This document summarizes a presentation given by Jeff Kallal of the DEA on prescription drug abuse and diversion. It discusses how prescription drug abuse has led to a national crisis and opioid epidemic, with many users transitioning to heroin due to lower costs. It outlines trends seen across various states and provides data on prescription drug-related deaths in Nevada and Clark County specifically. The presentation covers commonly abused prescription opioids and depressants, as well as methods of diversion such as doctor shopping, pharmacy theft, and internet sales.
A More Dangerous Heroin: Presented at Grand Rounds, Dept of Psychiatry, Rush ...Dan Ciccarone
This document summarizes a presentation on the changing heroin epidemic in the United States. It discusses rising overdose deaths, particularly from fentanyl-laced heroin. Interviews with heroin users find they face a unpredictable drug supply with wide variations in potency and effects. As the heroin market transitions, users must adopt new harm reduction strategies to navigate an increasingly dangerous situation.
Cannabis Disruption - How Legal Marijuana Will Change Big Pharma, Alcohol, To...Cannabis News
Cannabis may be the biggest disruption our our lifetime, here is why https://cannabis.net/blog/opinion/disrupting-healthcare-cannabis-will-destroy-big-pharma-big-alcohol-and-big-tobacco
This document provides an overview of prescription drug abuse in the United States. It discusses how the U.S. consumes a disproportionate amount of opioids and other prescription drugs globally. The document traces the historical factors that have contributed to the development of America's drug culture, from the Civil War era to modern pharmaceutical marketing practices. It also shares current statistics on prescription drug abuse rates and risks in Nevada. The presentation concludes by outlining the activities of Nevada's Controlled Substance Prescription Abuse Prevention Task Force and its prescription monitoring program.
Animation is key component of beautiful and useful product design. Salesforce, Google, and IBM all feature motion design in their design systems, and there’s every reason you should, too. When designers and developers agree upon constraints, they can create UI components faster and present a unified, polished look and feel users appreciate.
Communicating animation is all about identifying patterns and setting boundaries and behavior expectations. This means:
- creating custom easings that reinforce branding and physics
- choreographing scalable timing values
- creating a vocabulary of reusable components
- combining those components into unique yet universal animation patterns.
Whether your project is big or small, if it has a style guide, you will want to include motion design. In this talk, you will learn how to bring animation to heel.
Adolescent Drug Use and Management: An Updatedpark419
Objectives:
1. Briefly discuss the prevalence of drug references in popular culture
2. Review pre-teen and adolescent drug use trends from the 2014 Monitoring the Future Survey
3. Briefly review the main categories of drugs of abuse, their physical manifestations, and other pertinent topics related to each drug
4. Discuss the overarching theme of resuscitating patients with drug intoxication in the PED
The document discusses America's growing addiction crisis, noting that over 1 in 7 Americans over 12 have an addiction. Heroin use has nearly doubled from 2005 to 2012. However, only 1 in 10 with an addiction receives treatment, far lower than rates for other diseases. There are many barriers to treatment, including stigma, lack of access, and cost. Addiction affects all demographics and youth are most at risk, with 1 in 4 who first use drugs before 18 becoming addicted. The document calls for recognizing addiction as a national health crisis, reducing stigma through education, ensuring treatment access and coverage, and focusing on prevention for youth.
Holding Hands With The Hopeless Edps Project Finalcmadison
This was initially completed as a project in one of my courses. However, understanding substance abuse as a disease and not a moral issue or lack of willpower is vitaly important to continue to make advancements in treatments and reimbursement issues, which are a huge threat.
This document discusses the link between marijuana use and mental illness. It outlines several studies that have found regular marijuana use increases the risk of developing psychotic illnesses like schizophrenia, especially for those with a family history or who start using in adolescence. The document also discusses the experiences in Colorado since legalizing marijuana, including an increase in marijuana-related emergency room visits and traffic deaths involving marijuana. The authors argue for a "smart approach" to marijuana policy that decreases access and availability, especially to youth, through prevention programs and increased treatment options rather than an "all or nothing" legalization vs prohibition debate.
A More Dangerous Heroin: Presented at Grand Rounds, Dept of Psychiatry, Rush ...Dan Ciccarone
This document summarizes a presentation on the changing heroin epidemic in the United States. It discusses rising overdose deaths, particularly from fentanyl-laced heroin. Interviews with heroin users find they face a unpredictable drug supply with wide variations in potency and effects. As the heroin market transitions, users must adopt new harm reduction strategies to navigate an increasingly dangerous situation.
Cannabis Disruption - How Legal Marijuana Will Change Big Pharma, Alcohol, To...Cannabis News
Cannabis may be the biggest disruption our our lifetime, here is why https://cannabis.net/blog/opinion/disrupting-healthcare-cannabis-will-destroy-big-pharma-big-alcohol-and-big-tobacco
This document provides an overview of prescription drug abuse in the United States. It discusses how the U.S. consumes a disproportionate amount of opioids and other prescription drugs globally. The document traces the historical factors that have contributed to the development of America's drug culture, from the Civil War era to modern pharmaceutical marketing practices. It also shares current statistics on prescription drug abuse rates and risks in Nevada. The presentation concludes by outlining the activities of Nevada's Controlled Substance Prescription Abuse Prevention Task Force and its prescription monitoring program.
Animation is key component of beautiful and useful product design. Salesforce, Google, and IBM all feature motion design in their design systems, and there’s every reason you should, too. When designers and developers agree upon constraints, they can create UI components faster and present a unified, polished look and feel users appreciate.
Communicating animation is all about identifying patterns and setting boundaries and behavior expectations. This means:
- creating custom easings that reinforce branding and physics
- choreographing scalable timing values
- creating a vocabulary of reusable components
- combining those components into unique yet universal animation patterns.
Whether your project is big or small, if it has a style guide, you will want to include motion design. In this talk, you will learn how to bring animation to heel.
Adolescent Drug Use and Management: An Updatedpark419
Objectives:
1. Briefly discuss the prevalence of drug references in popular culture
2. Review pre-teen and adolescent drug use trends from the 2014 Monitoring the Future Survey
3. Briefly review the main categories of drugs of abuse, their physical manifestations, and other pertinent topics related to each drug
4. Discuss the overarching theme of resuscitating patients with drug intoxication in the PED
The document discusses America's growing addiction crisis, noting that over 1 in 7 Americans over 12 have an addiction. Heroin use has nearly doubled from 2005 to 2012. However, only 1 in 10 with an addiction receives treatment, far lower than rates for other diseases. There are many barriers to treatment, including stigma, lack of access, and cost. Addiction affects all demographics and youth are most at risk, with 1 in 4 who first use drugs before 18 becoming addicted. The document calls for recognizing addiction as a national health crisis, reducing stigma through education, ensuring treatment access and coverage, and focusing on prevention for youth.
Holding Hands With The Hopeless Edps Project Finalcmadison
This was initially completed as a project in one of my courses. However, understanding substance abuse as a disease and not a moral issue or lack of willpower is vitaly important to continue to make advancements in treatments and reimbursement issues, which are a huge threat.
