1. Drug Diversion-The Scope of the Problem Teleconference Commander John J. Burke

2. PHARMACEUTICAL DIVERSION Commander, Warren County Drug TF (1999-Present) Coordinator- Southern Ohio HIDTA Pharmaceutical Diversion Initiative Vice President- National Association of Drug Diversion Investigators (NADDI)(1996- Present) President- PDE Inc. (1995-Present) 32 years Cincinnati Police Division (1968- 1999) Commander Pharmaceutical Diversion Squad (1990-1999)

3. PHARMACEUTICAL DIVERSION Developed in 1990 Average 500 cases a year Average 250 arrests a year Investigate illegal diversion of Rx drugs Investigate health care fraud

4. SCOPE OF THE PROBLEM Almost 30% of the overall drug problem in America Ranks second only to marijuana #1 drugs of abuse over the last 30 years

5. SCOPE OF THE PROBLEM 2003 SAMHSA Survey Results: 6.2 million people abused Rx drugs in the last year Significant rise in Rx abuse for those 12-17 years of age

7. WHATS THE BIG DEAL? THEYRE JUST PRESCRIPTION DRUGS! l Elvis Presley - pain/sleeping medication l Sonny Bono - pain medication l Bret Favre - pain medication l Matthew Perry- pain medication

8. VICTIMLESS CRIME? Andrew Cunanan - pain medication Nevada Casino Incident - Dexedrine HP Abuse/Patient Care - pain medication

9. TOP Rx DRUGS OF ABUSE 1. HYDROCODONE (Vicodin, Lortab, Lorcet) $6 - $8 2. OXYCODONE (Percocet, Percodan, Tylox) $6- $8 (OxyContin $.50-1.00 mg.) 3. ACETAMINOPHEN WITH CODEINE (Tylenol #3, Tylenol #4) $3 - $5 4. BENZODIAZEPINES (Xanax/Valium) $1 - $4 5. PROPOXYPHENE (Darvon, Darvocet) $2 - $4

10. TOP Rx DRUGS OF ABUSE 6. CARISOPRODOL (Soma) $3 - $4 7. MORPHINE SULFATE (MS Contin) 100mg - $60; 60mg - $45; 30mg - $30 9. MEPERIDINE (Demerol) N/A (H/P Usage) 10. METHYLPHENIDATE (Ritalin) $10 - $12 11. HYDROMORPHONE (Dilaudid) 4mg - $60

11. OTHER SIGNIFICANT PROBLEMS 1. Stadol Nasal Spray 2. Proventil 3. Ultram 4. Methadone 5. Fentanyl patches

12. DRUG DIVERSION SOURCES l Forged/Altered Prescriptions l Doctor Shopping l Other Rx Scams l Internet

13. DRUG DIVERSION SOURCES l Reverse Distributors l Health Professional Diversion l Package Interdiction l International Smuggling

14. WHY Rx DRUGS ? Less risk of overdose Easier to obtain through legal script Cheaper than cocaine and heroin Less risk of detection - lack of enforcement

15. FORGED AND ALTERED PRESCRIPTIONS Alteration of prescription Changing doses, refills or strength White out

16. FORGED AND ALTERED PRESCRIPTIONS Nail polish remover Photocopying Computer generated prescriptions

17. DECEPTIONS Doctor shopping/ER shopping Phony call-ins After hours patient scam Employee of health professionals

18. WHAT CONSTITUTES DECEPTION ? Patient gives false name and address to obtain drugs Patient gives fictitious story to obtain drugs (out of town) Patient lies about ailment or injury Patient denies seeing any other doctors and obtaining any other Rx drugs

19. TYPICAL Rx DRUG SEEKER Every bit as addicted as the heroin and cocaine addict Spends most of their waking hours planning on how to get their drugs Consumes much of their time deciding how to scam YOU!

