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Two unique approaches_final


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Law Enforcement Track: Two Unique Approaches
National Rx Drug Abuse Summit
April 2-4, 2013
Dr. Gary Martin and Jason Parman

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Two unique approaches_final

  1. 1. Two  Unique  Approaches   Dr.  Gary  Mar7n  Homicide  Detec7ve,  Palm  Beach  County  (FL)  Sheriff’s   Department     Jason  Parman   Assistant  U.S.  AJorney,  London,  KY   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  2. 2. Lesson  Objec7ve  1.  Outline  inves7ga7ve  priori7es  in  building  an   overdose  death  prosecu7on.  2.   State  the  benefit  of  building  strategic   coopera7on  between  federal  and  state  law   enforcement  agencies.  3.   Demonstrate  how  law  enforcement  can  work   together  with  community  preven7on   programs  in  inves7ga7ons.  
  3. 3. Overdose  Suppression  Project:     A  Comprehensive  Response  
  4. 4. •  Law  Enforcement  •  Public  Awareness    •  Quan6ta6ve  Research  
  5. 5. •  Reviewing  each  overdose  death  inves7ga7on.    •  Applying  all  relevant  statutes  to  the   circumstances.  •  Forwarding  all  narco7cs  intelligence.  •  19.3  %  of  the  case  reviews  generated  narco7cs   intelligence.        
  6. 6. •  Overdose  and  poisoning  should  be  ruled  out  in   all  cases  of  non-­‐violent  deaths.    
  7. 7. •  Scene  Inves7ga7on  •  Physical  Examina7on  of  the  Decedent  •  Autopsy  Results  •  Toxicology  Findings  
  8. 8. If  a  person  dies  of  an  apparent  drug  overdose:  (1)  A  law  enforcement  agency  shall  prepare  a  report  iden7fying  each   prescribed  controlled  substance  listed  in  Schedule  II,  Schedule  III,  or   Schedule  IV  of  s.  893.03  which  is  found  on  or  near  the  deceased  or  among   the  deceaseds  possessions.  The  report  must  iden7fy  the  person  who   prescribed  the  controlled  substance,  if  known  or  ascertainable.  Thereaeer,   the  law  enforcement  agency  shall  submit  a  copy  of  the  report  to  the   medical  examiner.  (2)  A  medical  examiner  who  is  preparing  a  report   pursuant  to  s.  406.11  shall  include  in  the  report  informa7on  iden7fying   each  prescribed  controlled  substance  listed  in  Schedule  II,  Schedule  III,  or   Schedule  IV  of  s.  893.03  that  was  found  in,  on,  or  near  the  deceased  or   among  the  deceaseds            possessions.  
  9. 9. •  All  prescrip6on  drug  containers  (including  empty  containers)  should  be   photographed,  seized,  and  then  individually  described  on  a  property   receipt.    •  All  unfilled  prescrip6on  authoriza6ons  “scripts”  should  be   photographed,  seized,  and  individually  described  on  a  property  receipt.  •  All  illegal  drug  containers  (plas6c  baggies,  film  vials,  e.t.c.)  should  be   handled  in  such  a  way  that  poten6al  trace  evidence  could  be  extracted.  •  Within  reason,  samples  of  drinking  fluids  discovered  within  the   immediate  area  of  the  suspected  overdose  death  should  be  collected.    
  10. 10. Evaluate  physical  evidence  of  prescrip7on  drug  abuse  and   diversion  by  the  decedent:    •  Appointment  cards  •  Address/phone  books    •  Cell  phones/caller  id    •  Personal  computers      •  Calendars  •  Prescrip7on  vials    •  Unfilled  scripts    •  Pharmacy  receipts  •  Drug  warning  documents    
  11. 11. •  Forging  coopera6ve  rela6onships  with  families  who  have   lost  loved  ones  to  drug  overdose  death.  •  Providing  overdose  risk  awareness  programs  to  students   and  parents.  •  Designing  a  mul6media  public  service    campaign  focusing   on  the  risks  associated  with  prescrip6on  drug  misuse  and   abuse.  •  Seeking  legisla6ve  ac6on  to  discourage  doctor  shopping   and  prescrip6on  drug  diversion.      
  12. 12. “All  Bets  Are  Off”    
  13. 13. The  Cri7cal  Point  
  14. 14. Ineffec7ve  Remedies  •  Do  NOT  put  them  in  an  ice  cold  bath.  •  Do  NOT  inject  them  with  salt  water  or  milk.  •  Do  NOT  give  them  s7mulants  (like  cocaine,   methamphetamine,  or  Adderall).  •  Do  NOT  give  them  food  or  water  or  induce  vomi7ng   (they  could  choke)  •  Do  NOT  leave  them  alone.  •  If  you  must  leave,  call  911  first  and  leave  them  in  the   recovery  posi7on.  