This document discusses the link between marijuana use and mental illness. It outlines several studies that have found regular marijuana use increases the risk of developing psychotic illnesses like schizophrenia, especially for those with a family history or who start using in adolescence. The document also discusses the experiences in Colorado since legalizing marijuana, including an increase in marijuana-related emergency room visits and traffic deaths involving marijuana. The authors argue for a "smart approach" to marijuana policy that decreases access and availability, especially to youth, through prevention programs and increased treatment options rather than an "all or nothing" legalization vs prohibition debate.
In now days so many peoples are addicted to drugs and alcohol. This life-threatening disease affects all who come in content with the addicted person: friends, family, and co-workers. BLVD treatment center mission is to instill in our clients a deeply held sobriety, emotional wellness and unshakable joy of life.
Ethics legalization of marijuana.final online.pdfSasha Nazarchuk
This document outlines a presentation on the legalization of marijuana. It discusses pros and cons in terms of impact on patients/nursing, healthcare systems, and government/society. Key points include marijuana's medical uses in alleviating pain and symptoms but also potential increased usage. The healthcare system impact involves ethical issues for nursing as well as costs. Government/society sections note potential economic benefits from taxation but also social effects. The presentation concludes with a question and answer segment.
The document provides information about crack cocaine, including what it is, its effects, who uses it, and dangers of use. It discusses crack cocaine as a highly addictive stimulant derived from powder cocaine. It notes statistics on lifetime and recent use among different age groups in the US. The rest of the document covers street terms, health risks, societal impacts, and advice for avoiding crack cocaine use.
This document provides an overview of a presentation given at the Virginia Rural Health Association Annual Conference on December 11, 2014 about the REVIVE! project in Virginia. The presentation discusses the high rates of opioid overdose deaths in the US and Virginia, describes how naloxone works to reverse opioid overdoses, and outlines the development and implementation of the REVIVE! pilot programs which trained laypeople to administer intranasal naloxone to reverse overdoses.
The document discusses drug addiction as a dangerous disease. It notes that all forms of addiction are bad, whether from alcohol, morphine, or other narcotics. The objective is to eliminate drug problems and monitor drug use trends. A survey was conducted where most people agreed that drug addiction is a mental illness and that drugs can cause dependency. The findings show addiction alters brain function and taking drugs triggers feelings of pleasure. Common drugs in Pakistan include cannabis, opium, and heroin. Drug addiction is a major problem costing over $600 billion annually.
- The document discusses drug culture among children and youth in Central PA. It notes that drug use is driven by American culture and is too easy for teens to obtain drugs.
- The types of drugs used in Central PA have expanded beyond just marijuana, cocaine, and alcohol to include meth, synthetic drugs ("bath salts"), and abused prescription drugs. Synthetic cannabinoids are often marketed as incense but are not meant for human consumption.
- Reasons for teen substance abuse include needing healing from trauma and the drugs providing an accepting social circle. The document calls for greater awareness of dangers and encouraging teens to resist peer pressure.
A study which chillingly lays bare the “public health crisis” that arose over a decade in the United States because of excessive alcohol consumption has received severe criticism for relying on comprised data to arrive at that conclusion. It has been criticized by some experts and the Distilled Spirits Council (DSC) for being less consistent, and for not including young adults aged below 18 years, who are increasingly taking to alcohol in America.
This document provides an overview of alcohol use and related health issues. It notes that alcohol is the most misused substance globally, consuming over 15% of national health budgets. Alcohol is linked to 50% of murders, 40% of violent acts, and more than 30% of rapes. While only 5-7% abuse alcohol, 10-20 million people need treatment. The majority of alcohol is consumed by men ages 20-29, with daily or near daily use reported by over 55% of female consumers and 68% of male consumers. On average, men and women consume 4.9 drinks containing 62 ml of alcohol during typical drinking occasions. Most countries focus on tertiary treatment for dependence rather than primary prevention or early intervention
A dodgy clinic.A reality TV crew. AWOL state regulators. .docxsleeperharwell
A dodgy clinic.
A reality TV crew.
AWOL state regulators.
How a t wentysomething
alcoholic’s last
best hope took
a fatal turn.
BY JOHN HILL
I L L U S T R A T I O N B Y M A X O M A T I C
O n D e c e m b e r 3 0 , 2 0 1 2 , as part o f a series called
Drugged, the N ational Geographic C hannel aired an
hourlong docum entary ab o u t a 28-year-old nam ed
Ryan Rogers. It appeared to be a classic tale o f a drunk
trying against the odds to sober up, albeit with espe
cially harrowing footage and an unusually charismatic
protagonist, often shown with a radiant smile on his
handsom e face. In one scene, Ryan, in the m idst o f
an o th er day o f drinking vodka straight o u t o f the
bottle, vomits into the trash can next to his armchair
as his distraught grandfather looks on. In another, he
roils aro u n d the passenger seat while badgering the
elderly m an to drive him to the liquor store.
“I apologize, you guys,” Ryan says to the camera
crew in the backseat. W ith o u t a drink, “I can’t even
focus o r th in k o r even understand anything.”
T h ese scenes o f crav in g an d self-ruin u n fo ld
along th e idyllic shores o f R yan’s h o m e n ear Lake
T ah o e , w ith a ch eerfu l, late-sp rin g alp in e lig h t
d an c in g in th e p ines. D u rin g th e rare m o m e n ts
o f relative calm , R y an ’s w arm th an d a loving, i f
fraught, relatio n sh ip w ith his fam ily reveal som e
o n e w ho m ig h t have a sh o t at kicking addiction.
This episode o f Drugged focused o n the medical
consequences o f alcoholism, so the British produc
tion com pany, Pioneer Productions, followed Ryan
until he entered a recovery program, which the com
pany arranged in exchange for his willingness to lay
bare his inner turmoil. Ryan’s first stop was a Texas
medical clinic, where he underw ent a comprehensive
evaluation. After palpating his pancreas and liver, the
doctor told Ryan th at parts o f his body were “scream
ing and dying” as a result o f all the alcohol. T he hip he
broke w hen he fell o ff his bike, drunk, while pedaling
to the liquor store never healed, leaving him with a
rolling limp and in constant pain. A t one p o in t Ryan
h ad perm ission from a psychiatrist to alleviate his
withdrawal with some vodka, which he knocked back
with an orange soda chaser in the m en’s room . Then
came the pivotal m om ent, a staple o f addiction reality
shows: the interview when the psychiatrist asked if he
was willing to go into rehab.
Ryan said he was terrified, b u t vow ed, “I w an t to
am aze p eo p le, to let th e m know : I was gone, b u t
here I am .”
The next day, Ryan arrived at Bay Recovery, a luxu
rious San D iego center where treatm ent ran about
$1,800 a day. In a baggy white T-shirt, sagging jeans,
H U N G O U T T O D R Y
and a blue bandanna, he earned his navy-
blue duffel bag from a taxi to the front door
o f his new residence, one o f sever.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect almost 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe that drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect around 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
Alcohol a social problem by dr. rajan bikram rayamajhi for medical studentswrigveda
This document discusses alcohol and smoking as social problems. It notes that alcohol abuse is associated with negative health, social, and economic consequences. Alcohol abuse is influenced by easy accessibility, perceptions of social norms, and cultural factors. Binge drinking and chronic drinking are defined. Smoking rates are also provided for Nepal. Smoking is linked to increased health risks and addiction. Both alcohol abuse and smoking are influenced by familial and social connections. They also result in significant societal and economic costs. Prevention strategies discussed include increased taxation, advertising regulation, brief interventions, and education.
