Enforcement StrategiesEnforcement Strategies Peggy Kelley Thu, 10/25/2018 - 02:36 PM EDT
In order for laws and regulations to be effective, they must be enforced. Police officers and law enforcement personnel therefore are key stakeholders and should be partners in prevention efforts. This means involving law enforcement on community advisory boards, health task forces, or coalitions to actively engage them in the work. While police are vital, they are not the only ones who can work on enforcement in the community. Local practitioners, school personnel, youth, and parents can work with law enforcement to:
- Shut down “pill mills.” These initiatives can deter aberrant prescribing practices and increase the likelihood that pain clinics will appropriately prescribe prescription drugs to patients. Burgeoning research suggests they can reduce overdose rates.
- Educate and train law enforcement personnel on supply and harm reduction strategies. Law enforcement may need current information and up-to-date training on the nascent policies and procedures surrounding recognizing clandestine pill mills and responding properly to drug overdoses. They can use this information to focus their work; thus, potentially reducing the supply of controlled substances in the community, and saving lives by providing appropriate antidotes when encountering overdoses on the job.
- Implement and sustain a tip and reward program. These programs encourage individuals to anonymously report to law enforcement information about prescription drug diversion happening in the community. Law enforcement can then act on this information; thereby potentially lessening the amount of controlled substances available in the community.
Enforcement strategies, summarized here, include the following:
Initiatives to Shut Down "Pill Mills" (Florida)Initiatives to Shut Down "Pill Mills" (Florida) Peggy Kelley Thu, 10/25/2018 - 02:38 PM EDT
The initiatives to shut down “pill mills” in Florida began in 2010. “Pill mills” are pain clinics that inappropriately prescribe large quantities of prescription drugs to patients. They can comprise a single physician or a group of physicians, often operating over a large geographic area, who cater to individuals seeking prescription drugs for nonmedical reasons. They accept only anonymous payment methods—primarily cash (Betses & Brennan, 2013).
To prevent physician-driven diversion of prescription drugs and to limit the supply of prescription drugs available for diversion
Florida’s widespread effort employed a variety of strategies to achieve its objectives:
- Maintaining a medical examiner report system that required medical examiners to provide detailed information on every death in which a drug (prescription or illicit) was identified as a cause of death. Florida’s system enables the state to report more detailed overdose information than other states (Johnson et al., 2014).
- Note: From 2003 to 2009, Florida experienced a large increase in the number of pill mills operating in the state and saw a 61% increase in the number of annual fatal prescription drug overdoses (1,804 to 2,904) (Johnson, Paulozzi, Porucznik, Mack, & Herter, 2014).
- Implementing pain clinic regulations and certification requirements, which are designed to prevent facilities from prescribing controlled substances indiscriminately or inappropriately, and which grant authority to state agencies to shut down violating pain clinics (Johnson et al., 2014).
- Note: Prior to Florida, in 2010, only three states had specific pain clinic regulations. By 2013, 13 states had implemented such regulations.
- Having state law enforcement agencies conduct raids on pill mills—seizing assets and arresting owners and prescribers. Florida established regional task forces to focus on pill mills in specific areas and cooperated extensively with the Drug Enforcement Administration.
- Enacting prescription drug limits of sale, which forbid physicians from dispensing Schedule II or III prescription drugs from their offices.
- Putting into practice the mandatory use of Prescription Drug Monitoring Programs (PDMPs) by pharmacies, requiring all pharmacies to register with the state PDMP and to report patient and prescriber data.
Physicians, pharmacists, patients, law enforcement
Florida’s initiatives were associated with a 23.2% reduction in the state’s prescription drug overdose rate, from 14.5 to 11.1 overdoses per 100,000 individuals, a statistically significant decrease (Johnson et al., 2014).
See guidelines for related records, such as Model Pain Clinic Regulations, Law Enforcement Training on Supply Reduction, Limits on Prescription Drug Dispensation and Sales, and Mandatory Use of Prescription Drug Monitoring Programs.
- Note: See also the “Acknowledged by” section for related records, such as Model Pain Clinic Regulations, Law Enforcement Training on Supply Reduction, Limits on Prescription Drug Dispensation and Sales, and Mandatory Use of Prescription Drug Monitoring Programs.
