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Westchester County District Attorney Janet DiFiore

Westchester County District Attorney Janet DiFiore. Westchester County District Attorney Janet DiFiore. District Attorney’s Office is located in the County Courthouse in White Plains, and in 8 Branch Offices that work in Village, Town and City Courts in Westchester County Jurisdiction

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Westchester County District Attorney Janet DiFiore

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  1. Westchester County District Attorney Janet DiFiore

  2. Westchester County District Attorney Janet DiFiore • District Attorney’s Office is located in the County Courthouse in White Plains, and in 8 Branch Offices that work in Village, Town and City Courts in Westchester County • Jurisdiction • Crimes committed in Westchester County • Offenders 16 years of age and older • Specialized areas include: • Child and Elder Abuse • Domestic Violence • High Technology Crimes • Narcotics • Animal Cruelty • Gang Violence & Firearms • Public Integrity • Environmental Crimes

  3. Westchester County District Attorney Janet DiFiore • The District Attorney’s Office partners with schools in Westchester County • Internet Safety and Bullying • Pro Law • Underage Drinking • Animal Cruelty • Prom Safety • In 2013, Assistant District Attorneys made over 400 presentations to teachers, administrators, staff, parents and students

  4. Prescription Drug Abuse • Involves Controlled Substances as defined by federal and New York State Law • Controlled Substances have medical uses and potential for abuse • Their use is subject to licensing, recordkeeping, security and storage requirements • They include: • Opioids • Depressants • Stimulants

  5. Prescription Drug Abuse Source: National Institute on Drug Abuse

  6. Prescription Increase Source: http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

  7. How Did We Get to This Prevalence of Opioid Prescriptions? • Bad Research and Misleading Marketing of Oxycontin • Oxycontin was a new, powerful long-acting opioid based pain medication introduced in 1995 • Heavily promoted to doctors with incorrect information about the potential for abuse and addiction • Oxycontin sales produced $2.1 billion between 1995-2001 • Problems of abuse and addiction surfaced- Oxycontin taken in excess quantity, snorted and injected Source: http://www.who.int/trade/glossary/story073/en/

  8. How Did We Get Here? • Purdue Pharma of Connecticut, manufacturer of Oxycontin: Purdue and three of its executives pled guilty in 2007 to criminal charges, conceding that it had made misstatements about the risks of Oxycontin in marketing the drug to doctors; resulted in over $600 million in fines and payments

  9. Prescription Drug Abuse • The CDC reports that 38,329 people died from a drug overdose in the U.S. in 2010, which includes prescription and illicit drugs • Continued rise over the past 11 years • In 2010, nearly 60% (approximately 23,000) of drug overdose deaths involved pharmaceutical drugs • Opioid analgesics (oxycodone, hydrocodone, methadone) were involved in about 3 of every 4 (over 17,000) pharmaceutical overdose deaths • Opioids depress breathing, leading to unconsciousness and possibly death Source: http://www.cdc.gov/media/releases/2013/p0220_drug_overdose_deaths.html

  10. How does this appear in our communities? Source: CDC Graph: ‘People Who Abuse Prescription Painkillers Get Drugs From A Variety of Sources’, from the 2012 National Survey on Drug Use and Health Source: http://www.cdc.gov/homeandrecreationalsafety/rxbrief/

  11. The Oxycontin Epidemic • According to the CDC, over 70% of those who abuse prescription painkillers get them from a relative or friend • Obtained free from friend or relative, 55% • Bought from friend or relative, 11.4% • Took from friend or relative without asking, 4.8% • Seem safer than street drugs

  12. The Oxycontin Epidemic • In New York State, highest rates of prescription per 100,000 residents are in medium and high income neighborhoods • Overprescription • Large supplies- much of it sitting in people’s homes • Person who abuses or becomes addicted may receive prescription for Oxycontin following an injury or surgery • Or it may be a teen who finds it in the medicine cabinet

  13. The Oxycontin Epidemic • Once addicted, person needs continuing supply- • Doctor shopping to obtain multiple prescriptions • Pill mills where doctors prescribe Oxycontin for a fee and conduct little or no medical examination • Doctors and pharmacists- for profit or to feed their own addiction- divert pills or prescriptions • Theft of drugs and prescription pads

