DrugBuyers.Com: Diversion investigators running all the time

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Few law enforcement resources are dedicated to clamping down on the misuse of prescription drugs.
By SHARON SMITH
Daily Record staff
Friday, September 12, 2003

See also: Harrisburg DEA coverage area [pdf file] 64.19k

In the war against drugs, men and women in law enforcement dedicated to quashing the growing prescription drug problem must feel a lot like the U.S. Army Rangers stranded in the streets of Mogadishu outnumbered and ill-equipped to deal with the situation.
The number of people who abuse prescription drugs each year is nearly equal to the number of people who use cocaine 2 percent to 4 percent of the U.S. population.

Despite the statistics, the number of local, state and federal investigators dedicated to stemming the illegal use of prescription drugs doesnt come close to the number of investigators devoted to fighting drugs like crack or heroin. For that reason, prosecutions are much lower for prescription drug cases compared to street-drug cases.

Federal level

With eight agents and 16 central Pennsylvania counties to cover, the emphasis of the Harrisburg U.S. Drug Enforcement Administration office is on street drugs, such as crack cocaine.

Obviously, were spread thin, said Rich Ford, the resident agent in charge of the Harrisburg office. Right now Im even short a guy.

When it comes to nabbing those who forge prescriptions, doctor shop or peddle OxyContin or other potent pain- killers, Fords office will usually turn those cases over to the Philadelphia office.

We dont have a diversion investigator here, he said. We would like to have somebody here, and we dont.

A September 2002 U.S. Department of Justice inspector general report criticized the DEA for not dedicating enough resources to prescription drug diversion cases. Drug diversion is when legal prescription drugs are secured illegally or abused.

Inspectors found that, despite prescription drugs being a factor in 25 percent of all reported overdose deaths nationally, just 10 percent of the agencys field officer positions were dedicated to prescription drug cases.

Diversion investigators deal more with the regulatory process of monitoring prescription drugs. They do not have arrest authority. They do not carry weapons, and they must rely on DEA special agents or other law enforcement officers to assist them in their investigations.

The diversion investigators lack of law enforcement authority means that they cannot conduct surveillance, perform undercover work, pay informants or serve arrest or search warrants.

In August 2001, the DEAs Operations Division issued a memorandum reminding the diversion investigators of those restrictions. An inspector general for the Justice Department found the reliance on other investigators had detrimentally affected the timeliness and quality of the DEAs diversion cases.

Although a 2000 National Household Survey on Drug Abuse found that 67 percent of the people who had used drugs in the past year were abusing prescription drugs, only 7.7 percent of the DEAs inspector time was spent on prescription drug cases.

Inspectors also found that the DEA provides minimal intelligence support to diversion investigators and, instead, focuses on developing and analyzing intelligence on illicit drug trafficking.

One of the few tools available to diversion investigators is a pharmaceutical tracking system, known as ARCOS. It is a comprehensive system that monitors the flow of controlled substances from its manufacturing to its distribution at pharmacies and hospitals.

The system, according to the inspector general report, was never intended to be used as an intelligence system. Investigators complained the reports were incomplete and inaccurate and the data was not timely.

The Inspector Generals Office recommended that the DEA increase the investigative resources devoted to prescription drug diversion; clarify the roles, responsibilities and law enforcement authorities of diversion investigators; and ensure adequate training for DEA special agents in diversion investigation procedures.

State level

With 20 agents at the Pennsylvania Attorney Generals Office, nine of which were hired in August, Pennsylvania is considered better off than most states.

Their primary job description is to investigate the diversion of prescription drugs, said Kevin Harley, spokesman for the Attorney Generals Office.

What the special unit does is basically deal with the four Ds disabled doctors, who are themselves addicted; dishonest doctors, who overprescribe certain medications; duped doctors, who write prescriptions for those who fake their pain; and older doctors, who are considered easy prescription writers.

Currently, two agents cover the central part of the state, which includes York County.

Were running all the time, said Andy Demarest, with the Pennsylvania Attorney Generals Office.

