Drug Enforcement Administration Kathy L. Federico Supervisory Diversion Investigator Milwaukee District Office

Pharmaceutical Trends 120 people die every day of drug overdoses, over ½ are related to pharmaceutical opioids. Every day, on average, 2,500 teens use prescription drugs to get high for the first time.

55% From a friend or relative 10% Bought from a friend or relative 5% Took from a friend or relative Total: 70% Obtained from a friend or relative

Circle of Addiction Oxycodone (Percocet®, Percodan®, Roxicodone®) OxyContin® Replacing it with (OPANA) Hydrocodone (Vicodin®, Lortab,® Lorcet®) Heroin

Pill to Heroin Trend Relieves Pain and Provides High Lower Cost WHY AS LAW ENFORCEMENT DOES THEIR JOB OXYCODONE IS HARDER TO GET ON THE STREET BASIC SUPPLY AND DEMAND ITS CHEAPER Relieves Pain and Provides High Lower Cost Availability: Snort/Smoke vs Inject

Opioid Usage in the U.S. 99 % Hydrocodone The United States makes up approximately 5% of the worlds population We consume approximately 99% of the world’s supply of hydrocodone and 80% of world’s supply of Oxycodone products Hydrocodone

Opioid Usage in the U.S. 80 % Oxycodone The United States makes up approximately 5% of the worlds population We consume approximately 99% of the world’s supply of hydrocodone and 80% of world’s supply of Oxycodone products Oxycodone

Pharmacy Purchases of Oxycodone DOSAGE UNITS PURCHASED State of Wisconsin Pharmacy Purchases of Oxycodone 2011 - 2015 DOSAGE UNITS PURCHASED Drug Enforcement Administration, Office of Diversion Control, Pharmaceutical Investigations Section, Targeting and Analysis Unit Source: ARCOS Date Prepared: 04/12/2016

U.S. Average = 72,726 dosage units WI Average = 92,565 dosage units State of Wisconsin by County 2015 Pharmacy Purchases of Oxycodone Douglas Bayfield Iron Ashland Vilas Burnett Washburn Sawyer Florence Oneida Price Forest Rusk Polk Barron Lincoln Marinette Langlade Taylor Saint Croix Chippewa Dunn Menominee Oconto Door Marathon U.S. Average = 72,726 dosage units Pierce Eau Claire Clark Shawano Pepin Portage Waupaca Kewaunee Buffalo Wood Outagamie Brown Trempealeau Jackson Adams Waushara Winnebago Calumet Manitowoc La Crosse Monroe Juneau WI Average = 92,565 dosage units Marquette Green Lake Fond du Lac Above Average = 115,707 dosage units or more Average = 69,424 – 115,706 dosage units Below Average = 69,423 dosage units or less Zero Dosage Units Sheboygan Vernon Sauk Columbia Dodge Richland Washington Ozaukee Crawford Dane Iowa Jefferson Waukesha Milwaukee Grant Racine Lafayette Green Rock Walworth Kenosha Source: ARCOS Date Prepared: 04/12/2016 Drug Enforcement Administration, Office of Diversion Control, Pharmaceutical Investigations Section, Targeting and Analysis Unit

Pharmacy Purchases of Hydrocodone DOSAGE UNITS PURCHASED State of Wisconsin Pharmacy Purchases of Hydrocodone 2011 - 2015 DOSAGE UNITS PURCHASED Source: ARCOS Date Prepared: 04/12/2016 Drug Enforcement Administration, Office of Diversion Control, Pharmaceutical Investigations Section, Targeting and Analysis Unit

U.S. Average = 95,866 dosage units WI Average = 85,437 dosage units State of Wisconsin by County 2015 Pharmacy Purchases of Hydrocodone Douglas Bayfield Iron Ashland Vilas Burnett Washburn Sawyer Florence Oneida Price Forest Rusk Polk Barron Lincoln Marinette Langlade Taylor Saint Croix Chippewa Dunn Menominee Oconto Door Marathon Pierce Eau Claire Clark Shawano Pepin Portage Waupaca Kewaunee Buffalo Wood Outagamie Brown Trempealeau Jackson U.S. Average = 95,866 dosage units Adams Waushara Winnebago Calumet Manitowoc La Crosse Monroe Juneau WI Average = 85,437 dosage units Marquette Green Lake Fond du Lac Above Average = 106,797 dosage units or more Average = 64,078 – 106,796 dosage units Below Average = 64,077 dosage units or less Zero Dosage Units Sheboygan Vernon Sauk Columbia Dodge Richland Washington Ozaukee Crawford Dane Iowa Jefferson Waukesha Milwaukee Grant Racine Lafayette Green Rock Walworth Kenosha Source: ARCOS Date Prepared: 04/12/2016 Drug Enforcement Administration, Office of Diversion Control, Pharmaceutical Investigations Section, Targeting and Analysis Unit

