Drug Enforcement Administration Greater Kansas City Chapter American Society for Pain Management Nursing October 24, 2015 Judy R. Williams Group Supervisor Kansas City District Office (913)

Outline of Topics Mission Statement Illicit Drug Use Most Commonly Diverted Controlled Substances DEA’s Closed System of Distribution Methods of Diversion Case Study

DEA Mission Ensuring an adequate and uninterrupted supply for legitimate medical and scientific purposes. 3 To prevent, detect, and investigate the diversion of controlled substances from legitimate sources while

METHAMPHETAMINE: 353,000 ANY ILLICIT DRUG: 22.6 million (8.7 % of population) MARIJUANA: 17.4 millionCOCAINE: 1.5 million Current Users Rx Drugs: 7 million HEROIN: 239,000 1 SOURCE: 2010 National Survey on Drug Use and Health (NSDUH) published Sept 2011 by the Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

Numbers in Millions Current Drug Users Age 12 & Older

Past Month Illicit Drug Use among Persons Aged 12 or Older, by Age 6

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Regulations: Scheduling of all controlled substances Under the Controlled Substances Act, all controlled substances, legal or illegal, are Scheduled Five established Schedules (I-V) Placement on Schedule depends on the drug’s potential for abuse and accepted medical use Different regulations apply depending on the drug’s Schedule 10

Regulations: The Controlled Substances Act Title 21, United States Code Title 21, Code of Federal Regulations “Except as authorized by this subchapter, it shall be unlawful for any person knowingly and intentionally to... distribute or dispense... a controlled substance.” 21 U.S.C. § 841(a)(1).library.unt.edu

Regulations: Applying criminal sanctions to doctors “Registered physicians can be prosecuted under [21 U.S.C.] 841 when their activities fall outside the usual course of professional practice.” United States v. Moore 423 U.S. 122 (1975)

Regulations: Applying criminal sanctions to pharmacists “[I]f the drug-dispensing pharmacist knows that a customer not only lacks a valid prescription but also will not use the drugs for legitimate medical purposes, then section 841 applies in full flower and treats the dispenser like a pusher.” United States v. Limberopoulos 26 F.3d 245 (1 st Cir. 1994)

Regulations: Registration of physicians Every person who distributes or dispenses any controlled substance must obtain a DEA registration number issued by the Attorney General; renewed every 1-3 years Prerequisites include: (1) valid medical degree 2) valid state medical license 21 U.S.C. § 822(a) 14

Regulations: Recognition of medical need for drugs The Controlled Substances Act recognizes that many drugs have “a useful and legitimate medical purpose and are necessary to maintain the health and general welfare of the American people.” 21 U.S.C. § 801(1) 15

Regulations Issue of Prescription Controlled substances may be distributed lawfully by prescription IF the prescription is issued for a legitimate medical purpose by a practitioner acting in the usual course of professional practice 21 C.F.R. § (a)

Most Commonly Diverted Controlled Substances 17 How big is the problem? 3.9 million people in the United States (1.7% of the population 12 years of age or older) abuse prescription drugs * This is nearly twice the percentage of people who abuse cocaine, crack, and heroin

Most Commonly Diverted Controlled Substances 18 How big is the problem? Highest risk group for abuse of prescription drugs are between 18 and 25 years of age Women twice as likely as men to develop addiction to sedatives and/or tranquilizers

19 Why the Increase in Rx Drug Abuse? A confluence of factors… Significant Increases in the volume of Rx’s Issued Increases in availability Aggressive Marketing by Industry Proliferation of Internet Pharmacies Greater Social Acceptability for medicating a growing number of conditions Source: Testimony of NIDA, July

20 Why are these people always outside in separate tubs?

21 Stimulants Sedatives Narcotic Pain Relievers Tranquilizers SOURCE: 2009 National Survey on Drug Use and Health (NSDUH) published Sept 2010 Dept of HHS / Substance Abuse and Mental Health Services Administration (SAMHSA)

DEA’s Most Wanted: Commonly Diverted Controlled Substances 22 Oxycodone (OxyContin; Percocet; Tylox; Percodan) Schedule II * Street value $1-$5 per mg

OxyContin ® Controlled Release formulation of C2 Oxycodone Similar to morphine in its effects and abuse / dependence potential ‘Hillbilly Heroin’ - addiction, crime and fatal overdoses have all been reported as a result of OxyContin® abuse AKA OC’s, Killers, Oxycoffins, Oxycotton The controlled release method of delivery allows for a longer duration of drug action so it contains much larger doses of oxycodone Abusers easily compromise the controlled release formulation by crushing the tablets for a powerful morphine-like high 23

DEA’s Most Wanted: Commonly Diverted Controlled Substances 24 Methylphenidate (Ritalin) * Street value $8-$10 per pill Schedule II