The unit has made 140 arrests since 1998.

Making prescription drug cases can be tough, though. The state agents have to check on a doctors clients and issues of patients privacy is always a concern.

Youre not just buying dope, Demarest said. Theyre not cases that happen overnight.

Charlie Cichon, president of the Baltimore-based National Association of Drug Diversion Investigators Inc., can relate.

Its a different kind of case when youre investigating a health care professional, Cichon said. You cant just go in there with a John Wayne attitude.

Perhaps one of the biggest arrests the Pennsylvania Attorney Generals Office has made in recent years was that of Bucks County doctor, Richard Paolino, in 2001. The investigators probe revealed Paolino was writing prescriptions for OxyContin, a painkiller, and Xanax, an anti-anxiety medication, in exchange for cash.

At the time of Paolinos arrest, Attorney General Mike Fisher issued a statement highlighting the dangers of prescription drug diversion, particularly the improper use of OxyContin.

OxyContin is an increasingly growing problem in Pennsylvania, Fisher said at the time. The drug is becoming in high demand and, when not properly prescribed, can result in severe addictions and even death. Investigations of this type are extremely important because we can go to the alleged source where we believe the pills are being illegally obtained.

Defendants such as Paolino have the means to put on a Cadillac defense, Demarest said.

Theyre not your average defendant, he said.

In that case, Paolino had issues with his medical license, and health insurance issues were a consideration. Agents could pursue the doctor from a lot of different angles, Demarest said. Having informants helped, too.

Paolino was convicted, though, and is currently serving 30 to 120 years in prison. Paolino did not respond to a request to be interviewed for this story.

Shortly after Paolinos arrest, Demarest was called to testify before Congress. The hearing was held in Bucks County.

In his testimony, Demarest pointed out the growing problem in Pennsylvania with OxyContin.

In the past two years, the Pennsylvania Attorney General has conducted nearly 100 OxyContin abuse investigations throughout the commonwealth, Demarest told lawmakers.

Since the abuse of OxyContin is such a new phenomenon, most local police forces lack the experience to properly target the problem in their communities. The Office of the Attorney Generals experience in dealing with OxyContin abuse needs to be disseminated throughout the commonwealth. For although the problem is particularly bad in the Southeast, it will quickly spread.

Demarest, during the hearing, told lawmakers the following recommendations from the Attorney Generals Office: The theft of a prescription pad should be a distinct crime, punishable as a third-degree felony; the theft of a prescription drug should be a felony under the Controlled Substances Act; and doctor shopping should be made a distinct offense.

Demarest also was asked by federal inspectors about the effectiveness of the DEAs diversion investigators in combating the nations growing prescription drug abuse problem.

I recommended that they have arrest powers, he said. Its true if you dont have arrest powers, you have to shop your case to someone who can make an arrest for you. Of course, it would double the number of arrests, Im sure.

With Pennsylvania now being the No. 1 drug manufacturer in the nation, Demarest said, DEA diversion investigators will have to spend more time performing their regulatory duties. That means they will have less time to devote to prescription drug diversion cases, he said.

It is not clear if the DEA implemented any of the changes suggested by the Inspector General.

York County

In response to a survey sent out by the York Daily Record, most of the eight local police departments that responded ranked crack cocaine, powder cocaine, heroin and marijuana as major threats to the area. Prescription drug abuse was seen as a minor or moderate threat by most.

For example, the York County Drug Task Force ranked the availability of prescription drugs as low and the danger posed by them minor. However, the task force listed the threat level posed by prescription drugs as increasing in the last year.

Pennsylvania State Police at Troop H, which covers York County, listed cocaine as the greatest threat to the area, followed by heroin. However, state police rated the availability of prescription drugs as high. As an aside, state police noted that it had seen a spike in OxyContin use about 18 months ago.

We dont see OxyContin out there a whole lot, said Cpl. Craig Fenstermacher, with Pennsylvania State Police Troop H. We see it from time to time.