This document summarizes a presentation on trends in drugs of choice. It discusses the transition from prescription opiate abuse to heroin use. Presenters include experts from law enforcement and addiction medicine. The presentation covers learning objectives on identifying abused opiates and signs of heroin use. It also explains treatment methods for heroin addiction, describing it as a chronic brain disease requiring long-term, multi-faceted treatment approaches.
This document provides an introduction and background on alcoholism. It defines alcoholism as a chronic disease influenced by genetic and environmental factors, characterized by impaired control over drinking and denial. It notes alcohol is widely consumed and abuse is a major problem in many countries. Later sections discuss psychological and behavioral explanations for alcoholism, the objectives and need for studying alcohol abuse among caretakers in medical wards, and a review of previous literature on definitions and studies of alcoholism.
The document discusses several risk factors for alcoholism and drug addiction. Some key risk factors include starting alcohol or drug use during adolescence, having a family history of substance abuse or experiencing abuse as a child, and having certain psychiatric or behavioral disorders. Adolescents who begin drinking or using drugs are much more likely to develop an addiction compared to those who begin later. Those with a family history of substance abuse or a personal history of abuse or neglect are also at higher risk. Certain psychiatric conditions like depression, anxiety, bipolar disorder and ADHD can increase one's risk as well. Race and gender can also influence risk levels, though biological and cultural factors affecting risk among groups are not fully understood.
Slide Show: Risk Factors for Alcoholism & Drug AddictionHillside
Drug and alcohol addiction develops over time, but it often comes with copious warning signs before casual use grows into full-blown addiction. Even before a person uses, there are many signs that could indicate a person is more likely to fall into abusive patterns of drug use. While risk factors don’t necessarily mean that addiction is inevitable, it’s important for individuals to be aware of their risk level so their behavior will be more informed if they choose to engage in drug use. Watch our slide show for information and statistics about drug and alcohol abuse risk factors. For more information about seeking help with addiction recovery for yourself or a loved one, contact Hillside.
Escaping the temptations of Drub abuseOladele Situ
1) Drug and substance abuse among youths in Nigeria is a significant problem, with cannabis being the most commonly abused drug.
2) Drug abuse has many negative health effects and can lead to addiction due to changes in the brain's reward pathway.
3) Preventing drug abuse requires efforts like education, strong social support systems, and treatment for those already addicted through medical and behavioral therapies.
Alice P. Mead gave a presentation on the history of medical marijuana and the potential for developing marijuana-based medicines. She summarized that while crude marijuana extracts were used medically in the past, modern synthetic medicines replaced them. Identification of cannabinoids like THC in the 1960s renewed scientific interest. GW Pharmaceuticals is developing standardized pharmaceutical cannabinoid medicines and conducting international clinical trials through the FDA process to establish safety and efficacy. Developing marijuana as a modern medicine requires meeting standards for composition, dosage, and delivery unlike herbal "medical marijuana".
Marijuana use among youth poses significant risks to brain development and mental health. Regular marijuana use is associated with cognitive decline across all domains even after years of abstinence. It can also increase the likelihood of developing psychiatric disorders like depression and psychosis. Prenatal marijuana exposure has been linked to lower birth weight, abnormal development and long term cognitive impairments in offspring. Overall, the evidence shows that marijuana jeopardizes the healthy development of youth.
In now days so many peoples are addicted to drugs and alcohol. This life-threatening disease affects all who come in content with the addicted person: friends, family, and co-workers. BLVD treatment center mission is to instill in our clients a deeply held sobriety, emotional wellness and unshakable joy of life.
Ethics legalization of marijuana.final online.pdfSasha Nazarchuk
This document outlines a presentation on the legalization of marijuana. It discusses pros and cons in terms of impact on patients/nursing, healthcare systems, and government/society. Key points include marijuana's medical uses in alleviating pain and symptoms but also potential increased usage. The healthcare system impact involves ethical issues for nursing as well as costs. Government/society sections note potential economic benefits from taxation but also social effects. The presentation concludes with a question and answer segment.
The document provides information about crack cocaine, including what it is, its effects, who uses it, and dangers of use. It discusses crack cocaine as a highly addictive stimulant derived from powder cocaine. It notes statistics on lifetime and recent use among different age groups in the US. The rest of the document covers street terms, health risks, societal impacts, and advice for avoiding crack cocaine use.
This document provides an overview of a presentation given at the Virginia Rural Health Association Annual Conference on December 11, 2014 about the REVIVE! project in Virginia. The presentation discusses the high rates of opioid overdose deaths in the US and Virginia, describes how naloxone works to reverse opioid overdoses, and outlines the development and implementation of the REVIVE! pilot programs which trained laypeople to administer intranasal naloxone to reverse overdoses.
The document discusses drug addiction as a dangerous disease. It notes that all forms of addiction are bad, whether from alcohol, morphine, or other narcotics. The objective is to eliminate drug problems and monitor drug use trends. A survey was conducted where most people agreed that drug addiction is a mental illness and that drugs can cause dependency. The findings show addiction alters brain function and taking drugs triggers feelings of pleasure. Common drugs in Pakistan include cannabis, opium, and heroin. Drug addiction is a major problem costing over $600 billion annually.
- The document discusses drug culture among children and youth in Central PA. It notes that drug use is driven by American culture and is too easy for teens to obtain drugs.
- The types of drugs used in Central PA have expanded beyond just marijuana, cocaine, and alcohol to include meth, synthetic drugs ("bath salts"), and abused prescription drugs. Synthetic cannabinoids are often marketed as incense but are not meant for human consumption.
- Reasons for teen substance abuse include needing healing from trauma and the drugs providing an accepting social circle. The document calls for greater awareness of dangers and encouraging teens to resist peer pressure.
A study which chillingly lays bare the “public health crisis” that arose over a decade in the United States because of excessive alcohol consumption has received severe criticism for relying on comprised data to arrive at that conclusion. It has been criticized by some experts and the Distilled Spirits Council (DSC) for being less consistent, and for not including young adults aged below 18 years, who are increasingly taking to alcohol in America.
This document provides an overview of alcohol use and related health issues. It notes that alcohol is the most misused substance globally, consuming over 15% of national health budgets. Alcohol is linked to 50% of murders, 40% of violent acts, and more than 30% of rapes. While only 5-7% abuse alcohol, 10-20 million people need treatment. The majority of alcohol is consumed by men ages 20-29, with daily or near daily use reported by over 55% of female consumers and 68% of male consumers. On average, men and women consume 4.9 drinks containing 62 ml of alcohol during typical drinking occasions. Most countries focus on tertiary treatment for dependence rather than primary prevention or early intervention
A dodgy clinic.A reality TV crew. AWOL state regulators. .docxsleeperharwell
A dodgy clinic.
A reality TV crew.
AWOL state regulators.
How a t wentysomething
alcoholic’s last
best hope took
a fatal turn.