Betses, M., & Brennan, T. (2013). Abusive prescribing of controlled substances: A pharmacy view. New England Journal of Medicine, 369(11), 989–991. Retrieved from https://www.nejm.org/doi/full/10.1056/NEJMp1308222
Johnson, H., Paulozzi, L., Porucznik, C., Mack, K., & Herter, B. (2014). Decline in drug overdose deaths after state policy changes—Florida, 2010–2012. Morbidity and Mortality Weekly Report, 63(26), 569–574. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a3.htm
Law Enforcement Training on Harm ReductionLaw Enforcement Training on Harm Reduction Peggy Kelley Thu, 10/25/2018 - 02:40 PM EDT
Law enforcement training on harm reduction involves preparing law enforcement to better respond to and prevent drug overdoses, including those caused by prescription drugs. Most such training focuses on opioid overdoses. The Bureau of Justice Affairs (BJA) and several states’ law enforcement agencies have recently begun offering harm-reduction training to state and local law enforcement officers, in addition to supply-reduction training. Some states have also authorized community-based organizations to train lay responders and law enforcement in naloxone administration (New York State Division of Criminal Justice Services, 2014).
To reduce the harm caused by prescription drug misuse and abuse
Before the training, it’s important to do the following:
- Determine the state’s system for providing supplemental training courses to law enforcement officers
- Note: Some states require training to be provided through state-administered classes, while others allow law enforcement agencies to implement their own onsite training. Training on naloxone administration is usually provided by local hospital staff, other health professionals, or community-based organizations that provide naloxone access (BJA, 2014).
- Identify a funding source to equip law enforcement officers with naloxone kits and then train officers to use them
- Acquire the naloxone kits, to be dispensed after the training
- Acquire BJA training manuals and other resources from states that have already initiated harm-reduction training, to be shared with participants (BJA, 2014)
- Secure trainers who possess the required state training certifications
- Note: For example, New York requires police trainers to receive certification from an Instructor Development Course approved by the state Office of Public Safety.
- Seek cooperation with law enforcement commanders, both to ensure that training is required for officers and to assure them that such training will be available
- If needed, request technical assistance from BJA, state agencies, or nonprofits
Harm-reduction training generally takes place over multiple days, or during a single day with breaks to prevent fatigue. Sessions can include some or all of the following (New York State Division of Criminal Justice Services, 2014):
- Lectures on a variety of topics, for example:
- The purpose of harm-reduction training for law enforcement
- Background on prescription drugs and other opioids
- The signs and symptoms of an overdose
- The purpose of naloxone, how it works, and how to administer it
- State laws protecting lay administrators of naloxone
- The role of community organizations that provide naloxone
- How to handle individuals post-administration of naloxone
- How to complete a naloxone incident report
- Opportunities to practice administering naloxone in cases of opioid overdose (U.S. Department of Justice, 2014)
- An assessment of the state’s naloxone access law (New York State Division of Criminal Justice Services, 2014):
- As of December 2014, 27 states and the District of Columbia allow nonmedical personnel, including law enforcement, to use naloxone without civil or criminal liability (The Network for Public Health Law, 2014)
- As of March 2015, state and local law enforcement agencies in 19 states have received training to administer naloxone (North Carolina Harm Reduction Coalition, 2015)
- As of December 2014, 23 states restrict naloxone administration exclusively to medical professionals, and do not allow law enforcement officers or other laypersons to administer it (The Network for Public Health Law, 2014)
- Development of a naloxone incident report for law enforcement use
After completing the training, participants are assessed on their ability to do the following (New York State Division of Criminal Justice Services, 2014):
- Identify the existence and location of community naloxone programs
- Explain the purpose of syringe-access programs and Good Samaritan laws
- Identify the characteristics of opioid overdose
- Identify the steps to care for a person suffering from an opioid overdose
- Demonstrate how to use naloxone to treat an opioid overdose
Law enforcement personnel
No outcome data have been found regarding the role of law enforcement training on harm reduction in preventing the non-medical use of prescription drugs and/or its consequences.