  15. 15. Recovery  Posi7on  
  16. 16. •  A  Drug  Overdose  Interven7on  Strategy.    •  Offers-­‐limited  immunity  from  criminal  prosecu7on   for  person(s)  who,  in  good  faith,  seek  medical   aJen7on  during  a  drug-­‐related  medical  crisis.    •  Intent-­‐reduce  the  number  of  drug  overdose  deaths   by  removing  the  fear  of  arrest  as  a  barrier  to  seeking   emergency  medical  assistance.      
  17. 17. 911  Good  Samaritan     893.21  Drug-­‐related  overdoses;  medical  assistance;  immunity  from   prosecu6on.  •  (1)  A  person  ac7ng  in  good  faith  who  seeks  medical  assistance  for  an  individual   experiencing  a  drug-­‐related  overdose  may  not  be  charged,  prosecuted,  or   penalized  pursuant  to  this  chapter  for  possession  of  a  controlled  substance  if  the   evidence  for  possession  of  a  controlled  substance  was  obtained  as  a  result  of  the   person’s  seeking  medical  assistance.  •  (2)  A  person  who  experiences  a  drug-­‐related  overdose  and  is  in  need  of  medical   assistance  may  not  be  charged,  prosecuted,  or  penalized  pursuant  to  this  chapter   for  possession  of  a  controlled  substance  if  the  evidence  for  possession  of  a   controlled  substance  was  obtained  as  a  result  of  the  overdose  and  the  need  for   medical  assistance.  •  (3)  Protec7on  in  this  sec7on  from  prosecu7on  for  possession  offenses  under  this   chapter  may  not  be  grounds  for  suppression  of  evidence  in  other  criminal   prosecu7ons.  •  This  act  shall  take  effect  October  1,  2012.  
  18. 18. •  Collec7ng  extensive  demographic  and   circumstan7al  data  from  each  overdose  death   inves7ga7on.  •  Designing  a  prac7cal  overdose  death   database.  •   Exposing  overdose  correla7ons  and  trends.    
  19. 19. Case  Examina6ons          •  353  overdose  death  cases  •  Palm  Beach  County,  Florida    •  Selected  by  chronological  occurrence    •  Data  derived  from:    Police  and  paramedic  reports        Autopsy  and  toxicology  findings    Family  and  friend  interviews      Medical  records        
  20. 20. Decedents’  Average  Age   40.08  Years  
  21. 21. •  Age  breakdown    
  22. 22. •  White  •  Male  •  Approximately  40  years  old  •  High  School  Diploma  or  GED  •  Employed  
  23. 23. •  History  of  substance  abuse  •  History  of  drug  related  arrests  •  History  of  substance  abuse  treatment  •  History  of  mental  health  treatment  •  History  of  non  fatal  drug  overdose  •  Under  physician’s  care  at  7me  of  death  
  24. 24. •  Died  at  home  •  Discovered  by  family  member  •  Last  act  is  sleeping  •  Found  unconscious  •  Others  present  at  death  scene  •  Other  recognized  distress  •  Died  from  accidental  mul7ple  drug  toxicity  •  Most  likely  combina7ons  are  alprazolam,   oxycodone,  cocaine,  and  methadone.  
  25. 25. Detec7ve  Gary  Mar7n    Violent  Crimes  Division  –  Homicide  Unit  Palm  Beach  County  Sheriff’s  Office    West  Palm  Beach,  Fl  33406  561-­‐688-­‐4058  Or    Gary  Mar7n,  Ed.D.  Associate  Dean  For  Student  Life  Lynn  University    Boca  Raton,  Fl  33431  561-­‐237-­‐7157    
  26. 26. Two  Unique  Approaches   April  2  –  4,  2013   Omni  Orlando  Resort     at  ChampionsGate  
  27. 27. Learning  Objec6ves  •  1.    Outline  inves7ga7ve  priori7es  in  building  an                      overdose  death  prosecu7on.  •  2.    State  the  benefit  of  building  strategic                      coopera7on  between  federal  and  state  law                    enforcement  agencies.  •  3.    Demonstrate  how  law  enforcement  can  work            together  with  community  preven7on                                      programs  in  inves7ga7ons.  
  28. 28. Disclosure  Statement  
  29. 29. Controlled  Substances  Act  covers   overdose  deaths  21  USC  841(A)(1):    1.  Knowing  distribu7on  of  controlled                          substance                2.  Death  results  from  use  of  controlled                                                          substance        21  USC  846:                1.  Two  or  more  people  must  conspire  to                        distribute  a  controlled  substance              2.  Death  results  from  use  of  controlled                          substance  
  30. 30. Inves7ga7ve  Priori7es   What caused the death? Who did it?•  Medical  examiner’s  report  essen7al  –   •  Witnesses  who  observed  drug   work  to  develop  rela7onships  with   distribu7on  to  the  deceased?   coroners   •  For  prescrip7on  overdoses,  tracking  the  •  Toxicology  report  helpful,  but  not   disposi7ve   paper  trail  is  useful  •  Do  NOT  have  to  prove  intent  to  kill,   •  Standard  drug  inves7ga7ons  is   recklessness,  foreseeability,  or  other   important  parallel   mental  state  rela7ve  to  the  death    •  The  element  that  must  be  proven  is   “Did  death  result  from  the  use  of  the   controlled  substance?”  •  Distributed  drug  does  not  have  to  be   exclusive  or  primary  cause  of  death,   only  had  to  have  played  a  part.  
