These slides accompanied the third panel at PSM's 2018 Interchange, which was held on June 7, 2018 in Washington, DC, at the National Press Club, and was moderated by Sven Bergmann, PSM's Senior Advisor on Anti-Illicit Trade Strategies. Panelists were: * Marty Allain, Senior Program Manager, .Pharmacy Verified Websites Program, National Association of Boards of Pharmacy * Charlie Cichon, Executive Director, National Association of Drug Diversion Investigators * Lynn Thomson, Investigator for the Sarasota County Sheriff’s Office The full video of the 3 and a half hour event is available at https://www.youtube.com/watch?v=WlrMw1pAlIU&feature=youtu.be.

1. Introduction to the
Fentanyl Council
Marty Allain, Senior Program Manager, .pharmacy Verified Websites
Program, NABP
Lynn Thomson, Investigator, Sarasota County Sheriff's Office
Charlie Cichon, Executive Director, NADDI
Sven Bergmann, Senior Advisor, Anti-Illicit Trade Strategies, Partnership
for Safe Medicines
The Partnership for Safe Medicines Interchange
June 7, 2018

2. The Fentanyl Council, A Joint Project To
Raise awareness of illicit fentanyl’s danger
Develop federal and state solutions to the
problem of illicitly manufactured fentanyl
contaminating the illicit and counterfeit medication
supply

3. Deliverables for 2018
A Resource Guide to Law Enforcement Policies in
the Wake of Fentanyl
An Assessment of State and Federal Regulation of
Pill Presses

4. National Association of
Boards of Pharmacy (NABP)
• Founded in 1904
• NABP is a nonprofit, international, impartial professional
organization that supports its member Boards of pharmacy in
protecting the public health. (Member Boards of pharmacy
include the 50 United States, four US jurisdictions, 10 Canadian
provinces, the Bahamas, and Australia)
• NABP has identified over 11,000 drug sites operating out of
compliance with US federal and state pharmacy laws and practice
standards
• 96% of the total number of sites NABP has evaluated since 2008
have been found to be out of compliance

5. Consumer Online Pharmacy Trends
• Consumers do 47% of their shopping online
(outside of groceries)*
• 33% of respondents (N=500) to a recent Alliance for Safe
Online Pharmacies (ASOP Global) survey stated they have
bought Rx drugs online**
• 55% of respondents to the ASOP Global survey have
bought, or have plans to buy, Rx drugs online**
* MarkMonitor, http://img03.en25.com/Web/ThomsonReutersMarkMonitorInc/%7Befc99a89-5df8-49b3-ae07-
970fc2b93fcd%7D_MarkMonitor_Online_Barometer-2017-US.pdf
** Alliance for Safe Online Pharmacies, https://buysaferx.pharmacy/public-awareness-campaigns/
canadian-online-pharmacies/factsheets/online-pharmacy-consumer-behavior-and-perception-survey/

6. NABP Report on the Availability of Opioids
Online
• The National Association of Boards of Pharmacy® (NABP®)
recently evaluated 100 websites selling medication to patients
in the United States
• All were operating illegally (98% offering Rx-only medicine
without a prescription and 76% selling unapproved drug
products)
• 54% offered controlled substances and 40% offered one or
more of the drugs frequently counterfeited with fentanyl
(Xanax®, oxycodone, Percocet®, and Norco®)*
*The average number of NABP Not Recommended websites selling controlled substances is 13% over the past 9 years

7. Regulation of Pill Presses
• Possession of a pill press (aka tableting or encapsulating machine),
is not, in and of itself, illegal
• HOWEVER, the distribution, importing, or exporting of a pill press
does require DEA record keeping and may be subject to additional
scrutiny depending on the intended use of the pill press:
• A domestic sale requires verbal notice to DEA with post-notification DEA
form filing
• Importation and exportation require additional information concerning
the need for importation and port information
• All sales require the seller to obtain proof of a buyer’s identification and
to keep these records on file for two years

8. A Pill Press Start-up Story
• In March 2015, Duane Anthony Rouch, a convicted felon on parole,
received a package from China containing a pill mold
• From 2015 until December 2016, Rouch received packages containing
microcrystalline cellulose, a binding agent used to manufacture
pharmaceutical pills
• Rouch also purchased narcotics from websites using cryptocurrency,
which were shipped to a warehouse in Memphis, TN from China and
Canada

9. A Pill Press Start-up Story (cont.)
• On September 16, 2016, Memphis Homeland Security Agents received
information from U.S. Customs and Border Protection about a Canadian
company shipping contraband to Memphis, Tennessee and specifically
to the aforementioned warehouse address
• The Canadian company was known to transship contraband from China
to the United States and supply pill presses and chemicals for producing
counterfeit pills or tablets
• Rouch was subsequently arrested, convicted by a federal jury, and
sentenced to 180 months in federal prison for trafficking narcotics,
possession with intent to distribute and manufacture controlled
substances and being a felon in possession of a firearm

10. Pill Press Screenshots

12. Fentanyl Has Wide-Ranging Effects on
Police Work

14. Law Enforcement Risk: Officer Exposure
Reported in New Jersey, Utah, Connecticut,
Rhode Island, Florida, Kentucky, Maryland,
Ohio, Pennsylvania, Georgia, New Hampshire,
South Dakota, Wisconsin, Massachusetts,
Virginia, Indiana, Illinois, North Carolina,
Maine and West Virginia

15. Law Enforcement Policy Working Paper
Offer LEO a framework to develop policies that
comprehensively address the dangers of synthetic opioids
Gather resources to help agencies assess the research and
make their own decisions about the best policies for their
specific organization

16. Already have a policy? Tell us about your resources and the
factors you considered when you were developing it.
Still working on a policy? Contact us with your questions.
Email: fentanyl.council@safemedicines.org
The Fentanyl Council Needs Your Help