Drug Trends &Trafficking I/S Brian Dempsey

Drug Trends &Trafficking I/S Brian Dempsey 412-777-6945 brian.w.dempsey@usdoj.gov

Sources

360 Degree Strategy Strategic collaboration and guidance via three interconnected avenues. Community (Outreach, Education & Prevention) Enforcement (Local, State & Federal) Diversion / Regulatory

Counties of the Western Judicial District Of Pennsylvania

Trends Over Time 2010- Opioids Heroin Synthetics 2000 s Methamphetamine Opioids 90 s Methamphetamine Ecstasy 80 s Cocaine/Crack 60 s/70 s Marijuana Psychedelics

DREAM LAND

Drug Overdose Deaths In 2009, drugs passed traffic accidents as the #1 cause of death, killing 37,000+ In 2015, drugs have killed 47,000+ In 2016, drugs have killed 64,000+ Fuel - Rx drugs Substance Abuse and Mental Health Services Administrator s National Survey on Drug Use and Health (NSDUH) *Substance Abuse

Opiates VS Opioids Opiates - Narcotic Analgesic derived from an Opium Poppy (Natural) - Not manufactured by chemical synthesis - Derived for the Opium Poppy Plant Opioids - A synthetic narcotic that mimics the natural poppy plant - Chemically manufactured narcotics - Narcotic analgesic that is not found in nature

Actual Billboards in Baltimore, MD

Heroin 101 Heroin Stamp Bag Weighs Approximately.01 to.03 gms Heroin Stamp Bags Cost $5 to $15 Heroin BUNDLE Consists of 10 Individual Stamp Bags Heroin BUNDLE Costs $50 to $80 Heroin BRICK Consists of 50 Individual Stamp Bags Heroin BRICKS Cost $150 to $400 One (1) Gram of Heroin Sells for $150 One (1) Ounce of Heroin Sells for $2,000 to $3,000 One (1) Kilogram of Heroin Sells for $50,000 to $80,000

Heroin Types

Heroin Types (Cont.)

Carfentanil Pill

Heroin Stamp Bags

Groups of Prescription Drugs Abused Opioids: Derived from the opium poppy, or synthetic versions of it; for pain relief. Benzodiazepines: Central nervous system (CNS) depressants used as sedatives to induce sleep, prevent seizures, and relieve anxiety. Amphetamine-Like Drugs: CNS stimulants used to treat attention deficit hyperactivity disorder (ADHD).

Pennsylvania Prescription Drug Monitoring Program In 2015: 79,706 prescribers issued 6,608,691 prescriptions for Oxycodone and Hydrocodone Products TOTALING 475,192,963 DOSAGE UNITS The total dosage units dispensed in 2015 equates to About 37 pills for every Pennsylvanian.

Popular Prescription Drugs of Abuse Oxycodone OxyContin Percocet/Percodan Oxymorphone Opana Amphetamine Mix Adderall #1 Hydrocodone Vicodin Norco Lortab Alprazolam Xanax Suboxone/Subutext Valium #2 #3

Popular Prescription Drug Prices (Pittsburgh) SUBOXONE - $10 TO $20 HYDROCODONE 7.5 mg - $3 TO $7 OXYCODONE 30 mg - $30 TO $50 OXYCONTIN 80 mg - $30 TO $60 OXYMORPHONE 40 mg - $35 TO $140 PERCOCET 10 mg - $7 TO $9 ROXYCODONE 30 mg - $15 TO $30 XANAX 2 mg - $3 TO $7

Pittsburgh District Office 25 Counties & Over 20,000 Registrants 940 15,000 160 1,470 1,710 187 6 1 Pharmacies Physicians Hospitals/Clinics Certified Nurse Practitioners Physician Assistants Researchers Distributors Manufacturer

Methadone Treatment Programs In Western Pennsylvania Treatment Programs report prescription drugs as primary drugs of abuse for many of their patients. 1995: Western Pennsylvania had 6 Methadone Clinics 2005: Western Pennsylvania had 20 Methadone Clinics 2015: Western Pennsylvania had 29 Methadone Clinics 2016: Western Pennsylvania had 32 Methadone Clinics The 2015 figure does not include approximately 796 physicians who are licensed in Western Pennsylvania to prescribe Buprenorphine (Suboxone/Subutext) for the treatment of drug addiction.

2016 4,642 DRUG RELATED OVERDOSE DEATHS This Number Represents a 37% increase in Overdose Deaths from 2015. This Number Established a Death Rate of 36.5 per 100,000 People. In 2016, approximately 13 people died of a drug-related overdose each day.

2016 4,642 DRUG RELATED OVERDOSE DEATHS In 2016, the presence of a prescription or illicit opioid was identified in 85% of the overdose deaths. Fentanyl and fentanyl-related substances were the most frequently identified (52% of deaths), exceeding heroin (45 % of deaths) for the first time.

2016 4,642 DRUG RELATED OVERDOSE DEATHS Younger Pennsylvanian s were impacted significantly; individuals aged 15-24 had a 380% increase in their odds of a fentanyl-related death than other age groups, while individuals aged 25-34 had a 970% increase in their odds of dying of a heroin-related overdose when compared to other age groups.