Bureau of Justice Assistance. (2014). Law enforcement naloxone toolkit. Washington, DC: U.S. Department of Justice. Retrieved from https://www.bjatraining.org/tools/naloxone/all
The Network for Public Health Law. (2014). Legal interventions to reduce overdose mortality: Naloxone access and overdose Good Samaritan laws. Retrieved from https://www.networkforphl.org/_asset/qz5pvn/network-naloxone-10-4.pdf
New York State Division of Criminal Justice Services. (2014). Opioid overdose and intranasal naloxone training for law enforcement: Trainer’s guide. Retrieved from https://www.bjatraining.org/sites/default/files/naloxone/Opioid%20Overdose%20Intranasal%20Naloxone%20Training%20-%20Trainer%20Guide.pdf
North Carolina Harm Reduction Coalition. (2015). Law enforcement departments carrying naloxone. Retrieved from http://www.nchrc.org/law-enforcement/us-law-enforcement-who-carry-naloxone/
U.S. Department of Justice. (2014). Attorney General Holder announces plans for federal law enforcement personnel to begin carrying naloxone. Retrieved from http://www.justice.gov/opa/pr/attorney-general-holder-announces-plans-federal-law-enforcement-personnel-begin-carrying
Law Enforcement Training on Supply ReductionLaw Enforcement Training on Supply Reduction Peggy Kelley Thu, 10/25/2018 - 02:39 PM EDT
Law enforcement training on supply reduction prepares law enforcement officers to recognize and reduce the availability of illicit drugs and diverted legal substances, including prescription drugs.
To reduce the availability of prescription drugs for nonmedical use
- Supply-reduction training:
- Can be spread over 2–14 days and is usually conducted in person
- Covers all drug enforcement laws, including prescription drug diversion
- Includes some or all of the following topics: tactical aspects of drug enforcement; operational planning; management of confidential sources; recognizing clandestine laboratory operations; legal issues; executive decision-making; professionalism within the ranks; supervising, motivating, and evaluating officers; detecting drug-related crimes; recognizing drug types; and roadside interviewing (Federal Law Enforcement Training Centers [FLETC], n.d.; U.S. Drug Enforcement Administration [DEA], n.d.)
- Federal and state agencies offer supply-reduction training to state and local law enforcement supervisors and officers on reducing the availability of illicit drugs and diverted legal substances, for example, by preventing prescription drug diversion.
- Note: The U.S. Department of Justice (DOJ) and the U.S. Department of Homeland Security primarily support diversion prevention training for state and local law enforcement through the Drug Unit Commanders Academy, Narcotics Supervisor Leadership Program, and FLETC (DEA, n.d.).
- Federal law enforcement agents receive specialized supply-reduction training through internal programs accredited by the Federal Law Enforcement Training Accreditation (FLETA) board (FLETA, n.d.).
- Federal agencies fund training and technical assistance centers (TTACs) that support federal, state, and local agencies through training and technical assistance programs, events, and courses on specific topics, including supply reduction (National Training and Technical Assistance Center [NTTAC], n.d.). Supply-reduction training is generally offered through resource guides and in-person courses and is tailored to the agency’s specific circumstances (NTTAC, n.d.).
- Note: For example, DOJ funded Brandeis University’s Prescription Drug Monitoring Program (PDMP) TTAC to develop a PDMP training course for law enforcement. The course covered how PDMPs operate; how law enforcement can access and interact with PDMPs; and how to interpret, disseminate, and validate PDMP reports for stakeholders (Brandeis University, 2013).Law enforcement can use PDMP data to help identify potential areas of the community that have high supply.
- State and local police academies provide specialized diversion courses for state law enforcement officers (Brandeis University, 2013; Morris County Public Safety Training Academy, n.d.).
- Nonprofit and law enforcement organizations (such as Crime Stoppers USA, the Federal Bureau of Investigation—Law Enforcement Executive Development Association [FBI-LEEDA], the National Association of Drug Diversion Investigators [NADDI], the National Association of State Controlled Substance Authorities, and the Pharmaceutical Security Institute) often partner to offer supply-reduction training and technical assistance which is funded by pharmaceutical industry grants, fundraising, membership fees, and training fees (FBI-LEEDA, n.d.; NADDI, 2015; RxSafetyMatters, n.d., 2013). Typically, these trainings are founded and/or managed by former or current law enforcement personnel and address the following topics: leadership and management, current diversion trends, recognizing diversion activities, and current laws related to supply reduction.
Law enforcement officers and supervisors
Though not entirely attributable to training efforts, in 2013 law enforcement seized 1,194,748 diverted dosage units of oxycodone, 83,449 diverted dosage units of hydrocodone, and 1,363 diverted dosage units of hydromorphone (DEA, 2014).