  14. Monitoring Prescriptions for Opioids and other Controlled Substances • New York State’s I-STOP • Internet System for Tracking Over-Prescribing • Law promoted by Attorney General Eric Schneiderman and signed by Governor Andrew Cuomo, with first effective date of 2013 and phased in provisions effective in 2015

  15. Monitoring Prescriptions for Opioids and other Controlled Substances • First real time on line reporting system to research and track prescribing and dispensing of Controlled Substances • Doctors can review a patient’s controlled substances prescription history via I-STOP database prior to prescribing • Pharmacists report dispensing controlled substances as they fill the prescriptions

  16. Monitoring Prescriptions for Opioids and other Controlled Substances • When the law is fully phased in, doctors will report prescriptions for controlled substances at the time they are issued and pharmacists will be able to verify the legitimacy of the prescription • Exemptions include: Emergency Rooms may prescribe up to a five-day supply without consulting I-STOP

  17. Monitoring Prescriptions for Opioids and other Controlled Substances • Benefits • Helping doctors identify and refer patients in need of drug treatment • Alerting doctors to possible adverse medical interactions from a controlled substance prescription • First three months • Utilized by over 45,000 practitioners • Performed approximately 2.4 million searches

  18. Opioids- Link to Heroin • One side effect of crackdown on prescription drug diversion is abusers’ switch to heroin • Snorted, used intravenously • Easily available, cheaper, highly addictive • Dangerous – purity is uncertain, can be cut with other substances

  19. New England Journal of Medicine Study of 2,500 patients in treatment centers from 2009-2012 • Oxycontin was reformulated in 2010 to make it more difficult to crush, snort or inject • The number of survey respondents reporting Oxycontin as primary drug of abuse went from 35.6% to 12.8% within 21 months of the formula change • 24% of respondents found a way to defeat the tamper-resistant properties of the new formula • 66% of respondents reported a switch to another opioid, with heroin as the most common response Source: http://www.nejm.org/doi/full/10.1056/NEJMc1204141

  20. Opioids- Link to Heroin Source: http://www.nytimes.com/2014/02/11/us/heroins-small-town-toll-and-a-mothers-pain.html?hpw&rref=health&_r=0

  21. Westchester County • The number of felony prosecutions involving illegal possession or sale of oxycodone and hydrocodone tripled from 2008 to 2012 in Westchester County • In Westchester County 107 people died as a result of a drug overdose in 2011 and 2012 Source: Desk of the DA on Prescription Drug Abuse and Disposal, March 2013

  22. Prescription Drug Abuse by High School Students • Prescription and over-the-counter medications account for most of the commonly abused illicit drugs by high school seniors • In 2011, nearly 1 in 12 high school seniors reported nonmedical use of Vicodin • Nearly 1 in 20 reported abuse of OxyContin Source: http://www.drugabuse.gov/publications/topics-in-brief/prescription-drug-abuse

  23. Past-Year Use of Various Drugs by 12th Graders (percent)2013 Monitoring the Future Survey Source: http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends

  24. Past-Year Use of Various Drugs by 12th Graders 2013 Monitoring the Future Survey • Percentage of 12th graders who reported using prescription drugs not under a doctor’s orders: 28% • Percentage of 12th graders who reported using over-the-counter or prescription drugs not under a doctor’s orders: 33%

  25. Cough/Cold Medicine Abuse • Dextromethorphan (DXM): Cough suppressor found in more than 120 over-the-counter cold medications • When taken as directed, side-effects are rarely observed • When abused, medications containing DXM can cause a euphoric high and dangerous side effects such as loss of coordination and hypertension • DXM taken with antidepressants can be life-threatening Source: http://inhealth.cnn.com/what-parents-should-know-about-otc-medicine-abuse/primer-on-cough-cold-medicine-abuse

  26. Cough/Cold Medicine Abuse • In 2003, a 14-year-old Colorado boy who abused DXM died when he was hit by two cars as he attempted to cross a highway • State law enforcement investigators suspect the drug affected his depth perception and caused him to misjudge distance and speed of oncoming vehicles • Governor Andrew Cuomo signed 2013 law prohibiting pharmacies and stores from selling products containing DXM to minors without a prescription Sources: http://www.justice.gov/dea/pr/multimedia-library/publications/drug_of_abuse.pdf#page=76 http://www.governor.ny.gov/press/09272013-legislation-prohibiting-sale-of-dxm-to-minors

