Overview of Prescription Drug Abuse and the Diversion and Illegal Distribution of Pharmaceuticals - PowerPoint PPT Presentation

Loading...

PPT – Overview of Prescription Drug Abuse and the Diversion and Illegal Distribution of Pharmaceuticals PowerPoint presentation | free to view - id: 5a214-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Overview of Prescription Drug Abuse and the Diversion and Illegal Distribution of Pharmaceuticals

Description:

Overview of Prescription Drug Abuse and the Diversion and ... Tramadol (Ultram , Ultracet ) Muscle Relaxant: Carisoprodol (Soma ) Cyclobenzaprine (Flexeril ... – PowerPoint PPT presentation

Number of Views:696
Avg rating:3.0/5.0
Slides: 74
Provided by: FreeDownlo2
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Overview of Prescription Drug Abuse and the Diversion and Illegal Distribution of Pharmaceuticals


1
Overview of Prescription Drug Abuse and the
Diversion and Illegal Distribution of
Pharmaceuticals
4th Annual Substance Abuse Conference
Addressing Substance Abuse in Critical
Populations A Call to Action
  • Joseph Rannazzisi
  • Deputy Assistant Administrator
  • Office of Diversion Control
  • Drug Enforcement Administration

2
The 1960s
Marijuana
LSD
Seconal
Dexedrine
Meprobamate
3
The 1970s
Heroin
4
The 1980s
Ts and Blues (Talwin and Pyrabenzamine)
4s and Doors Tylenol w/Codeine and Doriden
Hydromorphone
Cocaine
5
The 1990s
Methamphetamine
6
2000
Hydrocodone
Alprazolam
Ketamine
Flunitrazapam (Rohypnol)
MDMA
7
THE PERFECT STORM
  • Technology
  • Law enforcement struggling to keep up
  • Training
  • Rapidly changing environment
  • Equipment
  • Costly
  • Rapidly changing / outdated
  • Laws
  • Written prior to technological advancements
  • Encryption (Skype)
  • Wi Fi (Coffee shops)
  • Jurisdictional issues
  • Drug seeker in one state
  • Web server in another state or offshore
  • Financial component in another location or
    offshore
  • Source of supply in yet another state or offshore

8
The Perfect Storm
  • Misperception When we dont see specific drugs
    anymore the problem has gone away
  • Industry is producing a wider variety of
    controlled substance pharmaceuticals
  • Industry is producing record numbers of
    controlled substance pharmaceuticals
  • Baby Boomers are retiring in record numbers and
    will need additional medications
  • Federal, State and local labs are reporting
    higher numbers of exhibits and cases related to
    pharmaceuticals
  • Shift in the user / abuser population
  • Use of Medicare / Medicaid or insurance to fund
    drug habits
  • Information / Electronic era
  • Web sites such as Erowid
  • Social networking blogging, twitter, or chat
    rooms for instant exchanges of information
  • Anonymity no more face-to-face meetings

9
Scope and Extent of Problem
Source 2004 and 2007 National Survey on Drug Use
and Health
10
Teens and Their Attitudes
  • 1 in 5 teens report abusing Rx medications to get
    high
  • 2 in 5 teens believe that Rx meds are much
    safer than illegal drugs
  • 31 teens believe theres nothing wrong with
    using Rx meds without a prescription once in a
    while
  • Nearly 3 in 10 teens believe Rx pain relievers
    are not addictive

Source Partnership for Drug Free America
11
(No Transcript)
12
Teen and Their Attitudes
  • The abuse of prescription and over-the-counter
    medicines among teens continues to be a troubling
    trend
  • Teens mistakenly believe that abuse of
    prescription drugs is less dangerous than abuse
    of illegal street drugs
  • Teens report prescription drugs are easier to get
    than illegal drugs, up significantly from 2005
  • Majority of teens report abusing a prescription
    medication at least once in their lives
  • 10 of teens report having abused a Rx pain
    reliever
  • 7 of teens have abused OTC cough medicine

