Specialist Jerry O. Mitchell

Attorney General Chief law enforcement official of the

Commonwealth. Protects citizens by prosecuting criminal

offenses that are multi-jurisdiction as well enforcing regulations relating to consumer protection issues.

Represents the Commonwealth against all law suits.

EDUCATION & OUTREACH PROGRAMS “Truth & Choices” – Shane’s Story

– addresses drug/alcohol abuse “Operation Safe Surf”

– addresses dangers of internet predators “Faux Paw - the Techno Cat”

– In a partnership with i-Keep Safe Coalition addresses internet safety for young children.

“Sticks & Stones” – addresses cyber bullying. “Stop Gun Violence” – straw purchasing of firearms. “Senior Crime Prevention University” – educate

senior citizens about identity theft and scams that target seniors.

“Consequences” – addresses Rx drug abuse.

Q/A How many of you know someone

who has overdosed? How many of you consider

prescription drugs to be dangerous? Did you know that Rx overdose

death rate is 300% greater than death rate by firearms?

Schedule of Controlled Substances Schedule I – high potential for abuse with no

accepted medicinal use in U.S. Schedule II – high potential for abuse which may lead

to severe psychological or physical dependence. Limited medicinal use with severe restrictions.

Schedule III – potential for abuse which may lead to moderate physical and high psychological dependence.

Schedule IV – low potential for abuse with limited physical and psychological dependence.

Schedule V – low potential for abuse and limited physical dependence.

Prescription Drug Diversion Diversion of prescription drugs come from: ◦Doctor shopping ◦Illegal internet pharmacies ◦Drug theft ◦Prescription forgery ◦Illicit prescribing by physicians Unlike illegal drugs because people can obtain them through legal channels Illusion of safety

Prescription Drug Diversion ◦Illegal internet pharmacies ◦Approximately 400 illegal internet pharmacies, 50% outside the US (2003) ◦Fake, substandard, inappropriate medication

Prescription Drug Diversion ◦Drug Theft ◦Any point from manufacturer to patient ◦Doctor’s offices, patients homes being robbed ◦Pharmacy robbery

Prescription Drug Diversion Prescription Forgery ◦Making/stealing blank prescription pad ◦Altering legitimate prescription

Rx Drug Classifications Opioids – analgesics

prescribed to treat pain. CNS Depressants – prescribed

to treat anxiety disorders. Stimulants – prescribed to treat

ADHD.

COMMONLY ABUSED Rx Drugs Oxycodone/OxyContin,Percocet, Percodan (II) Hydrocodone/Vicodin, Lorcet (III) Methadone/Dolophine, Methadose (II) Fentanyl/Duragesic, Actiq, Fentora (II) Methylphenidate/Ritalin (II) Dexedrine/Adderall (II) Suboxone/Naloxone (III) Diazepam/Valium (IV) Alprazolam/Xanax (IV) Carisoprodol/Soma (Rx)

Downers Major Depressants ◦Opiates ◦Sedative Hypnotics ◦Alcohol Minor Depressants ◦Skeletal muscle relaxants ◦Antihistamines ◦OTC depressants ◦Look-a-like depressants

Depress CNS ◦Induce sedation ◦Muscle relaxation ◦Drowsiness ◦Coma ◦Induce “rush” ◦Mimic and suppress neurotransmitters

Oxycodone Abuse Schedule II controlled substance. Synthetic opioid designed to treat

moderate pain over (12) hour period. When abused it is usually crushed/snorted

or liquefied/injected to produce heroin high.

Rate on illicit market usually $1/mg. ER visits rose 152% between 2006 to

2012. Tamper resistant pill introduced in 2011.

Fentanyl Schedule II controlled substance. Most potent synthetic opioid. 40 – 100 x Morphine

– Duragesic - transdermal patch applied to skin.– Actiq - lozenge on a stick dissolves orally.– Sublimaze – injectable used in operating rooms.– Fentora – pill designed to dissolve in mouth.– Methylfentanyl- produced in clandestine labs in

Mexico and mixed with street heroin. – Desylmethylfentanyl-produced in clandestine

labs in Canada and marketed as Fentanyl.

