Drug Diversion Investigations

Ofc. Joe Gho

Drug Diversion Investigator

Tulsa Police Department

Special Investigations Division

Drug Diversion

• National Association of Drug Diversion Investigators (NADDI) defines drug diversion as:

“Any criminal act involving a prescription drug”

• Drug Diversion occurs when someone diverts a prescription medication from its intended purpose to an unlawful one

• Drug diversion is accomplished by deception, fraud, forgery, outright theft of the drugs and, increasingly via the internet

Drug Diversion

• Many ways to divert drugs:

– Forged Prescriptions

– Computer generated prescriptions

– Photocopying/Scanning prescriptions

– Fraudulent Call-in prescriptions

– Altering prescriptions

– Stolen RX forms

– Thefts and embezzlements

– Scamming doctors/doctor shopping

– Scams (going out of town/transferring prescription)

Prescription Drug Abuse

• Common misconception is the belief that prescription drugs are not as addictive or abused as the more familiar illicit drugs

• The “TRUTH” is that prescription drugs are every bit as potent and addictive as the illicit drugs like heroin, methamphetamine and cocaine…etc.

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Schedule II Prescriptions

• Until the electronic prescribing law goes into effect 01-01-2020, CII prescriptions can only be in written form, from a doctor with exception to emergencies. They can be electronically prescribed as long as the pharmacy and prescriber are EPCS certified

• Cannot be phoned in, but a faxed original copy for hospice program

• No refills - doctor must write new prescription

• Photo ID required

• Prescription valid “30 days” from date written

(Became a new law on 11-01-05 - used to be 5 days) 6

Schedule III / IV Prescriptions

• Can be written, phoned-in or electronically prescribed as long as the pharmacy and prescriber are EPCS certified

• Prescription valid for six months from date written

• No more than five refills allowed and no refills after six months (must get new rx)

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PMP Schedule II - V Prescriptions

• The “Prescription Monitoring Program” (PMP) was enacted into law by the Oklahoma Anti-Drug Diversion Act (Title 63 OS 2-309) effective 07-01-06

• Goal is to reduce prescription fraud, substance abuse, “doctor shopping” and other illegal activity related to pharmaceutical drug diversion

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• Requires all dispensers to submit prescription information for Schedule II - V CDS prescriptions to OBN, who compiles the data all by computer link

• Identifies patient, prescriber, pharmacy, drug, quantity

• The following have access after submitting an application and being approved to retrieve the information: Law Enforcement, Pharmacies, Practitioners and Regulatory Boards

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PMP Schedule II - V Prescriptions

Electronic Prescriptions• Oklahoma H.B. 2931 (effective January 01, 2020)

• Requires electronic prescribing by all prescribers for all schedules of drugs instead of written prescription forms (Title 63 OS 2-309)

• There are certain conditions where a prescriber can be granted a waiver

• Veterinarians have been granted an exemption

“E-prescribing is one of the most significant pieces

of legislation that will prevent the diversion of prescriptions

from flooding the market. Paper prescriptions are too easy

to counterfeit and lead to fraudulent prescriptions, which

continue fueling the opioid epidemic.”

– Attorney General Mike Hunter10

Anti-Drug Diversion Act• 63 O.S. §2-309D(G)(1) Registrants shall have access to the central repository

for the purposes of patient treatment and for determination in prescribing or screening new patients. The patient's history may be disclosed to the patient for the purposes of treatment of information at the discretion of the physician.

• 63 O.S. §2-309D(G)(2) Prior to prescribing or authorizing for refill, if one hundred eighty (180) days have elapsed prior to the previous access and check, of opiates, synthetic opiates, semisynthetic opiates, benzodiazepine or carisoprodol to a patient of record, registrants or members of their medical or administrative staff shall be required until October 31, 2020, to access the information in the central repository to assess medical necessity and the possibility that the patient may be unlawfully obtaining prescription drugs in violation of the Uniform Controlled Dangerous Substances Act. The duty to access and check shall not alter or otherwise amend appropriate medical standards of care. The registrant or medical provider shall note in the patient file that the central repository has been checked and may maintain a copy of the information.

• 63 O.S. §2-309D(G)(4) Failure to check the PMP is grounds for disciplinary action by the licensing board.

Anti-Drug Diversion Act

• 63 O.S. §2-309I (A) For acute pain, practitioner shall not issue an initial prescription for an opioid drug in a quantity exceeding seven (7) day supply. Any opioid prescription for acute pain shall be the lowest effective dose of an immediate-release drug.

• 63 O.S. §2-309I(H) This section shall not apply to a prescription for a patient who is currently in active treatment for cancer, receiving hospice care from a licensed hospice or palliative care, or is a resident of a long-term care facility, or to any medications that are being prescribed for use in the treatment of substance abuse or opioid dependence.