Brandeis University. (2013). Prescription drug monitoring program administrators guide for training law enforcement. Waltham, MA: Prescription Drug Monitoring Program Training and Technical Assistance Center, The Heller School for Social Policy and Management at Brandeis University. Retrieved from http://www.pdmpassist.org/pdf/PDMP_admin/LE_USE_OF_PDMP_CURRICULUM_Final.pdf
Federal Bureau of Investigation—Law Enforcement Executive Development Association. (n.d.). Who we are. Retrieved from https://fbileeda.org/page/Who_we_are
Federal Law Enforcement Training Accreditation. (n.d.). Accredited programs. Retrieved from https://www.fleta.gov/accredited-programs
Federal Law Enforcement Training Centers. (n.d.). Drug law enforcement training program (XP). Washington, DC: U.S. Department of Homeland Security. Retrieved from https://www.fletc.gov/drug-law-enforcement-training-program-xp/drug-law-enforcement-training-program-xp
Morris County Public Safety Training Academy. (n.d.). Alphabetical course listing. Retrieved from https://academy.morriscountynj.gov/police/course-descriptions/
National Association of Drug Diversion Investigators. (2015). Welcome. Retrieved from https://www.naddi.org/
National Training and Technical Assistance Center. (n.d.). About us. Washington, DC: Bureau of Justice Assistance, U.S. Department of Justice. Retrieved from https://www.bjatraining.org/about
Office of National Drug Control Policy. (n.d.). HIDTA initiatives. Retrieved from https://obamawhitehouse.archives.gov/ondcp/hidta-initiatives
RxSafetyMatters. (n.d.). Law enforcement and government: A resource guide to help stem the illegal trafficking of prescription drug abuse. Retrieved from www. rxsafetymatters.org/wp-content/uploads/2013/10/RXSM_LawEnforceGov-V2.pdf
U.S. Drug Enforcement Administration. (n.d.). Domestic training—State and local training. Washington, DC: U.S. Department of Justice. Retrieved from www. dea.gov/ops/Training/StateLocal.shtml
U.S. Drug Enforcement Administration. (2014). National drug threat assessment summary 2014. Washington, DC: U.S. Department of Justice. Retrieved from https://publicintelligence.net/dea-drug-threats-2014/
Tip and Reward ProgramsTip and Reward Programs Peggy Kelley Thu, 10/25/2018 - 02:41 PM EDT
Tip and reward programs enable individuals to submit tips, sometimes anonymously, to law enforcement or private organizations working with law enforcement about crimes involving prescription drugs (theft, fraud, etc.). Some programs offer monetary rewards for tips that lead to arrests.
To encourage individuals with information about prescription drug diversion to come forward and report it to law enforcement
- Tip and reward programs were established by the U.S. Drug Enforcement Administration (DEA), which accepts tips from individuals about potential crimes in its jurisdiction, including prescription drug diversion (DEA, 2015).
- The programs can be implemented by private and non-governmental organizations working with law enforcement, such as prescription drug manufacturers, to offer rewards for tips on prescription drug diversion (RxPatrol, 2012; RxTip, 2015).
- Tip and reward programs can be instituted as clearinghouses of “data related to pharmacy robberies, burglaries and theft that involve the loss of controlled substances” for law enforcement (RxPatrol, 2012, ¶ 1).
- Such programs can promote formal or informal relationships between pharmacies, federal and state agencies, and other security professionals as they work to better address crimes involving prescription drugs (RxPatrol, 2012).
- Monetary reward sizes will likely vary, depending on the nature of the tip (RxPatrol, 2012).
- Note: RxPatrol offers rewards of up to $2,500 for tips that lead to arrests. The DEA offers rewards of up to $5 million, but only for arrests of major drug traffickers (RxPatrol, 2012; U.S. Department of State, n.d.).
- Programs can choose to use different reporting tools (hotlines, online forms, etc.).
- Some programs accept anonymous tips.
Law enforcement, the general public
No outcome data have been found regarding the role of tip and reward programs in preventing the nonmedical use of prescription drugs and/or its consequences.
No acknowledgements have been found regarding the role of tip and reward programs in preventing the nonmedical use of prescription drugs and/or its consequences.
RxPatrol. (2012). What’s RxPatrol? Retrieved from http://www.rxpatrol.com/aboutrxpatrol/
RxTip. (2015). About the program. Retrieved from rxtip. org/about-the-program/
U.S. Department of State. (n.d.). Narcotics Reward Program: Target information. Retrieved from https://www.state.gov/j/inl/narc/rewards/
U.S. Drug Enforcement Administration. (2015). Submit a tip. Retrieved from https://www.dea.gov/submit-tip