BY JOHN HILL
I L L U S T R A T I O N B Y M A X O M A T I C
O n D e c e m b e r 3 0 , 2 0 1 2 , as part o f a series called
Drugged, the N ational Geographic C hannel aired an
hourlong docum entary ab o u t a 28-year-old nam ed
Ryan Rogers. It appeared to be a classic tale o f a drunk
trying against the odds to sober up, albeit with espe
cially harrowing footage and an unusually charismatic
protagonist, often shown with a radiant smile on his
handsom e face. In one scene, Ryan, in the m idst o f
an o th er day o f drinking vodka straight o u t o f the
bottle, vomits into the trash can next to his armchair
as his distraught grandfather looks on. In another, he
roils aro u n d the passenger seat while badgering the
elderly m an to drive him to the liquor store.
“I apologize, you guys,” Ryan says to the camera
crew in the backseat. W ith o u t a drink, “I can’t even
focus o r th in k o r even understand anything.”
T h ese scenes o f crav in g an d self-ruin u n fo ld
along th e idyllic shores o f R yan’s h o m e n ear Lake
T ah o e , w ith a ch eerfu l, late-sp rin g alp in e lig h t
d an c in g in th e p ines. D u rin g th e rare m o m e n ts
o f relative calm , R y an ’s w arm th an d a loving, i f
fraught, relatio n sh ip w ith his fam ily reveal som e
o n e w ho m ig h t have a sh o t at kicking addiction.
This episode o f Drugged focused o n the medical
consequences o f alcoholism, so the British produc
tion com pany, Pioneer Productions, followed Ryan
until he entered a recovery program, which the com
pany arranged in exchange for his willingness to lay
bare his inner turmoil. Ryan’s first stop was a Texas
medical clinic, where he underw ent a comprehensive
evaluation. After palpating his pancreas and liver, the
doctor told Ryan th at parts o f his body were “scream
ing and dying” as a result o f all the alcohol. T he hip he
broke w hen he fell o ff his bike, drunk, while pedaling
to the liquor store never healed, leaving him with a
rolling limp and in constant pain. A t one p o in t Ryan
h ad perm ission from a psychiatrist to alleviate his
withdrawal with some vodka, which he knocked back
with an orange soda chaser in the m en’s room . Then
came the pivotal m om ent, a staple o f addiction reality
shows: the interview when the psychiatrist asked if he
was willing to go into rehab.
Ryan said he was terrified, b u t vow ed, “I w an t to
am aze p eo p le, to let th e m know : I was gone, b u t
here I am .”
The next day, Ryan arrived at Bay Recovery, a luxu
rious San D iego center where treatm ent ran about
$1,800 a day. In a baggy white T-shirt, sagging jeans,
H U N G O U T T O D R Y
and a blue bandanna, he earned his navy-
blue duffel bag from a taxi to the front door
o f his new residence, one o f sever.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect almost 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
The document summarizes the results of a survey on drug addiction. It finds that 41% of male respondents and a similar percentage of females believe that drugs create dependency. The most commonly used drug in Pakistan is cannabis, used by 3.6% of adults, while opiates affect around 1%. Drug addiction costs over $600 billion annually in the US due to healthcare, law enforcement, treatment and prevention. The survey aimed to understand perceptions and trends in drug use.
Alcohol a social problem by dr. rajan bikram rayamajhi for medical studentswrigveda
This document discusses alcohol and smoking as social problems. It notes that alcohol abuse is associated with negative health, social, and economic consequences. Alcohol abuse is influenced by easy accessibility, perceptions of social norms, and cultural factors. Binge drinking and chronic drinking are defined. Smoking rates are also provided for Nepal. Smoking is linked to increased health risks and addiction. Both alcohol abuse and smoking are influenced by familial and social connections. They also result in significant societal and economic costs. Prevention strategies discussed include increased taxation, advertising regulation, brief interventions, and education.
This document summarizes a presentation on trends in drugs of choice. It discusses the transition from prescription opiate abuse to heroin use. Presenters include experts from law enforcement and addiction medicine. The presentation covers learning objectives on identifying abused opiates and signs of heroin use. It also explains treatment methods for heroin addiction, describing it as a chronic brain disease requiring long-term, multi-faceted treatment approaches.
This document provides an introduction and background on alcoholism. It defines alcoholism as a chronic disease influenced by genetic and environmental factors, characterized by impaired control over drinking and denial. It notes alcohol is widely consumed and abuse is a major problem in many countries. Later sections discuss psychological and behavioral explanations for alcoholism, the objectives and need for studying alcohol abuse among caretakers in medical wards, and a review of previous literature on definitions and studies of alcoholism.
The document discusses several risk factors for alcoholism and drug addiction. Some key risk factors include starting alcohol or drug use during adolescence, having a family history of substance abuse or experiencing abuse as a child, and having certain psychiatric or behavioral disorders. Adolescents who begin drinking or using drugs are much more likely to develop an addiction compared to those who begin later. Those with a family history of substance abuse or a personal history of abuse or neglect are also at higher risk. Certain psychiatric conditions like depression, anxiety, bipolar disorder and ADHD can increase one's risk as well. Race and gender can also influence risk levels, though biological and cultural factors affecting risk among groups are not fully understood.
Slide Show: Risk Factors for Alcoholism & Drug AddictionHillside
Drug and alcohol addiction develops over time, but it often comes with copious warning signs before casual use grows into full-blown addiction. Even before a person uses, there are many signs that could indicate a person is more likely to fall into abusive patterns of drug use. While risk factors don’t necessarily mean that addiction is inevitable, it’s important for individuals to be aware of their risk level so their behavior will be more informed if they choose to engage in drug use. Watch our slide show for information and statistics about drug and alcohol abuse risk factors. For more information about seeking help with addiction recovery for yourself or a loved one, contact Hillside.
Escaping the temptations of Drub abuseOladele Situ
1) Drug and substance abuse among youths in Nigeria is a significant problem, with cannabis being the most commonly abused drug.
2) Drug abuse has many negative health effects and can lead to addiction due to changes in the brain's reward pathway.
3) Preventing drug abuse requires efforts like education, strong social support systems, and treatment for those already addicted through medical and behavioral therapies.
Alice P. Mead gave a presentation on the history of medical marijuana and the potential for developing marijuana-based medicines. She summarized that while crude marijuana extracts were used medically in the past, modern synthetic medicines replaced them. Identification of cannabinoids like THC in the 1960s renewed scientific interest. GW Pharmaceuticals is developing standardized pharmaceutical cannabinoid medicines and conducting international clinical trials through the FDA process to establish safety and efficacy. Developing marijuana as a modern medicine requires meeting standards for composition, dosage, and delivery unlike herbal "medical marijuana".
Marijuana use among youth poses significant risks to brain development and mental health. Regular marijuana use is associated with cognitive decline across all domains even after years of abstinence. It can also increase the likelihood of developing psychiatric disorders like depression and psychosis. Prenatal marijuana exposure has been linked to lower birth weight, abnormal development and long term cognitive impairments in offspring. Overall, the evidence shows that marijuana jeopardizes the healthy development of youth.