DEA Diversion Control Program Enforcement Within DEA, there are 2 main divisions… The Enforcement side of the house is what you would typically think of what you do see on TV… special agents, dressed in Kevlar, chasing drug dealers down the street. Their investigations focus on “illegal” street drugs like heroin, crack, escatsy, etc. And then you have our side of the house which is Office of Diversion Control. There are about 500 Diversion Investigators located all over across the country where as there are over 4000 special agents

Office of Diversion Control To prevent, detect, and investigate the diversion of controlled substances from legitimate sources Ensuring an adequate and uninterrupted supply for legitimate medical and scientific purposes

Diversion Investigators Regulatory DEA Registrants Criminal Investigations I characterize our positions as having two main areas of responsibility… One is the Regulatory side in which we perform inspections like I mentioned in the last slide, help process new applicants, provide education on rules and regulations in order to ensure that our registrants are operating in compliance with the US Code. Our other main area of responsibility is comprised of investigations… such investigations could rise to criminal charges, civil penalties and/or administrative actions. I would like to make mention that our two main functions are not mutually exclusive… for example, violations found during an inspection could just be a surface issue of a greater underlying problem like diversion… in which case the inspection turns into and investigation. Types of Investigations: Who are the targets:

Secure and Responsible Drug Disposal Act October 12, 2010, signed into law The DEA Disposal regulations became effective October 2014. Secure and Responsible Drug Disposal Act of 2010 Signed into law on 10-12-2010 New DEA Disposal Regulations became effective 10-2014 Allowed ultimate users to deliver unused pharmaceutical cs to appropriate entities Encourage the development of collection and disposal in a secure convenient and responsible manner.

DEA Prescription Drug Take-Back Initiative To get rid of unneeded prescription drugs in an effort to prevent those drugs from being introduced to the illicit market.

1 11th National Take Back Day: April 30, 2016 3 2 Total Weight Collected (pounds): 893,498 (447 Tons) 13,800 5095VT 12560 NH 2,920 988 31960 25,028 MA 10,842 5,858 3 3460 RI 1,581 3,068 47,596 64,247 1,477 8816 CT 16,707 9,084 43,778 17,785NJ 3,776 5,292 2 36,408 48,717 6,763 7,684 DE 29,125 24,170 5,876 13,894 64,320 43,975 31,017 9,752 11,482 MD 15449 21,229 3,247 DC 916 12,713 25,289 6688 5,715 8853 1,827 4,494 79,418 4,383 1604 PR & VI 1 4,162 2,917 HI & GU 27,322 Drug Enforcement Administration Diversion Control Program

DEA 360 Initiative What is DEA 360   A comprehensive approach to tackle the cycle of violence and addiction generated by the link of drug cartels, violent gangs, and the rising problem of prescription opioid and heroin abuse in the US. Coordinated LE operations targeting all levels of drug trafficking Engaging our DEA registrants to increase awareness of the opioid epidemic and encourage prescribing and usage of opioid painkillers throughout the medical community. COMMUNITY OUTREACH is a new effort for the DEA. The goal is to partnership with local organization to equip and empower our communities to fight the opioid epidemic.

Community Outreach Partners GOAL:   Stopping the deadly cycle of heroin and opioid prescription abuse by eliminating drug trafficking organizations and gangs fueling violence Partnering with the medical community and others to raise awareness of the dangers of prescription opioid misuse and the link to heroin. Strengthening community organizations best positioned to provide long-term and support for building drug-free communities.

Operation “Smack” Down Operation “Smack” down: DEA 360 Degree Strategy Partnerships Target Violent Drug Traffickers and Gang Members in Wisconsin. The investigation was worked with various local law enforcement organizations.   Operation “Smack” down culminated in mid-May with the execution of 27 search warrants and resulted in approximately 110 felony arrests, the seizure of 45 firearms, three ballistic vests in Milwaukee and other Southeast Wisconsin communities.  Investigators seized over­­ 425 grams of heroin, 600 grams of cocaine, and 2000 diverted prescription opiate pills.