneducated Prescribers Most practitioners have good intentions, however: Little education and training in appropriate use of narcotic therapy Dosages / Risks / Addictions / Combinations Limited view of patient Exams / Interview / Observations Constantly changing regulations with AMA and CDC CDC released new guidelines for opiate use AMA removing pain as a vital sign? Misleading information from Pharmaceutical Manufacturer In 2006, Purdue Pharma agreed to plead guilty and pay more than $630 million to settle federal charges that it misled doctors and patients about the risks of its top-selling drug.

14 Education / Training Presentations are offered to medical practices to increase knowledge of current drug trends in the community and law enforcement perspectives on existing statutes.

15 Prescriptions to be issued and drugs to be dispensed for medical or therapeutic purposes only. Any practitioner who prescribes any controlled substance with the knowledge that the controlled substance will be used otherwise than medicinally or for therapeutic purposes shall be subject to the criminal penalties provided in for violations of the provisions of law relating to the distribution or possession of controlled substances.

16 Patients Patients do not provide all relevant information Ignorance - Patient does not know what is pertinent and what is not relevant Lack of education - Communication can be difficult to express medical concerns/advice to the patient Priorities Patients can have complicated lives which can cause conflicts with the practitioner and patient goals. Intentional Withholding Prescription Fraud Obtaining drugs, procuring administration of controlled substances, etc., by fraud, deceit or forgery. A. It shall be unlawful for any person to obtain or attempt to obtain any drug or procure or attempt to procure the administration of any controlled substance or marijuana: (i) by fraud, deceit, misrepresentation, embezzlement, or subterfuge; (ii) by the forgery or alteration of a prescription or of any written order; (iii) by the concealment of a material fact; or (iv) by the use of a false name or the giving of a false address.

17 Prescription Fraud Patients can intentionally withhold certain information that they feel might prevent a practitioner from prescribing the desired medication. This information can be anything from a drug addiction, having multiple prescribing physicians, or lying about pain levels. Tools to detect these patients Opiate Contracts layout expectations of patient PMP - detect any patterns of prescribing Urine Screens / Pill Count track drug use (legitimate and illegitimate) Relying on Pathology No true gauge for a patient s pain. Physical observations track marks, signs of drug abuse Consult LE for their experience with drug habits Does not necessary require providing information

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20 End Result Note found during fatal overdose investigation.

21 End Result Oxycodone Intoxication Hydromorphone, cyclobenzaprine, and DXM Oxymorphone, amphetamine, and trazadone

22 Patient/Practitioner Priorities Patient s and the practitioner s priorities can differ. Most patients want quickest and simplest solutions Obtain information from other sources - WebMD, social media, friends Practitioner must overcome patient s immediate desire and convince that person of the overall medical goal and how it benefits the patient. Want Vs. Need Denial of desired medication can drive away patients (clients).

23 Acknowledge Source of the Problem Among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin. (CDC)

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25 Make the First Move Either Law enforcement or prescriber/medical staff will have to reach out to the other with a problem LE can make notification of an addiction or diversion Prescriber can notify LE of a doctor shopper :03. Health records privacy Subsection D. Health care entities may, and, when required by other provisions of state law, shall, disclose health records: 31. To law-enforcement officials if the health care entity believes in good faith that the information disclosed constitutes evidence of a crime that occurred on its premises Establish a working relationship to educate both sides to achieve the overall goal of serving the community by improving patient care

26 Questions?