State police do not have a unit that concentrates its efforts on prescription drugs, Fenstermacher said. And there is no special effort under way to target people who divert prescriptions.

We target anyone who is selling drugs, he said.

At Troop H, he said, they may see a couple of prescription drug diversion cases a year.

Its by far less than 10 percent of our work, he said.

Recently, state troopers handed over a case in Harrisburg to the Attorney Generals Office, he said.

Southern Regional Police seldom see prescription drug cases, either. When officers do, they will generally contact the York County Drug Task Force, said James Childs III, the departments police chief.

We would tap into their expertise, he said.

York Police filled out a National Drug Assessment Survey that the York Daily Record obtained through a Freedom of Information Act request. The department considered cocaine, heroin and crack to be major problems in York. Prescription drugs, city detectives wrote, were rarely abused and posed a minor threat to the community.

That seems to agree with the accidental overdose deaths seen at the York County Coroners Office. A majority of the accidental overdoses from prescription drugs occurred in the suburbs.

At the York County District Attorneys Office, Chief Deputy Prosecutor Bill Graff sees anywhere from 900 to 1,100 drug cases per year, such as possession or delivery of a controlled substance. He estimated that less than half a percent of those cases were prescription-drug related.

When the occasional prescription drug diversion case does land on his desk, it is generally easy to prosecute. All of the people Graff has prosecuted for prescription drug charges have pleaded guilty, he said.

Graff did not see prescription drugs as being any more or any less of a threat to residents than illegal drugs.

I think people are pill happy, he said. You cant teach people to read prescription bottles the right way. How do you teach common sense?

At the local level, though, more could be done to combat the problem. Educating and informing local police is key.

There are very few people in these agencies even in their narcotics units that have any knowledge of prescription drug diversion, Cichon said.

For that reason, he said, few resources at the local level are dedicated to prescription drug diversion.

Demarest sees the situation with local police as improving, but sees a need for more training. Getting local police involved with organizations such as National Association of Drug Diversion Investigators Inc., which has a state chapter, would be helpful.

The group, he said, can provide local police with access to experts and doctors. It also offers training.

Childs was unaware that the state Attorney Generals Office has a group of investigators dedicated to prescription drug abuse cases, underscoring the need for better communication among federal, state and local police.

Cambria County

The Cambria County Drug Task Force realized it had a problem with OxyContin when agents were finding it easier to buy the painkiller on the streets.

The coroners office there also was seeing an increase in OxyContin overdoses. At the same time, the area had an increase in pharmacy robberies and burglaries. To get high off of OxyContin people will usually crush a pill or chew it to circumvent its time-release mechanism. While doing that will get people high, it can also kill them.

If youre a drug addict, youll use what you can get, said Rod Miller, chief county detective with the Cambria Drug Task Force. It was like mainstreaming heroin. Because they circumvented the time-release, people became readily addicted to it.

The Cambria County task force moved quickly and formed a separate task force to deal with the influx of OxyContin into the area. The task force was made up of local, state and federal authorities, Miller said.

The task force teamed up with Purdue Pharma L.P., the makers of OxyContin, and worked to educate doctors and pharmacists on the problem.

Up until that point, a prescription was not difficult to obtain, Miller said.

James Heins, a spokesman for Purdue Pharma, said the company has tried to help quell prescription drug abuse by educating health care workers and law enforcement officials.

The company also has been involved with the development and distribution of tamper-resistant prescription pads. The company made the pads available to 14,000 doctors nationwide, including some in Pennsylvania.

Once the doctors and pharmacists in Cambria County were informed of the growing OxyContin abuse problem in the area, it became very difficult to get a prescription for the powerful painkiller.

When anyone came in for OxyContin, a red flag went up, Miller said.

The task force also stepped up its law enforcement efforts. The task forces efforts paid off. While OxyContin accounted for 30 percent of the undercover drug buys the task force made three years ago, it now accounts for about 5 percent.

Reach Sharon Smith at 771-2029 or

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"Whosoever is spared personal pain must feel himself called to help in diminishing the pain of others." Dr Albert Schweitzer