This document provides information on electronic cigarettes (e-cigarettes). It describes how e-cigarettes work by heating liquid nicotine into an aerosol, and that they are available in various flavors and refillable or disposable models. The document summarizes research showing e-cigarettes may be a gateway to traditional cigarettes for youth and that their vapor contains toxic chemicals. It also outlines marketing tactics used to promote e-cigarettes that mirror traditional tobacco and concerns they could re-normalize smoking.
This document discusses the risks of energy drinks, especially when mixed with alcohol. It notes that energy drinks contain large doses of caffeine and other stimulants that can cause short-term effects like increased heart rate and blood pressure. When mixed with alcohol, the stimulant effects of energy drinks can mask intoxication, leading people to drink more than they realize. This can be dangerous as the depressant effects of alcohol will still occur later on. The document lists some common ingredients in energy drinks and their purported benefits and risks. It expresses concern about marketing tactics that target youth and how energy drinks may introduce them to alcohol.
The Affordable Care Act outlines various preventive health services that must be covered under insurance plans, including screening services for adults, women, children, and seniors. Key provisions require coverage of services like mammograms and colonoscopies with no out-of-pocket costs. The law also expands coverage of tobacco cessation programs and annual wellness visits for Medicare recipients.
The document summarizes key provisions of the Affordable Care Act (ACA) and how it aims to improve access to affordable health care. It discusses how the law expands coverage to millions of uninsured Americans through Medicaid expansion and health insurance exchanges. It also outlines important consumer protections now required of health plans, such as prohibiting denial of coverage due to pre-existing conditions. The document also highlights how the ACA strengthens Medicare and aims to reduce health care costs.
The Silver State Health Insurance Exchange (SSHIX) is Nevada's state-based health insurance exchange created by SB 440. The SSHIX will facilitate the purchase of qualified health plans for individuals and small businesses, provide consumer assistance, and reduce the number of uninsured in Nevada. It has advisory committees that make recommendations on issues like plan certification, risk adjustment, and consumer outreach. The SSHIX is led by an executive director and governed by a 10-member board.
The document outlines preventive services covered by the Affordable Care Act for adults, women including pregnant women, children, and seniors over 65 years old. It provides lists of specific screening and counseling services covered in each category with no co-pay, such as annual physicals, cancer screenings, immunizations, HIV and STI testing.
Sandra Koch, MD discusses the impact of health care reform on the uninsured. The Affordable Care Act is estimated to reduce the number of uninsured women ages 19-64 from 20% to 8% when fully implemented. However, health care costs and access to providers will still be challenges as millions gain coverage. Electronic health records and data sharing aim to improve care coordination and lower costs but introducing technology brings privacy concerns. Overall the reforms seek to make health insurance and costs more transparent while shifting payment models to value health outcomes over procedures.
This document discusses pain management and opioid addiction. It begins with introductions and disclosures from the presenter, Dr. Mel Pohl. The objectives are then outlined as reviewing addiction as a brain disease, describing chronic pain, and discussing pain treatment in the context of opioid addiction. Key facts about chronic pain and definitions of pain and addiction are provided. The neurobiology of addiction and how it is similar to other diseases is examined through PET scan images. Issues with using opioids to treat chronic pain like side effects, tolerance, and hyperalgesia are covered. The emergence of the opioid epidemic in the US is shown through various graphs and charts. Non-opioid and non-medication treatment options at Las Vegas Recovery Center are
- Marijuana legalization advocates have effectively organized and messaged their position, securing support and passing ballot initiatives in some states.
- Opponents of legalization need to learn from their tactics and emphasize potential risks of legalization to public health and safety, especially for youth.
- While current drug policies could be reformed to reduce incarceration, legalizing marijuana could normalize and increase use, especially among kids, with negative health outcomes and unknown economic and social costs.
- Moving forward, opponents should focus on the specifics of legalization proposals rather than generalizations, build new partnerships, and position themselves as favoring sensible reform rather than appearing inflexible.
The document discusses the potential risks of legalizing marijuana for children and adolescents, citing research showing negative health impacts of marijuana use on developing brains and the tactics used by the tobacco industry to market and sell products to youth. It proposes contingency planning now to regulate a potential legal marijuana industry similarly to alcohol and tobacco, learning from past mistakes, in order to prevent targeting of underage users and protect public health.
This document discusses the history of opiate commercialization and addiction. It begins with the British East India Company trading opium to China in the 17th-18th centuries, leading to widespread addiction. In the 1990s, Purdue Pharma aggressively marketed OxyContin, leading to its overprescription and misuse. Today, 30-40% of prescribed opiates are misused. The document outlines strategies to educate prescribers on appropriate opiate prescribing through training, monitoring programs, and care agreements with patients.
This document provides information about synthetic drugs like "bath salts" and "spice" that contain cathinones and cannabinoids. It summarizes the chemicals found in these drugs, their scheduling as illegal substances in Nevada, common brand names and methods of ingestion. The document also describes some of the drugs' physiological and psychological effects. It discusses law enforcement challenges in investigating these drugs and provides strategies for criminal case development and preventing distribution.
Officer Eddie Dutchover of the Moapa Tribal Police Department provided information on law enforcement response to drug trafficking organizations. Interdiction teams work across agencies to gather intelligence and identify traffickers beyond typical traffic stops. They seize illicit currency and drugs moving north, south, east, and west. Hidden vehicle compartments are increasingly used to transport money out of Mexico, with about $35-40 billion returned yearly. Proper searches include inspection of areas like firewalls, exhaust systems, gas tanks, and spare tires, where drugs and money have been found. Emerging trends on I-15 include one-way rentals, avoidance of I-40, short-term vehicle registrations, and use of high-end
Synthetic cathinones ("bath salts") and cannabinoids ("spice") pose emerging public health threats. They produce effects similar to illegal drugs like cocaine and marijuana but are marketed as "bath salts", "plant food", or "incense" to avoid regulation. While little was known about them initially, reports show they can cause agitation, hallucinations, and even death. Most states have now controlled or criminalized them in response.
The document discusses the dangers of prescription drug and over-the-counter drug abuse among teens, noting that it can be as addictive and deadly as using illegal street drugs. It provides statistics showing that thousands of teens abuse prescription drugs daily, and that prescription drug abuse has become a new tier of substance experimentation for teens. The document outlines how teens obtain these drugs and which types are most commonly abused. It identifies factors driving teen medicine abuse and discusses how abuse has been normalized in teen culture. The document urges parents to take action by educating themselves and their children about the risks.
This document discusses the risks of underage drinking and provides tips for parents. It notes that alcohol use is normalized for kids through extensive advertising. Underage drinking can lead to unsafe sex, injuries, deaths from car crashes and other causes. Developing teen brains are especially vulnerable to alcohol's harms. Kids who begin drinking before age 15 are more likely to have problems later. The document encourages parents to clearly communicate their rules against underage drinking and model responsible behavior if they choose to drink. It provides hosting tips to help prevent underage drinking at parties.
Methamphetamine (meth) is a highly addictive stimulant drug that can be snorted, smoked, injected, or eaten. It provides feelings of euphoria and increased energy but also causes negative side effects like paranoia, aggression, and death from overdose. Meth use affects not only individual users but also communities through increased crime and environmental damage. It poses risks to children of users and threatens public safety through its association with identity theft and increased criminal activity.
