DEA’s Most Wanted: Commonly Diverted Controlled Substances Schedule II Morphine (MS Contin) * Street value $2 per mg ($30-$200 for most pills)

DEA’s Most Wanted: Commonly Diverted Controlled Substances Schedule II Hydromorphone (Dilaudid) * Street value $10 per mg (avg. $20-$60 per pill)

DEA’s Most Wanted: Commonly Diverted Controlled Substances Adderall Schedule II Meperidine (Demerol) Methadone www.druginjurylaw.com www.buy-adderall.com www.opt.pacificu.edu

DEA’s Most Wanted: Commonly Diverted Controlled Substances Schedule II Hydrocodone w/Acetaminophen (Lorcet; Lortab; Vicodin) * Street value $5-$10 per pill

Hydrocodone Vicodin®, Lortab®, Lorcet® #1 Most Prescribed Drug in US* Most commonly abused and diverted pharmaceutical Structurally related to codeine and approximately equal to morphine in producing opiate-like effects Rap star Eminem has a Vicodin® tattoo on his arm and a picture of a Vicodin® tablet on one of his CDs © Shady Records *AARP Bulletin; Vol 50, No 6; October 2009 *SOURCE: 2005 Monitoring the Future study released Dec 2006. MTF is conducted by the Institute for Social Research at the University of Michigan.

DEA’s Most Wanted: Commonly Diverted Controlled Substances Schedule III Codeine w/Acetaminophen (Tylenol #3) * Street value $2-$4 per pill

DEA’s Most Wanted: Commonly Diverted Controlled Substances Schedule IV Alprazolam (Xanax) * Street value $3-$5 per pill

The “Holy Trinity” Soma (carisoprodol) – Muscle relaxant Xanax (alprazolam) – anti-anxiety Vicodin (hydrocodone) – narcotic These three drugs, when taken in combination, are known as the “holy trinity” by abusers. This combination gives abusers a feeling of euphoria, similar to that of heroin.

Source of Rx Narcotics Used Non-Medically 2010 Bought on Internet 0.4% Drug Dealer/ Stranger 4.3% Other 4.9% More than One Doctor 1.6% One Doctor 18% Free from Friend/Relative 55.9% Bought/Took from Friend/Relative 14.3% Note: Totals may not sum to 100% because of rounding or because suppressed estimates are not shown.

Regulations: Closed System of Distribution Cyclic Investigations Established Schedules Record Keeping Requirements Registration Security Requirements Established Quotas ARCOS

Rx Diversion Methods Illegal prescribing Fraudulent Rx Forged or Altered Illegal sales Internet Employee theft Prescription rings Doctor shopping Pharmacy theft Hatfield Brothers – 85 Pharmacy Burglaries in 10 states. Foreign diversion and smuggling into the U.S.

Pharmacy Robberies & Break-Ins * thru June 27, 2011

Sanofi Aventis Armed Robbery Suspect attached rope to one drum and dragged it down the stairs, down a ramp, and to the pedestrian doorway at the loading dock level Suspect abandoned the other three drums

How Criminal Internet Pharmacies Really Work Pharmacy in Dubuque, Iowa Shipping 250 boxes daily for Medical Web Services, 600 daily for Pharmacom Two internet companies involved Approximately 50 practitioners Seizures in excess of $8 million Sentencing ranged from probation to five years incarceration.

Internet Targets 1 1 2 1 14 2 3 1 Pharmacy 2 5 1 1 2 1 1 2 2 3 1 1 1 2 3 2 1 2 1 1 13 14 9 2 3 1 Pharmacy 2 Internet Website Companies Pharmacists 50 Doctors 15 Corporate Directors, Employees

Internet Doctors Diaz, Mario, M.D. Pled guilty to conspiracy to distribute schedule III and IV controlled substances. Authorized at least 53,125 dosage units of schedule III controlled substances and 17,890 dosage units of schedule IV controlled substances. Sentenced to 30 months incarceration, two years supervised release, forfeiture of $272,061.

Internet Doctors McNeil, Apryl, M.D. Pled guilty to conspiracy to distribute schedule III and IV controlled substances. Authorized at least 220,090 dosage units of schedule III controlled substances and 15,510 dosage units of schedule IV controlled substances. Sentenced to 20 months incarceration, two years supervised release, forfeiture of $26,960.

Internet Doctors Millette, Michael J., M.D. Pled guilty to conspiracy to distribute schedule III and IV controlled substances. Authorized at least 61,202,400 dosage units of schedule III controlled substances and 1,446,810 dosage units of schedule IV controlled substances. Sentenced to 41 months incarceration, two years supervised release. Ordered to forfeit $1.6 million.

Schneider Medical Clinic A Case Study:

Schneider Medical Clinic March 2005, the Kansas City District Office received a complaint regarding the excessive prescribing of narcotics and other controlled substances by Stephen J. Schneider, D.O., and the staff at Schneider Medical Clinic, Haysville, Kansas. Prescribed Duragesic (fentanyl) Patches, Actiq suckers (a lollipop of fentanyl), hydrocodone, Xanax, Valium, Soma and Oxycontin Kansas Bureau of Investigation reported eight deaths of Schneider patients in the past two years.

Schneider Medical Clinic Red Flags: Clinic open seven days a week As many as 11 hours a day Patients scheduled 10 minutes apart Patients waited for hours for an appointment Numerous reports of overdose

Schneider Medical Clinic Over 300 patient files and other documents seized.

Cases Against Doctors Dr. Stephen Schneider Conspiracy to commit healthcare fraud Unlawful distribution of controlled substances Health care fraud resulting in death Submitting false claims to Medicaid and private insurers Money laundering Sentenced to 30 years imprisonment

Cases Against Doctors Linda Schneider Conspiracy to commit healthcare fraud Aiding and abetting the unlawful distribution of controlled substances resulting in death Health care fraud resulting in a death Aiding and abetting submitting false claims to Medicaid and private insurers Money laundering Sentenced to 33 years imprisonment

Questions Judy R. Williams Group Supervisor Kansas City District Office (913) 951-4108 Judy.R.Williams@dea.usdoj.gov www.DEAdiversion.usdoj.gov