SOURCE 2008 Partnership Attitude and Tracking
Study (PATS) Released FEB 2009 by The
Partnership for a Drug-Free America
13
Parents and Their Attitudes
  • Parents are still not discussing the risks of
    abusing prescription and over-the-counter
    medicines
  • Despite the increase in parent / teen discussions
    about the risks of illegal drugs
  • Only 24 of teens report that their parents
    talked with them about the dangers of abusing
    prescription (Rx) drugs or use of medications
    outside of a doctors supervision
  • Just 18 of teens say their parents discuss the
    risks of abusing over-the-counter (OTC) cough
    medicine

SOURCE 2008 Partnership Attitude and Tracking
Study (PATS) Released FEB 2009 by The
Partnership for a Drug-Free America
14
Prescription Drug Abuse
  • In 2004, there were 6 million Americans aged 12
    and older who used psychotherapeutic drugs
    non-medically in the past month
  • In 2007, that number increased to 6.9 million
    (15 increase)
  • In 2004, 4.4 million Americans used pain
    relievers non-medically in the past month.
  • In 2007 that number increased to 5.2 million.1
    (18 increase)
  • In 2004, 500,000 emergency department visits
    associated with drug abuse / misuse involving
    non-medical use of pharmaceuticals2

1 SOURCE 2007 National Survey on Drug Use and
Health (NSDUH) published Sept 2008 2 SOURCE
2004 DAWN (Drug Abuse Warning Network) Report
published May 2006
15
Trends in Prescription Drug Abuse
  • Non-medical use of prescription pain relievers
    was the category with the largest number of new
    initiates (2.1 million)1
  • Non-medical use of prescription drugs ranks
    second only to marijuana as the most prevalent
    category of drug abuse
  • Non-medical use of prescription drugs is higher
    than abuse of cocaine, heroin and hallucinogens
    combined

1SOURCE 2007 National Survey on Drug Use and
Health
16
(No Transcript)
17
Emergency Data
  • From 2004 to 2006
  • No Significant Change ER visits attributable to
    cocaine, heroin, marijuana, and stimulants (the
    major illicit drugs)
  • Increase of 44 ER visits attributable to
    pharmaceuticals alone (i.e., with no other type
    of drug)
  • Drugs most frequently implicated in non-medical
    use
  • benzodiazepines (36 increase)
  • hydrocodone/combinations (44 increase)
  • oxycodone/combinations (56 increase)

SOURCE 2006 DAWN (Drug Abuse Warning Network)
report published August 2008 (most recent data)
18
Law Enforcement Seizure Data
19
Number of Exhibits Submitted by SL Law
Enforcement
National trend estimates for selected
prescription drugs 2001- 2008
  • Hydrocodone increased 220
  • Oxycodone increased 201

Source NFLIS
20
The Controlled Substances Acts Closed System of
Distribution
21
CSA Registrant Population
Current Number of DEA Registrants.
1,328,064
April 2009
Provisional registrations in effect at the time
CSA was passed (relative to the Harrison
Narcotics Act of 1914)
480,000
1973
22
PHARMA
These new regulations will fundamentally Change
the way we get around them
23
Methods of Diversion
  • Pharmacy / Other Theft
  • Armed robbery
  • Burglary (Night Break-ins)
  • In Transit Loss (Hijacking)
  • Smurfing
  • Patients
  • Drug rings
  • Doctor-shopping
  • Forged / fraudulent / altered prescriptions
  • The medicine cabinet
  • The Internet
  • Practitioners / Pharmacists
  • Illegal distribution
  • Self abuse
  • Trading drugs for sex
  • Employee pilferage
  • Hospitals
  • Practitioners offices
  • Nursing homes
  • Retail pharmacies
  • Manufacturing / distribution facilities

24
International Scope

WS
WB
1. Consumer in California orders Xanax on the
Internet from a site found through a search engine
3. Web Broker, located in Asia, processes request
and forwards to Physician
S
C
2. Request goes through Website Server in Europe
Rx
Dr.
4. Rx written by Physician in United States
and returned to Web Broker
5. After physician writes Rx, Web Broker
arranges for order to be filled by Internet
Pharmacy
6. Order filled by Internet Pharmacy and sent to
Consumer via Shipper
25
Components for a Domestic Rogue Internet Operation
  • Web Broker / Facilitator (optional)
  • Practitioner
  • Pharmacy
  • All members of scheme are complicit thereby
    eliminating all checks and balances
  • Source of Supply

