Office of Diversion Control Drug Enforcement Administration Operations Division Office of Diversion Control Denise Curry, J.D. Deputy Director

Drug Addiction Treatment Act (DATA) of 2000 DEA started scheduled regulatory investigations October 1, 2003 Investigations usually last one to two hours Regulatory investigations are one doctor per diversion group once every fiscal year

DATA Waived Practitioners* DATA Waived Regulatory Investigations 425 Practitioners as of 12/31/2007 Registered as DATA Waived *12,826 Practitioners * as of 01/17/2008 per DEA Oracle Database Drug Enforcement Administration, Operations Division, Office of Diversion Control

DATA Waived Regulatory Investigations Surrendered Unique Identifier Practitioner died Facility where practitioner worked decided too costly to initiate treatment program Practitioner working for NTP instead of sole practitioner Practitioner changed his mind No clients for this service Psychiatric facility does not allow administering or prescribing office based opiate treatment

DATA Waived Regulatory Investigations Yet to Establish DATA Waived Practice 57 Practitioners Surrendered Unique Identifier 26 Practitioners No Problems Cited 253 Practitioners Problems Cited 74 Practitioners 2007

DATA Waived Regulatory Investigations Problems Cited/Action Taken 35Verbal Warnings record keeping and dispensing violations 23 Letters of Admonition record keeping and dispensing violations and security violations 8 Surrendered Registrations for Cause2 Show Cause Proceeding 1 Civil Action 5 Undergoing Active Investigations

Bubrenorphine Rx Source: IMS National Prescription Audit retrieved 02/12/08 Thousands From 2004 thru 2007 there was a 500% increase in buprenorphine prescriptions Source: IMS National Prescription Audit retrieved 02/12/08

Buprenorphine Distribution to Retail Registrants January 1, 2007 – December 31, 2007 Subutex and Suboxone 8mg Tablets 60,436,167 dosage units 71.6% Subutex and Suboxone 2mg Tablets 18,171,516 dosage units 21.5% Buprenex and Buprenorphine Injectables 5,816,281 dosage units 6.9% Source: ARCOS Date Prepared: 2/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

Mid-Level Practitioners Teaching Institutions Distribution of Subutex and Suboxone (8mg Tablets) to Retail Registrants January 1, 2007 – December 31, 2007 Pharmacies 56,805,196 dosage units 94.0% Hospitals 2,120,550 dosage units 3.5% Practitioners 1,068,371 dosage units 1.8% NTP’s 441,930 dosage units 0.7% Mid-Level Practitioners 120 dosage units <0.1% Teaching Institutions 0 dosage units 0.0% Source: ARCOS Date Prepared: 2/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

Mid-Level Practitioners Teaching Institutions Distribution of Subutex and Suboxone (2mg Tablets) to Retail Registrants January 1, 2007 – December 31, 2007 Pharmacies 16,320,618 dosage units 89.8% Hospitals 1,354,488 dosage units 7.5% Practitioners 298,560 dosage units 1.6% NTP’s 197,760 dosage units 1.1% Mid-Level Practitioners 0 dosage units 0.0% Teaching Institutions 90 dosage units <0.0% Source: ARCOS Date Prepared: 2/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

2007 ARCOS Distribution DATA Buprenorphine Top 10 States 2007 ARCOS Distribution DATA GRAMS PER 100K POPULATION VT ME MA RI CT UT MD PA WV NJ U.S. Average Source: ARCOS Date Prepared: 01/25/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

