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Oakland Tactical Diversion Squad
Steven Smith
Group Supervisor
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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
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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
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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 Department
o Marin County Sheriff ’s Office
• Diversion Investigator
• Intelligence Analyst
• Data Analyst
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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
Prescription Drug Abuse
“An American Epidemic”
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
Number of Drug Induced Deaths Compared to the Number of Motor Vehicle and Firearm Deaths, 2004 ‐ 2013
7
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
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
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
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
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Hydrocodone/Norco®/Vicodin®(Schedule II) OPIOD
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Oxycodone/OxyContin® (Schedule II)
OPIOD
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Oxymorphone/Opana® (Schedule II)
OPIOD
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Methadone (Schedule II)
OPIOD
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Fentanyl (Schedule II)
OPIOD
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Alprazolam/Xanax® (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS
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Diazepam/ Valium® (Schedule IV)
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Carisoprodol/Soma® (Schedule IV) DEPRESSANTS/SEDATIVES/TRANQUILIZERS
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Cough Syrup (Schedule V)
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Adderall® (Schedule II)
DEPRESSANTS/SEDATIVES/TRANQUILIZERS
DEPRESSANTS/SEDATIVES/TRANQUILIZERS
STIMULANT
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
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.
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
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WV
VA
MO
OK
NM
TN
425M
MS
TX
849M
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TEXAS
• 849,374,257
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MICHIGAN
• 428,622,176
SC
257
AR
AL
CALIFORNIA
• 1,048,899,555
KY
NC
AZ
AK
NY
WI
SD
ID
ME
GA
284M
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TENNESSEE
• 425,412,142
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FLORIDA
• 377,085,421
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LA
FL
377M
ILLINOIS
• 330,379,629
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INDIANA
• 286,312,679
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OHIO
• 284,657,108
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GEORGIA
• 266,530,942
HI
PHARMACIES AND PRACTIONERS
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SOUTH CAROLINA
• 257,783,878
Law Enforcement Sensitive
Oakland
Tactical Diversion
Squad
An
American
Epidemic
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
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FLORIDA
• 317,828,015
KY
MO
PENNSYLVANIA
• 319,344,791
WV
CO
CA
314M
AZ
178M
IL
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OH
274M
SC
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• 314,670,367
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NEW YORK
• 290,087,245
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GA
CALIFORNIA
OHIO
• 274,860,782
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NC
• 245,122,856
LA
FL
319M
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NEW JERSEY
• 183,685,620
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ARIZONA
• 178,537,952
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• 166,821,336
HI
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PHARMACIES AND PRACTIONERS
TENNESSEE
MA
• 151,848,808
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
U.S. Drug Enforcement Administration
Office of Diversion Control 20
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
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
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
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
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
• 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 Heroin
Contributing to increased demand for heroin
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19x higher among former CPD abusers
80% of new heroin abusers were CPD abusers
Elevated risk
Reasons
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Price
Availability
Tolerance
OxyContin® reformulation
Oxycodone
(Percocet®, Percodan®, Roxicodone®)
Fentanyl
Hydrocodone
(Vicodin®, Lortab,® Lorcet®)
Heroin
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Oakland Tactical
Diversion Squad
Overview
• Alprazolam/ Xanax® (Schedule IV)
 Benzodiazepines “Benzos”
 Anti-anxiety/nervous tension
 Extremely addictive
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Diazepam /Valium ® (Schedule IV)
 Benzodiazepines “Benzos”
• Carisoprodol/Soma® (Schedule IV)
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Sedative
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
• “Dirty” registrants: e.g. Doctors, Nurses, Pharmacists,
etc.
• Illegal sales of legally obtained pills
• “Doctor shoppers”
• Fraudulent/ forged prescriptions
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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
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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
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• 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
• 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
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• 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
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
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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)
• Oxymorphone “Opana®” (40mg)
• Methadone (10mg)
• Hydrocodone (10mg)
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October 6th Schedule III to II
• Increase Alprazolam “Xanax®”
• Increase Carisoprodol “Soma®”
$9
$30
$7- $10
$3- $5
$2-5
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
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
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
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

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