Drug Diversion LawsObtaining a Controlled Drug by

• Fraudulent prescription phoned-in: 63 O.S. 2-407.A1

Obtaining a Controlled Drug by Fraud

• Forged prescription form presented: 63 O.S. 2-407.A2

Obtaining a Controlled Drug by Forged Prescription

• Altering a prescription: 63 O.S. 2-407.A2

• Give false name or address: 63 O.S. 2-407.A4

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Drug Diversion Laws• Information communicated to a physician in an effort

unlawfully to procure a controlled substance, or unlawfully to procure the administration of any such drug, shall NOT be deemed a privileged

communication Title 63 O.S. 2-407.C

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Drug Diversion Laws

• A person cannot manufacture, create or possess a prescription form illegally

Title 63 O.S. 2-407.B

• Larceny, Burglary or Theft of a Controlled Substances is a Felony charge and does not require a monetary value Title 63 O.S. 2-403

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Drug Diversion Laws

• Engage in Pattern of Criminal OffensesTitle 21 O.S. 11-425.A

• Obtaining Merchandise by False Pretenses

Title 21 O.S. 61-1541.1

• Presenting False Claims to Insurance Company

Title 21 O.S. 1662

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Drug Diversion Laws

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• Labeling - Illegal to carry a CDS without proper label on the container; dispenser must have proper label affixed

• D. No person except a pharmacist for the purpose of filling a prescription shall alter, deface, or remove any label so affixed.

Title 63 O.S. 2-314

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Locally, the most abused and diverted prescription drugs:

1. Hydrocodone (Schedule II CDS)

Lortab, Norco, Vicodin, Tussionex

2. Oxycodone (Schedule II CDS)

Oxycontin, Roxicodone, Percocet

3. Alprazolam (Schedule IV CDS)

Xanax

4. Promethazine with Codeine (Schedule V CDS)

Hydrocodone – Schedule II

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OxyContin (Oxycodone – Schedule II)

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OxyContin 10 mg OxyContin 20 mg

OxyContin 160 mg

OxyContin 40 mg

OxyContin 80 mg

Has now been reformulated

08-15-10

Markings now has “OP”

Oxycodone – Schedule II

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Oxycodone 30 mg

Xanax (Alprazolam – Schedule IV)

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Promethazine with Codeine – Schedule V

Street terms: Lean, Purple Drank, Syrup, Sizzurp, Zyrup

2 Ounces (Deuce): $40-$50

One Pint (16 oz): $250-$300

Promethazine with Codeine – Schedule V

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Other Significant Problems

• Suboxone (Buprenorphine – Schedule III)

• Adipex (Phentermine – Schedule IV)

• Ultram (Tramadol – Schedule IV)

Street Prices

• Oxycodone $25 - $35 ($1.00 per mg)

• Hydrocodone $3 - $5

• Xanax $2 - $5

• Adderall $10

Drug Diversion Investigations

Drug Diversion Investigations

• Endorse all witnesses in the chain of custody of the prescription

• Biggest mistake is not endorsing the doctor as a witness

• The victim is the pharmacy not the doctor - using the doctors name to facilitate the crime

• Chronology of events • Who confirmed/verified the prescription with the

doctor• Who was presented the prescription or who

received the call-in• Who can identify the suspect

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Drug Diversion Investigations

• Check ID with person presenting

• Obtain ID of person obtaining and/or purchasing the prescription

• Keep ID - evidence

• Need original RX for evidence

• Report to police – call 911, if suspect is currently present

Fraudulent Prescription ??

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Misspelled Lortab

Total doesn’t add up

Can only have one

controlled medication

per prescription

Additionally, the

prescription was

photocopied

No directions

Fraudulent Prescription ??

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#30 and XX don’t match

Drug Diversion Investigations

• Emphrais McClendon & Deandre Murphy

• Ruben Castillo

• Roderick Frierson

• Matthew Richards

• Jarrod Jackson

Forged Prescriptions

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Fraudulent Call-in gone wrong

Pharmacy Laws

Identification

Inspection Authority

• A. Prescriptions, orders, and records, required by this act, and stock of substances specified in this act shall be open for inspection only to specifically designated or assigned state, county, and municipal officers, whose duty it is to enforce the laws of this state relating to controlled dangerous substances.

• 63 O.S. § 2-502(A)

Inspection Authority

• “It shall be unlawful for any person . . . [t]o refuse or fail to make, keep, or furnish any record, notification, order form, statement, invoice, or information required under this act . . . or [t]o refuse any entry into any premises or inspection authorized by this act . . .”

• 63 O.S. §§ 2-404(4), (5)

Inspection Authority

• Persons registered to manufacture, distribute, or dispense controlled dangerous substances under this act shall keep records and maintain inventories in conformance with the record-keeping and inventory requirements of federal law and with the additional rules the Director issues.

