2.  Commander, Warren County, Ohio, Drug Task Force  Coordinator- Southwestern Ohio HIDTA Major Case Initiative  President-National Association of Drug Diversion Investigators (NADDI)  32 years Cincinnati Police Division  Commander Pharmaceutical Diversion Squad  Six investigators, one secretary

3.  DEFINITION? Criminal deviation or counterfeiting of a prescription drug. Illegal removal of a prescription drug at any point in its path from manufacturer to patient

4.  Most likely drug to be abused in the workplace  Obtain through insurance  “Only prescription drugs”

5. SAMHSA SURVEY 2003:  6.2 million people abused Rx drugs  Significant increase in 12-17 YOA in abuse of Rx drugs

7.  According to ONDCP- Identified 34 rogue Internet pharmacies in 2006  Dispensed over 98 million dosages of hydrocodone  Would take 1,118 average pharmacies to equal amount dispensed by the 34 illegal Internet apothecaries

8.  Often high-price medications  Produced “legally” in India  Packaging often made in China  Unknown components in drug  Often made in unsanitary conditions

9.  Usually addicted individual involved  CII’s often the target  Weapon or threat of weapon involved  Potentially very dangerous situation  Cooperate with the offender  Remind police to check ER runs  Rx Patrol should be utilized

10.  Involve the after-hours entry of a pharmacy  Smash and grab likely addicted perpetrator  Usually planned criminal enterprises  Entry through the roof-adjoining business  Alarm disabled  Possible entry into safe  Hundreds of thousands of dollars street value Rx drugs often removed  Rx Patrol should be utilized

11.  Funded by Purdue Pharma  Reports of pharmacy robbery  Reports of pharmacy burglary  Reports of major pharmacy crime  Database for law enforcement  Only as good as the information provided by LE and pharmacy personnel  Reporting can be done online www.rxpatrol.org www.rxpatrol.org

12.  Alprazolam with roots in Mexico  Not dispensed in the United States  Delivered to Southwest Ohio 200,000 dosage units a month for 3.5 years  100% profit made on each load  Arrests made and over 100,000 dosage units confiscated  Activity continues

13.  Elvis Presley - pain/sleeping medication  Sonny Bono - pain medication  Bret Favre - pain medication  Matthew Perry- pain medication

14.  ONDCP indicates over 2 million teens abused Rx drugs (2007)  Estimates that 2,500 teens per day initiate Rx abuse and now top source of abuse for those 12 & 13 YOA (ONDCP 2007)  Associated Press December 2005- 9.5% of HS Seniors abused hydrocodone

15.  Parents medicine cabinet  Chronic pain patients  Garbage (fentanyl patches)

16.  Product still popular with juveniles  1 in 10 teens have abused (2 million)  Large doses consumed at one time  Often ends in vomiting/dizziness/confusion  Overdoses  Much of it stolen if not behind the counter  “Triple C” currently most popular

17.  HYDROCODONE (Vicodin, Lortab, Lorcet) $6- $8  OXYCODONE (Percocet, Percodan, Tylox) $6 - $8 (OxyContin- $.50-1.00 mg.)  ACETAMINOPHEN WITH CODEINE (Tylenol #3, Tylenol #4) $3 - $5  DIAZEPAM (Valium) $1 - $2

18.  CARISOPRODOL (Soma) $3 - $4  ALPRAZOLAM (Xanax) $3 - $4  MEPERIDINE (Demerol) N/A (H/P Usage)  METHYLPHENIDATE (Ritalin) $10 - $12  HYDROMORPHONE (Dilaudid) 4mg - $60

19.  Stadol Nasal Spray  Methadone  Tramadol (Ultram) n Phentermine (Adipex) n Fentanyl patches (Duragesic/Actiq)

20. Less risk of overdose Easier to obtain through “legal” script Cheaper than cocaine and heroin Less risk of detection - lack of enforcement

21.  Alteration of script is a felony in Ohio  Changing doses, refills or strength  White out

22.  Nail polish remover  Photocopying  Computer generated prescriptions

23.  Employee of Health Professionals  Phony call-ins  After hours “patient” scam  Doctor Shopping  Pill Brokers  ER Shopping

24. Slam car doors and trunks on hands Slam windows on hands & fingers Carry syringes with blood to squirt in their mouth to demonstrate bleeding Carry kidney stones in a jar to ER Insert objects into open wounds Deliberately irritate root canal work Beat on foot with 4.5 LB hammer

25. 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! Not illegal to be scammed!

26. Compliments physician Deliberately mispronounces drug name Agitated when cut off drugs of choice Threatens lawsuit Leaves abruptly when scam does not work

27.  PERIODIC URINE SCREENS (Include hydrocodone/oxycodone)  PILL COUNTS  CS RX INDICATES OTHER SCRIPTS WRITTEN  CHECK WITH RPH ON FILLING OF NON-CS SCRIPTS  MEDICATION AGREEMENT AND VIOLATIONS  DOCUMENT! DOCUMENT! DOCUMENT!

28.  FAMILY MEMBER/CARE GIVER DIVERSION  LIMIT CS IN HOUSEHOLD  DO NOT POST DATE SCRIPTS  “DO NOT FILL UNTIL” ISSUE (CII)  REMEMBER “3 DAY RULE” FOR ADDICTS

29. Drug seekers keep you from legitimate patients Lack of addressing the issue will increase the problem Perpetuates patient’s addiction or trafficking by ignoring the problem

30.  Diversion negatively impacts legitimate patients  Requires joint effort and balance between HP and LE  Vast majority of patients are legitimate  Vast majority of HP’s are legitimate