Steven Group Supervisor - American College Health ... · • San Juan/Ponce • Seattle • Seattle...

Oakland Tactical Diversion Squad

Steven SmithGroup Supervisor


• 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


Personnel• Group Supervisor• Special Agents • Task Force Officers

o San Ramon Police Departmento Marin County Sheriff ’s Office

• Diversion Investigator• Intelligence Analyst• Data Analyst


Napa

Contra CostaSan Francisco

San Mateo

Santa Cruz

Marin

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


Prescription Drug Abuse“An American Epidemic”


National Overdose DeathsNumber of Deaths from Prescription Drugs

0

5,000

10,000

15,000

20,000

25,000

30,000 Total Female Male

Source: National Center for Health Statistics, CDC Wonder


7

Number of Drug Induced Deaths Compared to the Number of Motor Vehicle and Firearm Deaths, 2004 ‐ 2013


More deadly to its population

Source: CDC, National Center for Health Statistics


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


0

2

4

6

8

10

12

14

16

1618202122232425262728293031323334353637383940414243444546474849505152535455565758596061626364656667686971737580

FREQUENCY

AGE OF DECEDANT

Age at Death from Prescription Drugs – 2010(Source: Clark County Coroner's Office)

Average age at Death: 44.42 yearsHighest Frequency: 48 years (14 deaths)Range: 16 years – 80 years Total Deaths: 289 Deaths

Clark County Coroner’s Office 2010


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 OPIOIDS1

22,767 Prescription

21,215 Non-

Presription

22,767 Rx related

16,2356,532

Opioid

Non-Opioid

16,235 involving OPIOIDS1CDC: Prescription Drug Overdose in the United States : Fact Sheet updated 2/9/2015


• 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


National Overdose DeathsNumber of Deaths from Prescription Opioid Pain Relievers

0

2,000

4,000

6,000

8,000

10,000

12,000

14,000

16,000

18,000




Source: IMS HEALTH April 2014, Medicine use and shifting costs of healthcare. A review of the use of medicines in the United States.

0

20

40

60

80

100

120

140

160

2009 2010 2011 2012 2013

HYDROCODONE/ACETAMINOPHENPain RelieverLEVOTHYROXINE Thyroid

LISINOPRIL High Blood Pressure

METOPROLOL High Blood Pressure

SIMVASTATIN High Cholesterol

Represented in Millions


AK

AL

AR

CA1.048B

CO

ID

IL330M

IN286M

IA

MN

MO

MT

NE

NV

ND

OH284M

OK

OR

TN425M

UT

WA

AZ

SD

NM

VA

WYMI

428M

GA284M

KS

HI

TX849M

ME

MS

WINY

LA

KY

NC

SC257

FL377M

WV

Hydrocodone Orders 2013

• 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• 257,783,878PHARMACIES AND PRACTIONERS


Law Enforcement Sensitive

An American Epidemic


AK

AL

AR

CA314M

CO

ID

IL IN

IA

MN

MO

MT

NE

NV

ND

OH274M

OK

OR

TN166

UT

WA

AZ178M

SD

NM

VA

WYMI

GA

KS

HI

TX

ME

MS

WINY

290M

LA

KYNC

245M

SC

FL319M

WV

Oxycodone Orders 2013

• 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

NJ 183M

MA 151M

PHARMACIES AND PRACTIONERS


OXYCODONE SALES CALIFORNIA

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

100,000,000

2008 2009 2010 2011 2012 2013

10 MG

30 MG

80 MG


U.S. Drug Enforcement AdministrationOffice of Diversion Control

20


OXYCODONE SALES NEW YORK

0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

2010 2011 2012 2013

10 MG

30 MG

80 MG


OXYCODONE SALES FLORIDA

0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

2010 2011 2012 2013

10 MG

30 MG

80 MG


OXYCODONE SALES 80 mg CA, FL, NY

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

2010 2011 2012 2013

CA

FL

NY



0

50,000,000

100,000,000

150,000,000

200,000,000

250,000,000

300,000,000

350,000,000

2010 2011 2012 2013

CA

FL

NY



0

10,000,000

20,000,000

30,000,000

40,000,000

50,000,000

60,000,000

70,000,000

80,000,000

90,000,000

100,000,000

2010 2011 2012 2013

CA

FL

NY


• 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



Fentanyl Deaths


Prescription Painkillers to HeroinContributing 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


Hydrocodone(Vicodin®, Lortab,® Lorcet®)

Oxycodone(Percocet®, Percodan®, Roxicodone®)

Fentanyl

Heroin


30



Overview


• Alprazolam/ Xanax® (Schedule IV)

Benzodiazepines “Benzos”

Anti-anxiety/nervous tension

Extremely addictive

• Diazepam /Valium ® (Schedule IV)

Benzodiazepines “Benzos”

• Carisoprodol/Soma® (Schedule IV)

Sedative


National Overdose DeathsNumber of Deaths from Benzodiazepines

0

1,000

2,000

3,000

4,000

5,000

6,000

7,000

8,000




• “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


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


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



• 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


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



• 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


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



• 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



• 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


HI

30

AK

AL

AR

CA60

CO

ID

IL IN71

IA

MN

MO

MT

NE NV

ND

OH28

OK

OR

TN 37

UT

WA23

AZ

77

SD

NM

WY MI

GA

KS

TX 24

ME

MS

WI

PA 41

LA

NC 33

SC

FL

NH MARI CT

NJ

DE

VT

Pharmacy Armed Robberies2013

MD

• ARIZONA• INDIANA• CALIFORNIA• PENNSYLVANIA• TENNESSEE• NORTH

CAROLINA• MASSACHUSETTS• OHIO• TEXAS• WASHINGTON


• 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 6th Schedule III to II

• Increase Alprazolam “Xanax®” $2-5• Increase Carisoprodol “Soma®”


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

46SOURCE: ONDCP’s 2011 Prescription Drug Abuse Prevention Plan released on Tuesday, April 19, 2011

April 30, 201610:00 AM – 2:00 PM


10th National Take Back Day: September 26, 2015Total Collection Sites: 5,202

85

123 178

81

63

56

125

167176MA35RI66CT

66VT

87NH

17PR & VI

21957

44

5819

296

18

139

24

18

46

146

229

93

348

25

21 HI & Guam

150

215NJ

33

188

26 96

258

246

79

90

44

27

9

208

41

101

120

22

26DE

79MD

Diversion Control Program

19DC

Drug Enforcement Administration


10th National Take Back Day: September 26, 2015Total Weight Collected (pounds): 742,771 (371 Tons)

5,32010,167

12,0149,497

17,427

5,800VT

24,396MA

897PR & VI

47,23318,400

62,277

1,139

20,3694,625

27,192

6,285

64,888

2,547

3,291HI & GU

30,193

2,883RI

6,501CT

14,875NJ

19,760

7,767NH

1,495

11,4795,600

2,746

763 14,853

3,489

37,890

1,8006,402

49,567

15,995

10,601

19,320

8,934

2,899

2,766

40,240

6,360

13,245

8,643

2,123

6,88027,229

7,227DE

7,593MD

Diversion Control Program

889DC

Drug EnforcementAdministration



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

How Are We Addressing the Threat?

Steven Group Supervisor - American College Health ... · • San Juan/Ponce • Seattle • Seattle...

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