• 63 O.S. §2-307

Inspection Authority

• A peace officer of the State of Oklahoma, upon stating his/her purpose and presenting to the owner, operator or agent in charge of the premises to be inspected his/her appropriate credentials, shall have the right to enter such premises and conduct inspections at reasonable times and in a reasonable manner.

• 475: 40-1-3

HIPAA• Frequently Registrants/Attorneys will attempt to

argue that HIPAA prevents them from releasing/providing access to law enforcement to patient records relating to CDS. The following represents the authority to be offered in response.

• A Registrant may be subject to discipline which might include suspension, revocation and/or fine for violating Oklahoma law and OBNDD Rules.

• 63 O.S. §2-304

HIPAA

Corresponding Responsibility

• The responsibility for the proper prescribing and dispensing of controlled substances is upon the prescribing practitioner, but a corresponding responsibility rests with the pharmacist who fills the prescription.

Corresponding Responsibility• A pharmacist also needs to know there is a corresponding responsibility for the

pharmacist who fills the prescription. An order purporting to be a prescription issued not in the usual course of professional treatment or in legitimate and authorized research is an invalid prescription within the meaning and intent of the CSA (21 U.S.C. § 829). The person knowingly filling such a purported prescription, as well as the person issuing it, shall be subject to the penalties provided for violations of the provisions of law relating to controlled substances. A pharmacist is required to exercise sound professional judgment when making a determination about the legitimacy of a controlled substance prescription. Such a determination is made before the prescription is dispensed. The law does not require a pharmacist to dispense a prescription of doubtful, questionable, or suspicious origin. To the contrary, the pharmacist who deliberately ignores a questionable prescription when there is reason to believe it was not issued for a legitimate medical purpose may be prosecuted along with the issuing practitioner, for knowingly and intentionally distributing controlled substances. Such action is a felony offense, which may result in the loss of one’s business or professional license

• United States v. Kershman, 555 F.2d 198 [United States Court Of Appeals, Eighth Circuit, 1977]

Theft/Stolen of CDS

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Heroin (Opiates)• Schedule I Drug

• Demerol (Meperidine), Morphine, Hydrocodone, Oxycodone and Dilaudid are opiate based drugs (Schedule II)

Naloxone

• Naloxone, also known as Narcan, or any of its generic equivalents may be dispensed or sold by a pharmacy without a prescription; provided, however, it shall be dispensed or sold only by, or under the supervision of, a licensed pharmacist.

• 63 O.S. 2-312.2 - Sales of Naloxone

Narcan / TPD

• Program started June 2014

• All TPD officers trained

• Mandatory In Service Training

• Over 30 other agencies in the State of OK including: OHP (800) & OCPD (700)

Controlled Drug Tax Stamp

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Marijuana Dosage Units Controlled Substance

Resources• DEA (Tulsa) 918-459-9600

• OBN (Tulsa) 918-446-1616

• Oklahoma Board of Osteopathic Examiners (DO)

1-405-528-8625

• Oklahoma State Medical Board (MD)

1-405-962-1400

• Oklahoma Board of Dentistry (DDS)

1-405-522-4844

• Oklahoma State Board of Pharmacy

1-405-521-3815

Resources• Drug Enforcement Administration

http://www.deadiversion.usdoj.gov/

• NADDI (National Association of Drug Diversion Investigators)http://www.naddi.org

• Oklahoma State Board of Pharmacyhttps://www.ok.gov/pharmacy/

• CAPSAT http://www.capsat.org/index.htm

• Take as Prescribed http://takeasprescribed.org/

• www.drugfree.org

• www.streetdrug.org

• www.nida.nih.com

• DEA list of Controlled Substances Schedule link: https://www.deadiversion.usdoj.gov/schedules/orangebook/e_cs_sched.pdf

CAPSAT

Coalition Against Prescription and Substance Abuse of TulsaMission

• To bring diverse organizations and individuals together to change policies, systems, and environments for the prevention of prescription and substance abuse.

Objective

• The prevention of non-medical prescription drug and opioid abuse through education, training, treatment, research, and enforcement.

Goals

• 1) Reduce the retail and social availability of opioid and non-medical use of prescription drugs through education, training, treatment, intervention, and enforcement within the city of Tulsa.

• 2) Work to develop access to prevention resources, treatment options, and referrals to treatment for non-medical use of prescription drugs and/or opioid abuse.

• 3) Work to develop city-wide accurate data collection methods and/or systems for capturing usage of non-medical prescription drugs and/or opioid abuse and related crimes.

NADDI Brochure

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Joe Gho, Jr.Drug Diversion Investigator

City of Tulsa Police DepartmentSpecial Investigations Division (SID)600 Civic Center, Tulsa, OK 74103

Office: 918-586-6337Cell: 918-271-4960

Email: jgho@cityoftulsa.org