Heroin is a highly addictive opioid that is sold as a white or brown powder or black sticky substance. It can be snorted, smoked, or injected, and causes euphoria, flushing, drowsiness, slowed breathing and heart rate. Heroin addiction is particularly dangerous because it enters the brain so rapidly. Many teens view heroin risk as low and access as easy, failing to see it as a "junkie" drug, and increased purity allows snorting instead of injection. Prescription drug abuse is a major risk factor, as teens often progress from abusing opioids to cheaper heroin. Parents should talk to their kids, monitor prescription drugs, and not assume their own children would not consider using heroin.
1. 2012 Nevada Drug Summit
Tactical Diversion Investigations
and
The Connection to Heroin
Jeff Kallal
SupervisorySupervisor
Drug Enforcement Administration
Las Vegas, Nevada
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
2. DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
3. DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
4. Objectives
To understand how doctors and pharmacists
contribute to the amount of prescription pills
available in the illegal market
To recognize that opioid use can lead to
heroin addiction
To recognize the red flags involved in this
activity
To understand why it’s important to stem the
tide of illegal prescription pill distribution
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
5. Prescription Drug Abuse: A National
Crisis
6.1 million Americans 12 or older were
current users of prescription-type
psychotherapeutic drugs without medical
necessity
Prescription painkillers kill more people than
cocaine, heroin, and methamphetamine
combined
Seven of the top 10 drugs abused by high
school seniors are sold in pharmacies
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
6. Prescription Drug Abuse: A National
Crisis
Estimated cost of CPD diversion and abuse to
public and private medical insurers is $72.5
billion a year
33 percent of all US traffic fatalities involve
drug users
18 percent of motor vehicle driver deaths
involve drugs
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
7. Trends from
Across the
Nation
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
10. Georgia on the Mind of Drug Dealers
“A worrisome new kind of drug dealer is gaining
a toehold in Georgia after fleeing crackdowns
in surrounding states, setting up in bedroom
communities northwest of Atlanta along I-75
to serve customers near and far”
Atlanta Journal-Constitution
July 9, 2011
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
11. Crisis on Long Island
16 Pharmacy robberies on Long Island from
October 2008 to July 2011
Armed robberies of pharmacies in NY state
increased 1400% in four years
Oxycodone prescriptions filled in Nassau and
Suffolk counties increased 46% from 2008 to
2010
Admissions to LI certified treatment programs
are up 26% in one year
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
12. Opioid Deaths: “The Real Orange
County”
80 accidental opioid-related deaths for South
[Orange] County and beach cities from 2007-2010
for people 24 and younger
“In a part of the world know for fun in the sun – and
money – teens and young adults are getting
wrecked on opioid-class prescriptions, and
especially heroin, like never before”
David Whiting, Columnist
The Orange County Register
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
13. Prescription Drug Threat in Nevada
CPD abuse contributed to more drug-related
deaths in Clark County than any other abused
substance
The most widely available and commonly
abused CPDs are opioids and depressants
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
14. Prescription Drug Threat in Nevada
The increasing distribution and abuse of CPD
pose a significant threat to Nevada
Nevadans consume about twice the national
average per capita of prescription narcotics
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
15. Prescription Drug Threat in Nevada
Las Vegas is a popular source destination for
CPDs
– Widely considered most prolific source destination in
Western region
California, Arizona, Utah, Colorado, Oregon, and
Washington
– Case intelligence also shows individuals travelling
from all over the United States
Alaska, Connecticut, Kentucky, Louisiana,
Massachusetts, Ohio, Tennessee, and Texas
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
16. Drug-Related Deaths Clark County
2006 v. 2011
Drug 2006 2007 2008 2009 2010 2011
% Change
CPDs 165 336 338 262 290 364 120%
Cocaine 115 58 39 44 29 68 -40%
Methamphetamine 80 56 34 55 56 107 33%
Heroin 35 45 17 8 5 33 -5%
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
17. Commonly Abused Opioids
Oxycodone (Schedule II)
– OxyContin is a brand name of a time
release version of oxycodone
– Users are susceptible to dependence
and tolerance within one to two weeks
Methadone (Schedule II)
Morphine (Schedule II)
Hydrocodone (Schedule III)
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
18. DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
19. Oxycodone
Many ways to abuse Oxycodone tablets:
- Orally
- Snorted
- Injected
- Smoked
Many users go through a transition:
- Other “pills” (Hydrocodone, Alprazolam, etc. are often mixed with
Oxycodone to make different “pharmaceutical cocktails” based
upon the abusers addiction.
- Heroin (Prescription drug abusers transition to heroin because it is
a cheaper and stronger ”high”)
- Transition occurs because 1 oxycodone tablet costs $25 to $40 vs.
1 gram Heroin $40
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
20. OxyContin ® v. Heroin
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
21. DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
22. Cheaper heroin gives rise to new set of users
Atlanta Journal-Constitution
Heroin is mounting a comeback, appealing to a younger, more diverse
audience than ever before, experts say…
They’re driven by cost, he said. Heroin is much cheaper than, say, an
OxyContin tablet, which typically sells for $30.
“A lot of young kids start on grandma’s Percocets and they get hooked.”
said Lee, adding that prescription painkillers often serve as a gateway to
heroin use.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
23. DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
24. Delco task force tackles heroin plague
September 09, 2012 By Mari A. Schaefer, Inquirer Staff Writer
Alarmed by a surge in heroin deaths, Delaware County officials
joined together for the first time Friday to attack a problem they see
devastating families and communities. There were 33 heroin-
related deaths in the county in the first six months of the year.
In 2011, there were 62 deaths, and in 2010 there were 50, said
Frederic Hellman, the county's medical examiner and a member of a
task force newly appointed to address the issue.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
25. Southern California OxyContin Abusers
Switching to Heroin
By StopOxy
Monday,February 27th, 2012
Drug treatment officials in San Diego County recently reported that
the use of heroin by young adults has more than tripled since 2006.
According to Susan Bower, director of San Diego County Alcohol and
Drug Services, the increase in heroin use is “scary.” Admissions for
heroin addiction now account for nearly one in five of all treatment
admissions at facilities operated by the county.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
26. Commonly Abused Depressants
Carisoprodol = Soma
(Schedule IV)
Clonazpam = Klonopin
(Schedule IV)
Diazepam = Valium
(Schedule IV)
Alprazolam = Xanax
(Schedule IV)
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
27. Commonly Diverted Pills
Oxycodone Xanax (alprazolam) Lortab (hydrocodone)
Methadone Valium (Diazepam)
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
28. Pharmaceutical Cocktails
“Vegas” Cocktail Holy Trinity
- Hydrocodone - Oxycodone
- Alprazolam - Alprazolam
- Carisoprodol - Carisoprodol
These dangerous combinations are highly sought
after by Rx abusers and those in the night club
scene. The abusers ingest the pills simultaneously,
commonly with alcohol to increase the pills effects.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
29. Methods of Diversion
Practitioners / Pharmacists
- Illegal distribution
- Self abuse
- Trading drugs for sex
Employee pilferage
- Hospitals
- Practitioners’ offices
- Nursing homes
- Retail pharmacies
- Manufacturing / distribution facilities
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
30. Methods of Diversion
Pharmacy / Other Theft
- Armed robbery
- Burglary (Night Break-ins)
- In Transit Loss (Hijacking)
- Smurfing
Patients / Drug Seekers
- Drug rings
- Doctor-shopping
- Forged / fraudulent / altered
prescriptions
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
31. Methods of Diversion
The Medicine cabinet / Obituaries
The Internet
Rogue Pain Clinics
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
32. The Practice of Good Medicine
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
33. The Practice of Bad Medicine
No exam or brief exam where doctor may not
even touch the patient
No equipment in the office
The doctor may be the only medical staff;
other workers may be clerical staff only
Doctors see excessive numbers of patients in a
work day
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
34. Results of Bad Medicine
Increased pills on the streets
More addicts in the community
Increased crimes
Overdoses and deaths
Increased cost of legitimate medical care
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
35. Drug Dealers?
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
36. Who
we
are!