20. PHARMACY COLLABORATION l Communicate regularly with local physicians l Understand and discuss your concerns l Encourage doctors to make you part of the pain management team

21. WHY GET INVOLVED? Drug seekers keep you from legitimate patients Lack of addressing the issue will increase the problem Perpetuates patients addiction or trafficking by ignoring the problem

22. Rx Patrol l Nationwide Law Enforcement Database l Invented & Funded by Purdue Pharma l Pharmacy Robbery & Burglary Offenses l Networking Opportunities for LE

23. Rx Patrol RX PATROL PARTNERS l National Association of Drug Diversion Investigators (NADDI) l National Community Pharmacists Association (NCPA) l National Association of Chain Drug Stores (NACDS) l Pharmaceutical Security Institute

24. Rx Patrol l Reporting necessary by LE &/or pharmacists l www.rxpatrol.org www.rxpatrol.org l Database compares like/similar offenses l LE agencies contacted if possible match occurs

25. PRESCRIBING PRACTICES l This program is NOT intended to discourage the dispensing of appropriate medication for legitimate medical purposes

26. PRESCRIBING PRACTICES l Legitimate patients with pain should not suffer because health professionals are fearful of law enforcement l Law enforcement is not interested in investigating appropriate dispensing of Rx drugs

27. PRESCRIBING PRACTICES l Its important that none of us allow those who divert prescription drugs to influence the legitimate prescribing and dispensing of controlled substances

28. METHAMPHETAMINE AND THE RETAIL PHARMACY

29. Methamphetamine Schedule II.Current accepted medical use, high potential for abuse.Schedule II.Current accepted medical use, high potential for abuse. Can be manufactured using material bought in Wal-Mart.Can be manufactured using material bought in Wal-Mart. National rapidly emerging drug problem.National rapidly emerging drug problem. Methods of use:Methods of use: SnortingSnorting SmokingSmoking InjectingInjecting EatingEating DrinkingDrinking

30. Methamphetamine Effects: Increased heart rateIncreased heart rate Irregular heartbeatIrregular heartbeat Increased blood pressureIncreased blood pressure Irreversible damage to blood vessels in the brain, producing strokes.Irreversible damage to blood vessels in the brain, producing strokes. Respiratory problemsRespiratory problems AnorexiaAnorexia Cardiovascular collapseCardiovascular collapse DeathDeath Central Nervous System Effects: IrritabilityIrritability ConfusionConfusion ParanoiaParanoia ConvulsionsConvulsions HyperthermiaHyperthermia InsomniaInsomnia TremorsTremors AggressivenessAggressiveness AnxietyAnxiety ConvulsionsConvulsions

31. Methamphetamine

33. Indications of Meth Lab Activity l Strong chemical smell (ether/ammonia) l Efforts made to cover windows or reinforce doors l Trash never put out; always burned l Considerable late night hour traffic l Lab materials surrounding property (fuel cans/chemically stained coffee filters/altered propane tanks)

34. Indications of Meth Lab Activity l Suspicious vehicles arriving with trunks/chemical containers and paraphernalia/rubber tubing, etc. l Occupants always smoking outside l Paranoid behavior of residents or extensive security

35. How Meth is Made l Made with common household products sold in pharmacies everywhere l Cold tablets containing Ephedrine/Pseudoephedrine l Ether (Starting Fluid) l Sulfuric Acid (Drain Cleaner)

36. How Meth is Made l Methanol/Alcohol (Gasoline Additives-Heet) l Salt l Lithium (batteries) * Hundreds of recipes on internet

37. How Meth is Made Anhydrous Ammonia (Farm Fertilizer) l Stolen (farmers, retail distributors) l Stored in altered propane tanks -bluish color at valve on tank

38. Equipment used to Manufacture Meth: l Mason Jars and Pyrex dishes l Bottles, funnels, coffee filters l Blenders, hot plates, rubber gloves

39. PHARMACEUTICAL DIVERSION EDUCATION INC. John J. Burke, President P.O. Box 146 Bethel, Ohio 45106 1-800-566-2049 (Office) 1-513-734-1647 (Fax) www.rxdiversion.com Email: burke@rxdiversion.comburke@rxdiversion.com

40. Questions ?