26
Domestic Rx Flow
WA
ME
MT
ND
MN
VT
NH
NY
OR
WI
ID
SD
MI
WY
PA
NJ
IA
NE
OH
DE
IN
NV
IL
WV
MD
UT
VA
CO
5. Approved order then sent by Web Company to an
affiliated Pharmacy
KS
CA
KY
MO
S
NC
TN
OK
SC
AZ
NM
AR
GA
AL
MS
LA
TX
FL
27
Actions Taken
  • Immediate Suspensions / Order to Show Cause
  • AmerisourceBergen Corp
  • Orlando, FL
  • McKesson Corp 13,250,000 civil penalty
  • Tampa, FL
  • Cardinal Corp 34,000,000 civil penalty
  • Lakeland, FL Stafford, TX Swedesboro, NJ and
    Auburn, WA
  • Bellco Drug Corp, Long Island, NY
  • Southwood, Lake Forest, CA
  • Voluntary Surrender
  • Richie Pharmacal, Glasgow, KY

28
Ryan Haight Online Pharmacy Consumer Protection
Act
  • New DEA registration requirements for all
    Internet pharmacies
  • Reporting requirements
  • Number of prescriptions
  • Dosage unit totals
  • Disclosure requirement on home page
  • Name, address, phone, E-mail of all pharmacies
  • Name license of pharmacists in charge
  • Name, address, phone, degree of all physicians
  • Statutory implementation 180 days from signing on
    October 15, 2008 (April 13, 2009)
  • As of April 28, 2009 DEA has received (5)
    applications

29
Current Schemes
  • Pain Clinics
  • Approx. 95 are based in Broward County, Florida
  • Treat on avg 100 patients per day
  • 150 - 250 cash for Doctors visit
  • 200 - 400 cash for prescription
  • Dispensation directly from clinic or script is
    issued
  • They do not accept insurance, Medicare/Medicaid
    or credit cards
  • Patients from Kentucky, Ohio, Tennessee, West
    Virginia
  • Travel to Florida individually by car, airplane
    or in groups on buses
  • Drug dispensed
  • Oxycodone (avg. 120 tablets per script)

30
Commonly Abused Controlled SubstancePharmaceutic
als
31
Hydrocodone, APAP C-III
  • Brand Names Vicodin, Lortab, Lorcet
  • Cocktail used by drug abusers
  • Hydrocodone
  • Soma / carisoprodol
  • Alprazolam / Xanax
  • Vicodin / hydrocodone second only to marijuana as
    the drug of choice for teens
  • In 2004 U.S. consumed 99 of worlds supply of
    hydrocodone yet the U.S. makes up only 4.5 of
    the worlds population


SOURCE JAMA, January 17, 2007 Vol 297, No 3,
Opioid Prescriptions Soar
32
NFLIS National Data - 2006Narcotic Analgesics
Number Percent
33
Top Five Prescription DrugsSold in the U.S.
(2005-2007)
Note Percentage change from the number of
prescriptions sold in the previous years.
6.9
(By Number of Prescriptions Sold)
7.9
8.5
61,704,000
55,122,0000
52,987,000
45,777,000
Lipitor
Amoxicillin
(Cholesterol)
(Pain reliever)
(Blood pressure)
(Antibiotic)
(Diuretic)
In 2007 Levothyroxine was 5
Source Drug Topics Revised September 19, 2008
34
OXYCODONE
35
NFLIS National Data - 2006Narcotic Analgesics
Number Percent
36
NFLIS National Estimates Oxycodone
Exhibits
Cases
37
  • BENZODIAZEPINES

38
Alprazolam Xanax (Z-bars) C-IV
  • Drug abusers often prefer alprazolam due to its
    rapid onset and longer duration of action
  • Alprazolam was ranked third in the number of
    prescriptions for controlled substances in 2003,
    2004, 2005 and 2006
  • For all sales of generic pharmaceuticals,
    alprazolam was ranked 7th
  • Source IMS Health
  • Source Verispan VONA