WA MT ND MN OR NY ID SD WI MI WY IA PA OH NE IN NV IL UT CO KS VA CA Subutex and Suboxone 8mg Tablets Distribution Per 100,000 Population (Pharmacies Only) January - December, 2007 WA (206) (VT-148) ME (258) MT ND V (NH-46) N (24) (12) MN T OR NY H (MA-651) (WV-76) MA ID SD (118) WI (555) (1,572) (151) CT MI (CT-262) (24) WY (8) (175) (796) N RI IA PA (85) J (17) OH NE DE (37) (35) (26) IN NV IL (357) W MD UT (524) CO (168) KS V VA DC CA (93) MO (325) (70) KY (164) (200) (135) (48) (129) NC (119) (1,440) (203) (NJ-573) TN (201) OK (114) AZ NM AR SC (72) GA (27) AL (262) (139) MS PR LA (146) (310) (139) TX (98) AK (189) (611) FL (46) (780) U.S. Average: 20,451 Dosage Units HI Above Average = 25,565 Dosage Units or more Average = 15,338 – 25,564 Dosage Units Below Average = 15,337 Dosage Units or less (54) Numbers in parenthesis represent number of Data Waived Doctors Source: ARCOS Date Prepared: 2/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

State of Massachusetts by Zip Code Subutex and Suboxone 8mg 2007 Pharmacy Purchases of Subutex and Suboxone 8mg 013 (4) 014 (8) 018 (33) 019 (33) 012 (14) 017 (30) 024 (83) 010 (22) 022 (8) 016 (31) 021 (209) 020 (28) 015 (21) 020 (28) (22) 011 023 (23) U.S. Average = 1,708 dosage units MA Average = 4,917 dosage units Above = 6,148 dosage units or more Average = 3,688 – 6,147 dosage units or more Below = 3,687 dosage units or less 027 (53) 026 (16) 025 (12) Numbers in parenthesis represent number of Data Waived Doctors Source: ARCOS Date Prepared: 02/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

State of Pennsylvania by Zip Code Subutex and Suboxone 8mg 2007 Pharmacy Purchases of Subutex and Suboxone 8mg 165 (11) 164 (6) 188 (0) 167 (0) 169 (1) 163 (4) 184 (7) 185 (11) 186 (4) 158 (5) 161 (6) 177 (5) 187 (15) 183 (4) 162 (2) 168 (15) 160 (6) 178 (11) 182 (4) 180 (9) 157 (7) 179 (1) 181 (14) 151 (17) 195 (10) (17_ 150 166 (21) 170 (32) 152 (96) 189 (18) 159 (16) 196 (11) 156 (15) 171 (14) 175 (10) 194 (29) 176 (21) 191 (118) 153 (8) 172 (6) 174 918) 154 (7) 193 (32) 190 (120) 155 (4) 173 (8) U.S. Average: 1,708 dosage units PA Average = 2,240 dosage units Above = 2,801 dosage units or more Average = 1,680-2,800 dosage units Below = 1,679 dosage units or less Numbers in parenthesis represent number of Data Waived Doctors Source: ARCOS Date Prepared: 02/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

Subutex and Suboxone 8mg 325 (22) 324 (4) 323 (6) 320 (28) 322 (54) State of Florida 2007 Pharmacy Purchases of Subutex and Suboxone 8mg by Zip Code 326 (22) 321 (16) 344 (16) 327(27) 346 (22) 328 336 (50) 347 (14) 335 (10) (18) 329 337 (33) 338 (15) 342 (27) 349 (25) 339 (27) 334 (112) U.S. Average = 1,708 dosage units 341 (17) 333 (52) FL Average = 1,593 dosage units Above = 1,992 dosage units or more Average = 1,195-1991 dosage units Below = 1,194 dosage units or less 331 (85) 330 (49) Numbers in parenthesis represent number of Data Waived Doctors Source: ARCOS Date Prepared: 02/20/2008 Drug Enforcement Administration, Office of Enforcement Operations, Pharmaceutical Investigations Section, Targeting and Analysis Unit

States With the Highest Number of Laboratory Exhibits (Source: NFLIS - State and Local Forensic Laboratories) 2003 2004 2005 2006 2007 Total MA 4 125 291 501 598 1519 PA 18 39 184 241 482 MD 6 20 108 236 370 NJ 9 37 72 137 258 VA 11 21 45 96 173

Buprenorphine Federal, State and Local Laboratory Exhibits (Source: NFLIS and STRIDE) (54% ↑) (123% ↑) (137% ↑ ) (628% ↑)

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