1. Drug Diversion for Investigators

2. Training Objectives 1.Correctly list the methods used to divert drugs. 2.Define the term “doctor shopper” as it relates to North Carolina General Statute 90-108. 3.Identify the methods/elements of the “doctor shopper.” 4.Correctly list the requirements of a valid prescription. 5.Discuss Health Insurance Portability and Accountability Act (HIPAA) and when protected health information can be disclosed to law enforcement officials.

3. Training Objectives 6.Identify the investigative process to complete a drug diversion investigation. 7.List three resources available to law enforcement to assist in drug diversion investigations. 8.Given a hypothetical situation(s), determine the need to make an arrest and the correct general statute to use for the charge.

4. Why do we need Drug Diversion Training? 20.3 percent of the American population aged 12 and over, have reported non-medical use of prescription drugs. Between 1999 and 2004, Methadone overdose deaths increased 390 percent.

5. What is Drug Diversion? The use of legitimate prescription drugs for illicit purposes or recreation use.

6. Who Can Divert? Doctor, Nurses, Pharmacists, Pharmacist Technicians, Dentists, Veterinarians, Patients

7. Methods Used to Divert Narcotics Prescription forgery Altered prescriptions Photocopied prescriptions Stolen prescription pads Computer generated prescription blanks False call-in prescriptions Doctor shoppers

8. The “Doctor Shopper”  A drug seeker who visits many doctors with the sole purpose of obtaining drugs.  May have no physical complaint or may have a valid medical problem.  Very time intensive  Controlled Substance Reporting System

9. Methods and Elements of Doctor Shoppers Vague or hard to diagnose complaints Specifies what drugs they want Manipulative Frequents urgent care facilities, walk- ins Falsifies information about themselves Pays cash

10. Prescription A prescription is legitimate only when it is written by a licensed provider for a valid medical use to a person with a true condition for therapeutic purposes in a genuine doctor-patient relationship.

11. Health Insurance Portability and Accountability Act

12. Catching the Doctor Shopper Arrest on a separate violation Phone calls from doctors or pharmacies Law Enforcement Officers

13. INVESTIGATION T H E

14. Where Do You Start? The Pharmacy  Remember, it’s a business!  Wait Your Turn!  Ask to speak with the pharmacist.  Identify yourself as law enforcement.  Ask for patient profile.  Determine the payment method.

15. Who Can Get Profiles? NCGS 90-107 Federal and State officers Employees of the North Carolina Department of Human Resources North Carolina Board of Pharmacy Investigators

16. Interview Doctors They have been victimized.Time is Money!BE ON TIME.BE PREPARED.

17. Important Questions Did you know that the patient was seeing other physicians and/or obtaining narcotics from other physicians? Had you known that the patient was receiving narcotics from another physician, would you still have prescribed medication to the patient?

18. Pain Management Agreement

19. Arrest of the Suspect

20. North Carolina General Statutes NCGS 90-108(a)(13) NCGS 108A-64

21. FRAUDULENT PRESCRIPTIONS

22. Arrest of the Suspect

23. North Carolina General Statutes NCGS 90-108(a)(10) NCGS 108A-64NCGS 90-95

24. Interview/Interrogation of the Suspect Different from street drug abuser Determine whether you are dealing with a dealer or a user Not usually street wise Contact suspect in person Take control of the interview Use props Appeal to suspect’s senses/mental roadblocks Can help with “damage control” Don’t interrupt if the suspect is talking

25. BE PREPARED FOR COURT

26. Undercover Investigations Prescription undercover operations are just like illicit undercover drug operations.

27. Undercover Operation on a Doctor Less than 1% of physicians in this country are sanctioned for anything. Joint investigations

28. Method of Operation Prescriptions/drugs for money Prescriptions/drugs for street drugs Prescriptions/drugs for sex No valid medical condition

29. Red Flags Little or no office staff No appointments Long lines outside the office Cash only business Odd operating hours

30. Health Care Diversion Usually for personal useNCGS 90-108(a)(14)

31. Resources Available SBI DECU NC Medical Board NC Board of Nursing NC Board of Pharmacy NC Board of Dentistry NC Board of Veterinary Sciences NC Department of Insurance Medicaid Investigative Unit Department of Social Services NC Department of Revenue

32. Training Objectives 1.Correctly list the methods used to divert drugs. 2.Define the term “doctor shopper” as it relates to North Carolina General Statute 90-108. 3.Identify the methods/elements of the “doctor shopper.” 4.Correctly list the requirements of a valid prescription. 5.Discuss Health Insurance Portability and Accountability Act (HIPAA) and when protected health information can be disclosed to law enforcement officials.

33. Training Objectives 6.Identify the investigative process to complete a drug diversion investigation. 7.List three resources available to law enforcement to assist in drug diversion investigations. 8.Given a hypothetical situation(s), determine the need to make an arrest and the correct general statute to use for the charge.