39
State and Local Seizure Data
40
DEA Seizure Data
41
Other Controlled Substances
  • Phentermine
  • Phendimetrazine
  • Amphetamine Alks
  • Methylphenidate

42
METHADONE
43
(No Transcript)
44
Dosage Forms
  • Tablets 5 mg/ 10 mg
  • Diskettes 40 mg
  • Liquid

45
Increase in Poisoning Deaths in the U.S. Since
1999
Source CDC
46
Deaths/100,000 Prescriptions in Florida
Deaths/100,000 Prescriptions
Source FDLE and NPA Plus
47
Increase in Forensic Exhibits 2003 - 2007
Increase in Forensic Exhibits
Source NFLIS
48
Who is Prescribing Methadone?
  • 5 and 10 mg tablets Rx
  • Top Prescribers
  • Anesthesiologists
  • Family Practitioners
  • Internists
  • Osteopaths
  • Physical Med. Rehab
  • Neurologists
  • Nurse Practitioners
  • 40 mg diskettes Rx
  • Top Prescribers
  • Family Practitioners
  • Anesthesiologists
  • Internists
  • Osteopaths
  • Physical Med. Rehab
  • Nurse Practitioners
  • General Practitioners

Source IMS Health, National Prescription Audit,
November 2006
49
Purchases of 40 mg Diskettesby Business
Activity - 2006
810 Hospitals 45,329 grams (1.40)
Source DEA ARCOS
58 Practitioners 44,285 grams (1.37)
51.8
45.4
424 NTPs 1,470,566 grams
19,275 Pharmacies 1,676,225 grams
Based on total gram amount
50
Purchases of 40mg Diskettes by Business Activity
- 2007
21,171 Pharmacies 2,065,346 grams
430 NTPs 1,452,164 grams
852 Hospitals 47,784 grams (1)
76 Practitioners 43,190 grams (1)
Source ARCOS Date Prepared 04/20/2009
51
Methadone Hydrochloride 40 mg Advisory
  • As of January 1, 2008, manufacturers of methadone
    hydrochloride tablets 40 mg (dispersible) have
    voluntarily agreed to restrict distribution.
  • The 5mg and 10 mg formulations indicated for the
    treatment of pain will continue to be available
    to all authorized registrants, including retail
    pharmacies.

52
Purchases of 40mg Diskettes by Business Activity
- 2008
410 NTPs 1,452,721 grams
623 Hospitals 26,835 grams (2)
690 Pharmacies 9,157 grams (1)
0 Practitioners 0 dosage units 0
Source ARCOS Date Prepared 04/20/2009
53
Non-Controlled Substances
  • Analgesic
  • Tramadol (Ultram, Ultracet)
  • Muscle Relaxant
  • Carisoprodol (Soma)
  • Cyclobenzaprine (Flexeril)
  • Cough Suppressant
  • Dextromethorphan (DXM)
  • Over-the-Counter (OTC) cold medication, such as
    Coricidin HPB Cough and Cold Tablets and
    Robitussin Cough Syrup.

54
(No Transcript)
55
Anabolic Steroid Overview
56
Steroid Use is all about appearance, not
performance
57
Anabolic Steroids
  • Performance enhancing drugs
  • Synthetic testosterone
  • Available as injectables, tablets, capsules,
    gels, and creams

58
Commonly Abused Steroids
  • Oral Steroids
  • ? Anadrol
  • (oxymetholone)
  • ? Oxandrin
  • (oxandrolone)
  • ? Dianabol
  • (methandrostenolone)
  • ? Winstrol
  • (stanozolol)
  • Injectable Steroids
  • ? Deca-Durabolin
  • (nandrolone decanoate)
  • ? Durabolin
  • (nandrolone phenproionate)
  • ? Depo-Testosterone
  • (testosterone cypionate)
  • ? Equipoise
  • (boldenone undecylenate)
  • ? Tetrahydrogestrinone
  • (THG)

59
Patterns of Steroid Abuse
  • Cycling alternating periods of anabolic steroid
    use (on cycle) with periods of either no use or
    the use of low doses of anabolic steroids.
  • Stacking concurrent use of two or more steroids
    together.
  • Stacking the Pyramid or Pyramiding increase in
    the dose/type early in the cycle and tapering the
    dose in the latter part of the cycle.

