Prescription Monitoring Program (PMP) for Opiate/Prescription Drug Abuse Prevention

1. Investigation Division ‘NDI’ Opiate/Prescription Drug Abuse Planning Meeting June 21, 2016

2. Investigation Division Brief Overview Background/Statutory Authority/Operations

3. SUMMARY PRESCRIPTION MONITORING PROGRAM (PMP) STATUTES NRS 453.162  (Prescription Monitoring Program [PMP]) • 1.  The Board and the Division shall cooperatively develop a computerized program to track each prescription for a controlled substance listed in schedule II, III or IV that is filled by a pharmacy that is registered with the Board or that is dispensed by a practitioner who is registered with the Board… • …be administered by the Board, the Investigation Division, the Division of Public and Behavioral Health of the Department and various practitioners, representatives of professional associations for practitioners, representatives of occupational licensing boards and prosecuting attorneys selected by the Board and the Investigation Division. NRS 453.163  • 2.  The Board and the Division may cooperatively enter into a written agreement with an agency of any other state to provide, receive or exchange information obtained by the program with a program established in that state which is substantially similar to the program established pursuant to NRS 453.162…

4. SUMMARY PRESCRIPTION MONITORING PROGRAM (PMP) STATUTES (cont) NRS 453.164 •   2.  The Board and the Division must have access to the program established pursuant to NRS 453.162 to identify any suspected fraudulent or illegal activity related to the dispensing of controlled substances. •       3.  The Board or the Division shall report any activity it reasonably suspects may:   (a) Be fraudulent or illegal to the appropriate law enforcement agency or occupational licensing board… •       4.  The Board and the Division shall cooperatively develop a course of training for persons who are required to receive access to the database… •       8.  If the Board, the Division or a law enforcement agency determines that the database of the program has been intentionally accessed by a person or for a purpose not authorized … must notify any person whose information was accessed by an unauthorized person or for an unauthorized purpose.

5. SUMMARY PRESCRIPTION MONITORING PROGRAM (PMP) STATUTES (cont) NRS 453.165 • 1.  Except as otherwise provided in this section, the Board shall allow a law enforcement officer to have Internet access to the database of the computerized program … (a) The primary responsibility of the law enforcement officer is to conduct investigations of crimes relating to prescription drugs… •  2.  Before a law enforcement officer may be given access to the database pursuant to subsection 1, the employer of the officer must certify … that the law enforcement officer has been approved … • 6.  The Board or the Division may suspend or terminate access … pursuant to this section if a law enforcement officer or his or her employer violates any provision…

6. INVESTIGATION DIVISION RESOURCES & ACTIVITIES TO ADDRESS OPIOID ABUSE

7. RESOURCES • (1) Detective (Carson City established during the last year ) assigned to: • Triage incoming information (PMP, practitioners, citizens) • To investigate specific cases • To assign and coordinate investigative activities with statewide regional task forces • (5) task force operations, each comprised of 4 state/local detectives • To make appropriate notifications to and liaison with local and federal law enforcement, regulatory/licensing bodies. • The Resources of the 5 Regional Task Forces • The Resources assigned to the Division’s Las Vegas Investigation Unit • (1) Detective (Las Vegas) assigned to (DEA) High Intensity Drug Trafficking Area (HIDTA) prescription diversion task force (Pharm-Net). • Investigates doctors and pharmacies in southern Nevada who provide pharmaceuticals illegally.

8. OTHER ACTIVITIES • Participation with the Board of Pharmacy through the Controlled Substance Abuse Prevention Task Force related to the PMP. • Consists of participants from SAPTA, health licensing boards, Medicaid, professional organizations, pain management practitioners, impaired professional help groups and industry members. Meets once or twice a year to set policy and to discuss the operation of the program. • Participation with the Legislative Committee group, “Industry Coalition on Prescription Drug Abuse,” attending meetings in person. • The Committee studies abuse, monitoring efforts, and methods to address abuse. • Attend other meetings and conduct training and presentations for practitioners and community groups. • Conduct statewide investigations. • Cooperation/collaboration with other local and federal LE partners.

