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handout ( format)
Oakland Tactical Diversion Squad Steven Smith Group Supervisor Oakland Tactical Diversion Squad • • • • • • • • • • • • • • • • • 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 Oakland Tactical Diversion Squad Personnel • Group Supervisor • Special Agents • Task Force Officers o San Ramon Police Department o Marin County Sheriff ’s Office • Diversion Investigator • Intelligence Analyst • Data Analyst Oakland Tactical Diversion Squad • • • • • • • • • • • • • • • 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 Oakland Tactical Diversion Squad Prescription Drug Abuse “An American Epidemic” Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad Number of Drug Induced Deaths Compared to the Number of Motor Vehicle and Firearm Deaths, 2004 ‐ 2013 7 Oakland Tactical Diversion Squad More deadly to its population Source: CDC, National Center for Health Statistics Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad Age at Death from Prescription Drugs – 2010 (Source: Clark County Coroner's Office) 16 14 F 12 R E 10 Q U 8 E N 6 C Y 4 2 0 16 18 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 71 73 75 80 AGE OF DECEDANT Average age at Death: Highest Frequency: Range: Total Deaths: Clark County Coroner’s Office 2010 44.42 years 48 years (14 deaths) 16 years – 80 years 289 Deaths Oakland Tactical Diversion Squad 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 Rx related 21,215 NonPresription 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 Oakland Tactical Diversion Squad • 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) • Carisoprodol/Soma® (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS • Cough Syrup (Schedule V) • Adderall® (Schedule II) DEPRESSANTS/SEDATIVES/TRANQUILIZERS DEPRESSANTS/SEDATIVES/TRANQUILIZERS STIMULANT Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 160 140 120 HYDROCODONE/ACETAMINOPHEN Pain Reliever 100 LEVOTHYROXINE Thyroid 80 LISINOPRIL High Blood Pressure 60 METOPROLOL High Blood Pressure 40 SIMVASTATIN High Cholesterol 20 0 2009 2010 2011 2012 2013 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. Oakland Tactical Diversion Squad Hydrocodone Orders 2013 WA MT ND OR MN MI 428M WY IA NE NV UT CO KS CA 1.048B OH IN 284M IL 330M 286M • WV VA MO OK NM TN 425M MS TX 849M • TEXAS • 849,374,257 • MICHIGAN • 428,622,176 SC 257 AR AL CALIFORNIA • 1,048,899,555 KY NC AZ AK NY WI SD ID ME GA 284M • TENNESSEE • 425,412,142 • FLORIDA • 377,085,421 • LA FL 377M ILLINOIS • 330,379,629 • INDIANA • 286,312,679 • OHIO • 284,657,108 • GEORGIA • 266,530,942 HI PHARMACIES AND PRACTIONERS • SOUTH CAROLINA • 257,783,878 Law Enforcement Sensitive Oakland Tactical Diversion Squad An American Epidemic Oakland Tactical Diversion Squad Oxycodone Orders 2013 WA MT ND OR MN NJ 183M MI WY IA NE NV MA 151M NY 290M WI SD ID ME UT IN KS VA OK NM AR MS TX AK NC 245M TN 166 AL • FLORIDA • 317,828,015 KY MO PENNSYLVANIA • 319,344,791 WV CO CA 314M AZ 178M IL • OH 274M SC • • 314,670,367 • NEW YORK • 290,087,245 • GA CALIFORNIA OHIO • 274,860,782 • NC • 245,122,856 LA FL 319M • NEW JERSEY • 183,685,620 • ARIZONA • 178,537,952 • • 166,821,336 HI • PHARMACIES AND PRACTIONERS TENNESSEE MA • 151,848,808 Oakland Tactical Diversion Squad OXYCODONE SALES CALIFORNIA 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 10 MG 50,000,000 30 MG 40,000,000 80 MG 30,000,000 20,000,000 10,000,000 0 2008 2009 2010 2011 2012 2013 Oakland Tactical Diversion Squad U.S. Drug Enforcement Administration Office of Diversion Control 20 Oakland Tactical Diversion Squad OXYCODONE SALES NEW YORK 90,000,000 80,000,000 70,000,000 60,000,000 10 MG 50,000,000 30 MG 40,000,000 80 MG 30,000,000 20,000,000 10,000,000 0 2010 2011 2012 2013 Oakland Tactical Diversion Squad OXYCODONE SALES FLORIDA 350,000,000 300,000,000 250,000,000 10 MG 200,000,000 30 MG 150,000,000 80 MG 100,000,000 50,000,000 0 2010 2011 2012 2013 Oakland Tactical Diversion Squad OXYCODONE SALES 80 mg CA, FL, NY 25,000,000 