60
(No Transcript)
61
Side Effects Men
  • Shrinking of the testicles
  • Reduced sperm count
  • Impotence
  • Baldness
  • Difficulty or pain in urinating
  • Development of breasts
  • Enlarged prostate

62
Side Effects Both Sexes
  • Acne
  • Jaundice
  • Trembling
  • Swelling of feet or ankles
  • Bad breath
  • Reduction in HDL, good cholesterol
  • High blood pressure
  • Liver damage and cancers
  • Aching joints
  • Increased chance of injury to tendons, ligaments,
    and muscles

63
Dietary Supplements - Designer Steroids
  • DRUGS
  • Must be proven safe before approved for market
  • SUPPLEMENTS
  • Must be proven harmful before removed from market

64
Dietary Supplements
  • Definition of products that can be sold as
    dietary supplements
  • A product (other than tobacco) intended to
    supplement the diet. The product contains one or
    more of the following vitamin mineral herb or
    other botanic amino acid dietary substance for
    use by humans or a concentrate, metabolite,
    constituent, extract or combination of these
    ingredients.
  • The product must also be intended for ingestion
    and cannot be advertised for use as a food.

65
Human Growth Hormone
  • The 1990 law inserted growth hormone into
  • 21 U.S.C. 333, the Steroid Trafficking
  • Act.
  • Indicated in children for poor growth due to
    certain medical conditions and for children born
    small for gestational age. Treatment in adults
    for Aids wasting and hGH deficiency.
  • Regulates body composition, glucose and lipid
    metabolism, skeletal muscle and bone growth.
  • Technically, not a controlled substance
  • (federal). But, federal law criminalizes
    whoever knowingly distributes, or possesses with
    intent to distribute, human growth hormone for
    any use in humans other than the treatment of a
    disease or other recognized medical condition.
  • DEA has authority to investigate

66
Human Growth Hormone (hGH)
  • Also known as somatotropin
  • Peptide hormone of 191 amino acids
  • It is synthesized and secreted by cells of the
    anterior pituitary.
  • Gigantism, acromegaly, hypothyroidism, cardiac
    disease, myopathies, arthritis, diabetes,
    impotence, osteoporosis.
  • Most Illicit hGH obtained from foreign
    sources/Internet-Jintropin
  • Injection

67
Disclaimer Cenegenics Medical Institute only
prescribes hGH if a comprehensive evaluation
reveals an adult growth hormone deficiency.
Our prescribing protocols and analyses are
based on multiple controlled studies in
peer-reviewed journals, in adherence with FDA
regulations. Cenegenics uses bioidentical
modulation to help patients regain and maintain
metabolic and endocrine functions at the upper
end of their normal range for their age
creating the best opportunity for a healthier and
more vigorous life.
68
Growth Hormone Releasers
  • Also called hGH Releasers, hGH Precursors,
    hGH Secretagogues
  • They do not contain hGH, they will read hGHr
    a compilation of amino acids.

69
The Future-Now
  • SALVIA
  • SPICE

70
THC-like Substances (Spice)
  • HU-210 is both chemically and pharmacologically
    similar to ?9-THC, the main active ingredient in
    marijuana.
  • HU-211 is chemically, but not pharmacologically
    similar to ?9-THC
  • JWH-018, JWH-073 and CP 47,497 are
    pharmacologically, but not chemically, similar to
    ?9-THC

71
Addressing the Problem
  • Enforcement
  • Education and Community Action (Stopping Drug Use
    Before it Starts)
  • Treatment
  • Health Care Monitoring and Intervention (PDMP)

72
For Additional Information
www.DEAdiversion.usdoj.gov or www.dea.gov
73
Thank You!
About PowerShow.com