Fentanyl Abuse Use of multiple patches. Chewing of patches. Boiling of patches. Chewing on patch while injecting heroin. Size of a grain of salt can be fatal. Addiction is severe and withdrawal

symptoms are debilitating. DEA/ARCOS reports pharmacy orders

increased 3 fold from 2000 thru 2005.

Fentanyl Patches

Methadone Abuse Schedule II controlled substance. Poisoning deaths increased 390% between

1999 and 2004. Highest among all opiate based analgesics.

ER visits rose 73% from 2004 to 2008. Historically used to treat heroin addiction but

prescribing for pain management has increased dramatically within medical community over the past few years.

Demerol Abuse Schedule II narcotic prescribed to treat

post surgical pain. Clear liquid in vials or pill form. Medical staff is most at risk for abuse

due to accessibility and stressful work environment.

Liquid removed from vials and replaced with saline solution.

Hydrocodone Abuse Commonly known as Vicodin. Schedule III controlled substance not tracked

by schedule II reporting system. Must canvass pharmacies to obtain accurate measure of addiction.

Abuse is popular among doctors, nurses and pharmacists.

Addiction is gradual but can escalate quickly due to increase in tolerance level.

Abuse can also lead to liver failure due to complications from acetaminophen toxicity.

ER visits rose 123% from 2004 to 2008.

Suboxone Abuse Schedule III prescribed to treat opioid addiction. Comprised of buprenorphine and naloxone. Buprenorphine is a synthetic opioid that produces less

euphoric high than morphine or heroin. Naloxone is designed to block opioid receptors. Injecting Suboxone can be dangerous and lead to

severe opioid withdrawal symptoms for person with opioid addiction.

Death from overdose increase when ingested with tranquilizers or other substances that may produce drowsiness such as anti-depressants, alcohol or sedatives.

Can cause drug dependence and doctor should be consulted prior to stopping dosage.

ADHD DRUG ABUSE Schedule II stimulant when abused produces a high

similar to cocaine with increased heart rate, blood pressure and heightened sense of awareness.

The CDC reported a 76% increase in teen abuse of ADHD drugs from 1998 thru 2005.

During same time period there was an 86% increase in number of prescriptions written for ADHD drugs to kids between 10 and 19 years old.

Reports of abuse on college campuses increase during final exam week.

NFLIS reported a 151% increase in ADD/ADHD diagnosis from 2007-2011 in northeast U.S.

ADHD drugs prescribed 3 times more to kids in U.S. than kids in UK.

Uppers Amphetamine, Adderal®Dexedrine ® Methylphenidate, Ritalin ®

Force release of body's own energy chemicals & stimulate brains reward/ reinforcement center Effects: ◦Induce paranoia ◦Anxious ◦Restlessness ◦More alert ◦Aggression

Parents Beware! “Pharming/Skittle” parties – kids

raid parents’ prescription drugs then combine them in a bowl and ingest them randomly.

According to NSDUH in 2007 (64%) of young abusers obtained their supply of Rx drugs from family and friends.

According to a 2008 ONDCP report, more teens abused Rx drugs more than all illicit drugs combined except marijuana.

SAMHSA reports that 73.8% of initiates of Rx drug abuse had previously abused an illicit drug.

Unintentional Poisoning Deaths CDC determined that from 1999 thru 2004 there was

a 62.5% increase in the overdose mortality rate in U.S.

Largest increases:– 113% persons 15-24 years of age– 113.6% southern portion of U.S.– 103% females– 75.8% whites

Florida Medical Examiners Commission found that the overdose rate from prescription drugs was 3x the rate of overdoses caused by illicit drugs during 2007.

Further Considerations Abuse among medical professionals and

pharmacists has increased. Robberies/burglaries of pharmacies and

veterinary clinics are more frequent. Hospitals in TN reporting ½ of newborn

babies in NICU suffer from Rx drug withdrawal.

Improper disposal of Rx drugs contaminates drinking water.Rx drug take-back programs, use of soiled kitty litter, used coffee grounds and cooking oil are recommended.

Specialist Jerry O. MitchellStrawberry Square, 16th floor

Harrisburg, PA 17120(717) 783-6279 office

(717) 884-4507 celljmitchell@attorneygeneral.gov

Specialist Jerry O. Mitchell