  31. 31. “Tradi7onal”  TARGETS   Sponsors,  Brokers,  Direct  Distributors  •  Developing  sources  of   informa7on  /  cooperators  key    •  Establish  rela7onships  between   targets  rela7ve  to  date  of   distribu7on  •  Was  target  in  the  chain  of   distribu7on  that  led  to  the  death  •  Tracking  the  line  from  the  end   user  to  the  drug  source  reveals   poten7al  targets    (All  in  the  chain   are  poten7al  defendants  as  long   as  distribu7on  to  end  user    was   reasonably  foreseeable)  
  32. 32.  POTENTIAL  TARGETS   Doctors  /  Pharmacists  •  Need  to  show  target  prescribed  /   filled  medica7on  without  legi7mate   medical  purpose  outside  the  usual   course  of  professional  treatment    •  PaJern  of  pa7ents  help  to  establish   unlawful  distribu7on    •  Cash  only  clientele  •  Superficial  examina7ons  •  Expert  review  of  records  •  Cooperators  beneficial  •  Conspiratorial  rela7onship  between   providers  (warning  pa7ents  where   to  or  not  to  fill  scripts)  
  33. 33. “Death  Resul7ng”  Penal7es    Statutory  Penal6es   Sentencing  Guidelines        21  USC  841(b)(1)(A)-­‐(C)   U.S.S.G.  §  2D1.1  •  Mandatory  Minimum  20  years   •  Deaths  from  Schedule  I  or  II  with  prior   with  Life  max   convic7on  for  trafficking  with  similar   drug  is  43  (360  –  life)  •  Applies  to  all  Schedule  I  and  II   •  No  prior  convic7on  is  38  (235-­‐293)   Controlled  Substances   (oxycodone,  methadone,  etc.)   •  Deaths  from  Schedule  III  and  IV  (ie:   hydrocodone,  alprazolam)  start  at  30   (97-­‐121)  with  prior  convic7on  and  26   (63-­‐78)  without  convic7on   •  All  ranges  assume  no  criminal  history   •  Ex:  Criminal  History  I  with  a  38   (235-­‐293)  is  (360  to  life)  with  a   Criminal  History  VI  
  34. 34. United  States  v.  McIntosh   DEA  inves6ga6on  with  State     partnerships   Result  ?  •  What  made  it  work?   •  McIntosh  sentenced  to  327  •  First  responders  treated  call  as  a   months  for  distribu7on  resul7ng   crime  scene  vs.  an  accident     in  death  (guideline  range  of  •  Autopsy  that  established  oxycodone   292-­‐327)  Lowest  criminal  history   as  a  contribu7ng  factor  in  the  death   category  •  DEA  later  implicated  McIntosh  in  a   Who  collaborated?   large  oxycodone  conspiracy  through   •  Kentucky  State  Police   cooperator  statements  and  local  law   •  Local  Law  Enforcement   enforcement’s  street  level  buys    •  Crucial  leads  in  the  inves7ga7ve   •  County  Coroner   report  from  10  months  prior   •  State  Medical  Examiner  •  Knew  the  Who,  What,  When  and   •  DEA   Where  and  it  was  documented  
  35. 35. Benefits  to  “death  resul7ng”   prosecu7ons   “Tradi6onal”  Drug  Dealers     “Professional”  Drug  Dealers  •  Dealing  is  ul7mately  a  decision   •  Doctors,  Pharmacists,  etc.  •  “The  nega7ve  has  to  outweigh  the   •  Enormous  profit  margins  for  pain  clinic   posi7ve”   owners,  doctors,  pharmacists  •  Reality  is  Rx  diversion  is  a  profitable   •  $100,000  cash  in  one  day,  for  example   revenue  plan  for  many   •  Violate  your  duty,  responsible  for  the  •  These  prosecu7ons  send  a  simple,   consequence   powerful  message     •  Given  the  harm  produced  from   prescrip7on  diversion,  must  target  •  Distribute  prescrip7on  drugs,  you  will   those  with  “keys  to  the  castle”   be  held  responsible  for  the   •  Treats  the  source  =  to  a  drug  dealer   consequence    
  36. 36. Ques7ons/Comments   Jason  D.  Parman  United  States  AJorneys  Office   Eastern  District  of  Kentucky   606-­‐864-­‐5523    Ext.  117