Number of Drug-Related Overdose Deaths in Pennsylvania Counties, 2015 Source: Pennsylvania Coroner Data

Number of Drug-Related Overdose Deaths in Pennsylvania Counties, 2016 Source: Pennsylvania Coroner Data

2016 Overdose Deaths of five or more in Beaver County by Zip Code 15001: 18 Overdose Deaths 15009: 16 Overdose Deaths 15010: 10 Overdose Deaths 15003: 8 Overdose Deaths 15074: 8 Overdose Deaths 15066: 7 Overdose Deaths 15061: 7 Overdose Deaths 16115: 5 Overdose Deaths Source: Pennsylvania Coroner Data

2016 Beaver County Overdoses Top Ten Drugs/Number of Cases With Drug Present Fentanyl 75 (73.5%) Buprenorphine 11 (10.8%) Cocaine 40 (39.2%) Diazepam - 11 (10.8%) Heroin - 37 (36.3%) Amphetamine - 8 (7.8%) Ethanol - 21 (20.6%) Oxycodone - 7 (6.9%) Alprazolam 18 (17.6%) Hydrocodone - 6 (5.9%) Source: Pennsylvania Coroner Data

Rate of Overdose Deaths Per 100,000 People in Pennsylvania Counties, 2016 Source: Pennsylvania Coroner Data

Rate of Overdose Deaths Per 100,000 People in Pennsylvania Counties, 2015 & 2016 Source: Pennsylvania Coroner Data

Percent Change in Drug Related Overdose Deaths in Pennsylvania Counties, 2015 & 2016 Source: Pennsylvania Coroner Data

Most Frequently Reported Drug Category in Drug Related Overdose Decedents in Pennsylvania Counties, 2015 & 2016 Source: Pennsylvania Coroner Data

Fentanyl

Fentanyl Citrate/Fentanyl HCL Schedule II

Primer on Synthetic Opioids

DEA National Forensic Laboratory Information System (NFLIS) January 2013 December 2016: 50,440 Fentanyl Reports 2013: 1,041 Fentanyl Reports 2016: 28,751 Fentanyl Reports CDC Morbidity & Mortality Weekly Report dated December 2016: The death rate from Synthetic Opioids (other than Methadone), which includes fentanyl, from 2014 to 2015, increased by 72.2% from 5,544 to 9,581.

Primer on Synthetic Opioids

Lethal Doses of Heroin, Fentanyl & Carfentanil

Primer on Synthetic Opioids On March 1, 2017, as a result of meeting with DEA, China agreed to regulate the following four fentanyl-related Substances under Chinese law: - Carfentanil - Furanyl Fentanyl - Acryl Fentanyl - Valeryl Fentanyl

Grey Death

2016 Fentanyl 4-methoxybutyrylfentanyl Acetylfentanyl Butyrylfentanyl 3-methylfentanyl (cis and trans) Furanyl fentanyl Para-fluoroisobutyryl fentanyl U-47700 Law Enforcement Sensitive Western Pennsylvania Seizures of Synthetic Opioids 2017 Butyrylfentanyl Carfentanil Cyclopropylfentanyl Furanyl fentanyl Methoxyacetyl fentanyl Acrylfentanyl U-47700

Availability of Fentanyl Products Via the Internet

Acetyl Fentanyl Internet Sales

Availability of Fentanyl Products Via the Internet Product Form Description U-47700 HCl powder, nasal spray, vape juice, edibles (gummy bears) Synthetic opioid MethoxyAcetylFentanyl Powder, nasal spray Fentanyl analog Gabapentin Pill Pill that treats nerve pain Epitalon Injection Anti-aging drug Elavil (Amitriptyline) Pill Treats neuropathic pain and mental illnesses Selank Injection Nootropic mental stimulant

Availability of Fentanyl Products Via the Internet 4-MEC a-php a-pvp AH-7921 Fentanyl powder (Attachment 2) Dibutylone crystal MDPV Furanyl fentanyl Pentedrone Methylone Crystals 25 I-NBOMe 2-FMA Hydrocodone Watson 853 Crystal Meth Soma Cocaine Vicodin Hydrocodone Watson 540 5F-AKB48 RoxiCodone AB-Chminaca Tramadol AM-2201 Actavis promethazine with codeine cough syrup Zolpidem 5fur 144 Methoxetamine AB-Pinaca Molly MDMA Pills PB-22 LSD pills Soma LSD powder Ketamine-Racemic LDS blotters Pure MDMA Diazepam Zopiclone

Availability of Fentanyl Products Via the Internet

CARFENTANIL

Primer on Synthetic Opioids

www.operationprevention.com There is a growing epidemic of prescription opioid misuse and heroin use nationwide. To combat this, Discovery Education and the DEA have joined forces to bring you Operation Prevention, a new education program for middle and high school classrooms which aims to educate students, using science, about the impacts of these drugs.

OverdoseFree PA