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
37. Tactical Diversion Mission
The Tactical Diversion Squad (TDS) program
combines the resources of DEA with State and
local law enforcement agencies in an
innovative effort directed at doctor shoppers,
prescription forgers, and prevalent retail-level
violators. Physicians and pharmacies involved
in retail diversion schemes are also targeted
based on information developed by the TDS.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
38. Las Vegas Tactical Diversion Squad
Participants
• Drug Enforcement Administration
• Las Vegas Metropolitan Police
Department
• Nevada Highway Patrol
• North Las Vegas Police Department
• Henderson Police Department
• Federal Bureau of Investigation
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
39. Pills are sold on the streets or used by the
addicts = Diversion
(Criminal act of illegal distribution)
21 USC 841 (a)(1)
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
40. Federal Criminal Charges
Related To Prescription Drugs
Federal Criminal Code and Rules
Controlled Substances Act (CSA)
Title 21 – Food and Drugs Chapter 13 – Drug Abuse
Prevention and Control
Part D – Offenses and Penalties § 841 through § 865
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
41. State Criminal Charges
Related to Prescription Drugs
Nevada Revised Statutes:
NRS 453.321: Sales of Controlled Substances
NRS 453.339-5: Trafficking in Controlled Substances – Schedule II
NRS 453.331: Unlawful Acts relating to Distribution of Controlled Substances
by Registrants i.e. signing blank Rx pads in advance.
NRS 453.381: Limitations on prescribing, possessing, administering,
transporting, and dispensing controlled substances ** only prescribe or
administer Controlled substances for legitimate medical purposes and in the
usual course of professional practice.
NRS 453.333: Penalties for making available controlled substances that cause
death. Imprisonment/ Fines/ Forfeitures.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
42. Rules and Regulations
Governing Registrants
Code of Federal Regulations (CFR)
Title 21 - Food and Drugs, parts 1300 – End
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
43. What
we
look
for!
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
45. Oxycodone
Powerful synthetic opiate legally used in long
term pain treatment
Many forms of Oxycodone: from 5mg to 80mg
tablets, including immediate release to controlled
release properties. Now comes in a liquid form as
well
Roxies, Percocet, Big Boys, Oxies, Oxy 80s, “O”
Rings
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
46. Oxycodone
Schedule II drug – high abuse potential and high
physical dependence
Schedule II substances carry the highest penalty
in sentencing guidelines
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
47. Street Prices
$2- $4 – Diazepam (Valium) 5mg
$2- $4 – Alprozolam (Xanax) 2mg
$3- $5 – Hydrocodone (Vicodin) 10mg
$25 - $40 – Oxycodone (Oxycontin) 30mg
$25 – Morphine Sulfate (MS Contin) 60mg
$ 5 – Methadone 10mg
Ex. 100 OxyContin 30mg weighs approx. 28 grams
and has the street value=$2,500 to $4,000
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
48. Types of Violators
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
49. Tactical Diversion Targets
Not all targets are DEA Registrants
Doctors : medical and osteopathic
Nurse practitioners
Physician Assistants
Medical Assistants
Dentists
Pharmacies
Pharmacists
Pharmacy Technicians
Patients
Drug distributors
Doctor shoppers
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
50. Cases Against Dirty Doctors and
Pharmacists
Our investigations begin with information
on the doctor’s and pharmacy’s practices
Intelligence from various sources
Information from database checks
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
51. Our Sources of Information
Complaints
Citizens
Coroner/Medical Examiner’s Office
Licensing boards
Documents/Databases
Prescription reports
Other information
Ordering habits
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
52. Additional Sources of Info
Former/current patients and customers
Former/current employees
Anonymous tips
Family members of patients who have died
Other law enforcement agencies
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
53. Red Flags
Pill transactions taken place in pharmacy
parking lot
Long lines at the office and the pharmacy
Groups traveling together to appointments
and pharmacy
Vehicles ‘camping out’ in parking lot
Office open for “unusual” number of hours --
either really short hours or into the night
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
54. Red Flags
Carloads of people drive across multiple states to
get pills / out of state tags in lot
Doctor offers to write prescriptions in pharmacy
parking lot; pharmacist is asked to fill them
without asking questions
Doctor and a pharmacist-in-charge agree to refer
“patients” back-and-forth; patients sign
agreement in doctor’s office to go to specific
pharmacy (kickbacks paid to doctor)
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
55. Red Flags
Patients report that doctor has them fill the
prescription and bring some of the pills back to
him
Doctor writes prescriptions in exchange for work
or other favors
Patients bring family and friends to doctor-they
all get the same prescriptions
Fee for visit ($100-$400) cash is paid directly to
doctor when prescription is written
Sliding Pay Scales
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
56. Successes
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
57. Las Vegas doctor charged with illegally
distributing prescription drugs:
Las Vegas doctor who advocates medical
marijuana therapy has been charged with
illegally distributing prescription drugs. Federal
agents arrested James Tinnell, 73, on Tuesday.
He appeared Wednesday before U.S. Magistrate
Judge Lawrence Leavitt and was released on his
own recognizance.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
58. Las Vegas doctor among 3 indicted in
oxycodone ‘pill mill’ case:
Federal authorities have indicted a Las Vegas
doctor, his unlicensed medical assistant and an
alleged conspiring pharmacist in connection
with illegally distributing painkillers. Dr. Henri
Wetselaar, 87, David Litwin, 52, and Jason C.
Smith, 43, each have been charged with one
count of conspiracy to distribute oxycodone.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
59. Another Las Vegas doctor arrested in
prescription drugs case:
Another Las Vegas physician has been arrested in a
federal crackdown on prescription drug abuse. A
federal indictment unsealed Wednesday charged
Sebastian M. Paulin Jr. with six counts of distribution of
controlled substances, four counts of money laundering
and one count of structuring transactions to evade
reporting requirements. The government also is
seeking forfeiture of $1.2 million. Paulin, 65, was taken
into custody on Wednesday and then released on his
own recognizance.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
60. Vegas doctor arrested for illegally
dispensing drugs and burglary:
A Las Vegas doctor has been arrested on numerous
charges including burglary and illegally prescribing and
dispensing drugs. 51-year-old Dr. James Eells was
arrested last Thursday on dozens of counts for each
charge. It is alleged that Dr. Eells wrote at least 41
prescriptions for his brother-in-law, Todd Hallenbec,
from Jan. 2010 through June 2011. The prescriptions
were for oxycodone, methylin, methylphenidate,
carisoprodol, and alprazolam. Upon arrest, Eells told
police he does not have a license to dispense drugs and
the prescriptions were intended for the treatment of
indigent patients.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
61. Las Vegas Doctor Accused of Selling
Drugs:
The I-Team has uncovered that a prominent
hospital doctor was arrested for illegally selling
thousands of powerful painkiller drugs. The
doctor, who at one time was the Chief of
Internal Medicine at Centennial Hills Hospital,
was snagged in an undercover drug sting.