9. CURRENT INFORMATION/TRENDS

10. TrendsCDC Morbitiy & Mortality Report 1-1-16 • Prescription opiod pain relievers are a driving factor in the 15 year increase in opiod overdose deaths • Since 1999, U. S. prescription opiod sales quadrupled • No overall change in pain reported by Americans • Deaths also quadrupled in same time frame.

11. TrendsCDC Morbitiy & Mortality Report 1-1-16 Heroin Use Trending Up • Between 2002–2013, past month and year heroin use and heroin addiction have increased among 18-25 year olds. • Number of new users in the past year is also trending up. • Among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin.

12. Other related Criminal activity/Trends Based on a “need” for increased medication, criminal acts may include: Calling in fictitious Rxs, posing as an employee of the prescribing doctor. Seeing multiple doctors to obtain larger quantities. Altering Rxs for stronger or additional pills. Stealing or producing fake Rxs and forging the doctor signature.

13. The Juvenile Problem Pharmaceutical drugs can be relatively easy for juveniles to obtain. Parents/grandparents/siblings may have medication sitting in the medicine cabinet, in a purse or on the dresser left unsecured. Many drugs of abuse for juveniles are Over The Counter medications. There is often the false belief that prescription medications are safer than “street” drugs because they are commercially manufactured and prescribed.

14. INVESTIGATION DIVISION ACTIVITIES TO COMBAT OPIOID ABUSE

15. CURRENT TASK FORCE PARTICIPATION The Division manages task forces in: • Carson City • Fallon • Winnemucca • Elko • Ely The Division participates in task forces: • Las Vegas – Drug Enforcement Administration’s (DEA) High Intensity Drug Trafficking Area (HIDTA) prescription diversion task force (Pharm-Net). • Investigates doctors and pharmacies in southern Nevada who provide pharmaceuticals illegally. • The Reno DEA HIDTA drug task force. • Identifies significant drug trafficking threats and targets the organizations that pose the greatest threat to the region.

16. Gaps REPORTING • NRS 453.154  Division required to prepare certain reports concerning controlled substances; Division and Board may enter into agreements with public agencies; requirements.   •       2.  The Division shall regularly prepare and make available to other state regulatory, licensing and law enforcement agencies a report on the patterns and trends of distribution, diversion and abuse of controlled substances. •       4.  The Division shall report annually to the Governor and the Legislative Committee on Health Care and biennially to the presiding officer of each house of the Legislature on the outcome of the program with respect to its effect on distribution and abuse of controlled substances, including recommendations for improving control and prevention of the diversion of controlled substances in this State. • NRS 480.460  Duties of Chief of Division.  The Chief of the Investigation Division shall:       2.  Disseminate information relating to the dangers of the use of controlled substances and dangerous drugs.   3.  Provide and operate a system of recording all information received by the Investigation Division relating to persons who have alleged connections with organized crime or have some connection with violations of laws regulating controlled substances or dangerous drugs. •       5.  Procure from law enforcement agencies and other reliable sources information relating to violators of laws which govern controlled substances and dangerous drugs, including information about their character, probable motives, circumstances of arrest, methods of operation and other pertinent information. • NRS 480.510  Sheriffs and chiefs of police to furnish to Division certain information concerning violations connected to controlled substances, dangerous drugs and theft of vehicles.  Each sheriff and chief of police shall furnish to the Investigation Division, on forms approved by the Division, all information obtained in an investigation or a prosecution of any person who has been alleged to have violated any criminal law of this State if in the investigation of the violation it appears that there is some connection with: •       1.  Controlled substances or dangerous drugs; or •       2.  The theft of vehicles, including special mobile equipment or off-road vehicles.

17. Gaps • Practitioners • The only focus on rogue doctors and other practitioners until recently was limited to southern Nevada and the DEA PharmNET operation

18. Pharmaceutical Drugs are Big Business • Doctors, Pharmacists, Nurses, Pharmacy Aids, Health Care • workers. Each profession listed has had representatives • arrested for illegal distribution, theft of, fraud involving, and • abuse of pharmaceutical drugs. • Traditional drug dealers and criminal organizations involved • in drug distribution are expanding operations by dealing in • prescription controlled substances. • There is a related side line in the distribution of pharmaceutical • controlled substances involving: • Printing/dealing fraudulent prescriptions, • insurance fraud, • soliciting “patients.”