  27. What Can Guidance Counselors Do? • Do what guidance counselors do best: • Speak with and advise students • Seek medical help • When you learn that students have used alcohol, pills, marijuana or other drugs, bring the student to the school nurse for an evaluation and possible emergency care • Why? • Students will often brush off questions about how they feel or whether they are okay but they may need medical care • Research tells us that students commonly use more than one type of substance- don’t assume the alcohol you smell or the Oxycontin the student admits to is the only thing the student has used- possibly complicating the medical profile

  28. Drug Interactions • The Drug Abuse Warning Network reported that approximately 1 million ER visits in 2009 could be attributed to prescription drug abuse • Roughly 343,000 involved prescription opioid pain relievers • More than half of ER visits for prescription drug abuse involved multiple drugs Source: http://www.drugabuse.gov/sites/default/files/rrprescription.pdf

  29. Drug Interactions • According to The National Institute on Drug Abuse, 7 out of 10 teen nonmedical users combine prescription opioids with other substances (2012) • The substances most commonly co-ingested were: • Marijuana • Alcohol • Cocaine • Tranquilizers • Amphetamines Source: http://www.drugabuse.gov/related-topics/trends-statistics/infographics/teens-mix-prescription-opioids-other-substances

  30. Effects and Risks • Abuse of opioids can cause drowsiness, nausea and potentially, slowed breathing • Stimulant abuse can cause paranoia, dangerously high body temperatures, and an irregular heartbeat, especially in large doses or when crushed and snorted or injected • Abusing depressants can cause slurred speech, shallow breathing, disorientation, lack of coordination, and seizures upon withdrawal • Used in combination, these drugs can produce magnified effects and block the effectiveness of other prescribed medications

  31. Good Samaritan Law • Students, parents and school staff should know: • Penal Law Section 220.78- immunity from prosecution for unlawful drug or alcohol possession offenses in most circumstances for people who seek emergency help for themselves or another • Even before the Good Samaritan Law, it was Westchester County District Attorney Janet DiFiore’s policy- consider the actions of an individual who seeks emergency help when evaluating such cases

  32. What Can the Community Do? • Proper Disposal of Controlled Substances • National Take-Back Initiative- Drug Enforcement Agency Office of Diversion Control • April 26, 2014- 10am-2pm • More information to be announced April 1, 2014 at http://www.deadiversion.usdoj.gov/drug_disposal/takeback/ Source: http://www.deadiversion.usdoj.gov/drug_disposal/takeback and http://whiteplains.dailyvoice.com/news/westchester-police-departments-now-accepting-unwanted-prescription-drugs

  33. Resources- Westchester County • Local police departments host MedReturn Boxes for safe disposal • Ardsley, Bedford, Briarcliff Manor, Croton, Eastchester , Greenburgh, Lewisboro, Mount Pleasant, Mount Vernon, Ossining Village, Peekskill, Pleasantville, Port Chester, Pound Ridge, Rye Brook, Rye City, Scarsdale, Somers, Tarrytown, White Plains, Yorktown • 24 hours a day, 7 days a week • An up-to-date list of participating police departments can be found at: www.westchestergov.com/medicationdisposal • Department of Environmental Facilities, 914-813-5400

  34. Resources- Rockland County and Putnam County • Rockland County: • Rockland County Sheriff’s Office collects medications the 2nd Saturday of each month, no questions asked • 55 New Hempstead Road, New City, NY 10956, 845-638-5400 • www.rocklandcountysheriffoffice.com • Putnam County: • Department of Health partners with agencies to host 2 medication drop-off days per year • 845-808-1390 • http://www.putnamcountyny.com/health/swm/

  35. Resources • New York Division of the Office of Diversion Control, 212-337-3900, http://www.deadiversion.usdoj.gov/ • The National Center on Addiction and Substance Abuse at Columbia University, 212-841-5200, http://www.casacolumbia.org/ • Partnership for a Drug Free America, 212-922-1560, http://www.drugfree.org • National Institute on Drug Abuse, 301-443-1124, http://www.drugabuse.gov

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