20,000,000 15,000,000 CA FL NY 10,000,000 5,000,000 0 2010 2011 2012 2013 Oakland Tactical Diversion Squad OXYCODONE SALES 30 mg CA, FL, NY 350,000,000 300,000,000 250,000,000 CA 200,000,000 FL 150,000,000 NY 100,000,000 50,000,000 0 2010 2011 2012 2013 Oakland Tactical Diversion Squad OXYCODONE SALES 10 mg CA, FL, NY 100,000,000 90,000,000 80,000,000 70,000,000 60,000,000 CA 50,000,000 FL 40,000,000 NY 30,000,000 20,000,000 10,000,000 0 2010 2011 2012 2013 Oakland Tactical Diversion Squad • 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 Law Enforcement Sensitive Fentanyl Deaths Oakland Tactical Diversion Squad Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad Oxycodone (Percocet®, Percodan®, Roxicodone®) Fentanyl Hydrocodone (Vicodin®, Lortab,® Lorcet®) Heroin Oakland Tactical Diversion Squad 30 Oakland Tactical Diversion Squad Law Enforcement Sensitive Oakland Tactical Diversion Squad Overview Oakland Tactical Diversion Squad • Alprazolam/ Xanax® (Schedule IV) Benzodiazepines “Benzos” Anti-anxiety/nervous tension Extremely addictive • Diazepam /Valium ® (Schedule IV) Benzodiazepines “Benzos” • Carisoprodol/Soma® (Schedule IV) Sedative Oakland Tactical Diversion Squad National Overdose Deaths Number of Deaths from Benzodiazepines 9,000 Total Female Male 8,000 7,000 6,000 5,000 4,000 3,000 2,000 1,000 0 Source: National Center for Health Statistics, CDC Wonder Oakland Tactical Diversion Squad • “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 Oakland Tactical Diversion Squad 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 • • • • • Oakland Tactical Diversion Squad 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 • • • • Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 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 • • • • Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad 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 Oakland Tactical Diversion Squad Pharmacy Armed Robberies 2013 VT WA 23 ND MT ME NH MA RI CT MN 30 OR WI SD ID MI PA 41 WY IA NE IL NV UT CO CA 60 IN 71 OH 28 DE MD KS MO NC 33 AZ NM NJ OK TN 37 77 MS TX 24 AK HI SC AR LA AL GA FL • • • • • • • • • • ARIZONA INDIANA CALIFORNIA PENNSYLVANIA TENNESSEE NORTH CAROLINA MASSACHUSETTS OHIO TEXAS WASHINGTON Oakland Tactical Diversion Squad • Oxycodone 30mg- Top Rx $14-$25 Distribution: Local / North West / ND • Increase other Schedule II’s, III’s • Hydromorphone “Dilaudid®” (4mg) • Oxymorphone “Opana®” (40mg) • Methadone (10mg) • Hydrocodone (10mg) • October 6th Schedule III to II • Increase Alprazolam “Xanax®” • Increase Carisoprodol “Soma®” $9 $30 $7- $10 $3- $5 $2-5 Oakland Tactical Diversion Squad 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, 2016 10:00 AM – 2:00 PM SOURCE: ONDCP’s 2011 Prescription Drug Abuse Prevention Plan released on Tuesday, April 19, 2011 46 Oakland Tactical Diversion Squad 10th National Take Back Day: September 26, 2015 Total Collection Sites: 5,202 66 VT 90 24 44 44 27 18 46 348 79 139 93 9 58 22 176 MA 35 RI 66 215 CT NJ 26 DE 258 146 246 120 219 101 18 296 229 57 208 56 123 178 188 33 19 DC 81 125 79 MD 63 26 96 85 150 21 HI & Guam 167 19 41 25 87 NH Drug Enforcement Administration Diversion Control Program 17 PR & VI Oakland Tactical Diversion Squad 10th National Take Back Day: September 26, 2015 Total Weight Collected (pounds): 742,771 (371 Tons) 19,320 5,800 7,767 VT 2,746 1,495 8,934 19,760 24,396 MA 5,600 2,899 NH 2,883 11,479 2,123 14,853 763 RI 49,567 6,501 CT 2,547 6,360 47,233 4,625 20,369 64,888 10,601 15,995 8,643 13,245 1,139 6,285 40,240 27,192 18,400 5,320 10,167 7,593 MD 889 DC 6,402 62,277 3,291 HI & GU 12,014 7,227 DE 27,229 17,427 1,800 2,766 NJ 6,880 9,497 37,890 14,875 3,489 Drug Enforcement Administration Diversion Control Program 30,193 897 PR & VI Law Enforcement Sensitive Oakland How AreTactical We Addressing Diversion theSquad 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 Oakland Tactical Diversion Squad Oakland Tactical Diversion Squad
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