Federal drug enforcement agents say Dr.
VinayBararia sold nearly $50,000 worth of
oxycodone painkillers.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
62. What You Don’t See In The News Paper
• Civil penalties up to a million dollars
• Seizures of assets, to include real estate and
financial accounts in excess of four million
dollars
• Revocation of DEA Registration and
applicable State Licensing
• Legal Fees
• Embarrassment and distrust amongst your
associates
• Loss of livelihood
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
63. Challenges
Criminal cases against doctors
are complicated, time-consuming
and require much greater
resources than typical drug
investigations. Prescription drugs
are, after all, legal.
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
64. Challenges
“Halo Effect”
Political influence
Social standing
Highly regarded professions
Powerful professional organizations
Halo Effect” results in lenient
prosecution
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
65. Challenges
Manpower
-Budget restraints across Federal, State, &
Local Law Enforcement limit required
resources to address epidemic
Complex Investigation
-Learning curve for investigators
Expensive
-Medical expert fees $300 plus an hour
-Expense of multiple Undercover visits
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
66. Our Tools for Success!
Criminal Investigations
Civil Penalties
Administrative Sanctions
Education
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
67. We don’t want Nevada to be the next
South Florida!
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
68. Our Goal: Put the criminals away!
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
69. The Way Ahead
Foster collaborative investigative efforts
Dismantle the practices of dirty doctors,
pharmacists and their criminal networks in
Nevada
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
70. WWW.DEADIVERSION.USDOJ.GOV
Jeff Kallal Jayne Tomko-Griffin
Supervisory Special Agent Diversion Group Supervisor
(702) 759-8068 (702) 759-8111
Jeffrey.G.Kallal@USDOJ.GOV Jayne.M.Tomko@USDOJ.GOV
Jennifer Zavestoski
Registration Program Specialist
(702) 759-8202
Jennifer.N.Zavestoski2@USDOJ.GOV
DEA TA C T I C A L D I V E R S I O N S Q U A D L A S V
Editor's Notes
Good Afternoon. My name is Jeff Kallal and I am a DEA Supervisory Special Agent in charge of an initiative called the Tactical Diversion Squad.
When we talk about Diversion we are talking about Prescription drugs…More specifically, this presentation will focus on the diversion of controlled prescription drugsObjectives next…
What do they have in common?
Theobjectives this afternoon are to help you… [paraphrase objectives]I will give an overview of the problem both here and nationwide….And then then I will talk about our squad, the TDS mission, and the resources we bring to Nevada.I’m not going to use “War on Drug” cliches and call this an epidemic… but…Make no mistake about it, this a national crisis because it affects us all[next, A national crisis]
The “Buckeye State” is in the heart of a huge destination region for controlled prescription drugs.Folks from Ohio travel down I-75 to South Florida… and more astonishingly…They travel out here to Vegas!However, South Florida is still the biggiest source destination in the country…..
….because Broward County is the pain clinic capital of the country.OPERATION PILL NATION I and II have stepped up enforcement efforts with significant successes.
This quote from an article in the Atlanta Journal-Constitution illustrates how Georgia is becoming the new Florida… and it’s only half as far from the pain pill consumer areas of Appalachia and the mid-west. [In addition to Georgia, the mid-atlantic has it’s own problems.
…In the form of skyrocketing Oxycodone abuse and pharmacy robberies.[The Hamptons aren’t the only place the well-to-do are getting hooked on pain pills…]
It’s happening in Orange County too as some of our investigators here today will tell you.And, increasingly, these kids are moving to heroin. A trend we are seeing in Northern San Diego County and Suburban Chicago as well…You may ask how bad are things at home in Nevada? Let’s take a look…[next]
[Read bullets]
PLAY VIDEO – Oxy – A Quick trip to Heroin.
Oxycontin, or synthetic Heroin as it is often call, has almost the exact same molecular makeup as Heroin.Heroin and Oxycontin both give the user an intense head rush, and then euphoria.The drug addict will use whichever drug is easiest for him to obtain, as Heroin and Oxycontin are interchangeable.Oxycontin is vastly over prescribed.Both are extremely addictive.
Circle of Addiction & the Next Generation Hydrocodone Lorcet®$5-$7/tab Oxycodone Combinations Percocet®$7-$10/tab OxyContin® $80/tab Roxicodone® Oxycodone IR 15mg, 30mg $30-$40/tab Heroin $15/bag
Here are some headlines from across the country…
The Abuser ingest these combination to increase the pills effects!
Next: Our mission
Next: What make up a TDS.
This is the current staffing of the participating agencies.
DEA enforces the controlled Substance Act (CSA)These regulations outline illegal sales and distribution of controlled substances; ordering and dispensing of controlled substances; licensing of registrants; audit/search/and forfeiture powers of the DEA and sentencing guidelines of guilty offenders.The penalty phase can include imprisonment/fines up to $10,000 per violation/and forfeiture of DEA license and real assets.
In addition to the CSA, the DEA mutually works with state and local law enforcement and licensing boards to address the problem. Here are some of the Nevada State laws that help us enforce pharmaceutical violations.
Registrant and health care providers have obligations under the CSA.One role of DEA, in addition to enforcing the Controlled Substance Act (CSA), is to educate the registrant population–including health care providers–of their obligations under CSA, as well as to educate parents, community leaders and law enforcement personnel regarding diversion trends, the scope or the problem, and how to best address prescription drug diversion in communities throughout the United States. The CFR outlines the requirements that registrants must adhere to.
Schedule II substances carry the highest penalty in sentencing guidelinesThis is a key factor since the prosecutors want to ensure the defendants meet heavy penalties.
However, because of the limited manpower, the TDS has been focusing on what we believe is the major source of supply of Controlled Prescription Drugs …Doctors and pharmacists.
As ridiculous as some of these Red Flags sound…we have observed all of these in our investigations.
Here are some headlines stemming from the Las Vegas TDS cases over the last 18 months.
Play Video
These cases do not simply require undercover operations.All prosecution requires a medical expert opinion to review all aspects of the case to certify the doctor is operating out of the scope of legitimate medical practice and is an imminent threat to public safety.
We as a society have to overcome and minimize the Halo Effect.And realize that Doctors are people, just like you and me, and they are just as susceptible to vices, such as greed and lust.
Budget constraints across Federal, State, and Local Law Enforcement limit required resources to address epidemicLearning curve for investigators – complex
We must foster joint / mutual investigative efforts amongst:State Licensing BoardsDEA RegulatoryAll Federal / State / Local Law EnforcementState / Federal Prosecutors