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### **A State and Local Law Enforcement Partnership Takes Back 207.2 Million Prescription Opioids**

June 2020 | Volume 13 | Issue 6

The illegal use of prescription drugs and its consequences  have been on the decline in North Carolina for the past few years,1 thanks  in large part to innovative programs developed by the State Bureau of Investigation (SBI)Diversion  and Environmental Crimes Unit (DECU).

 One of the most effective programs is Operation  Medicine Drop (OMD). According to the unit’s supervisor, Special Agent in  Charge John Keane, it is the most successful “take back” prescription drug  program in the southeast United States, collecting 68,056 lbs. of prescription  and over-the-counter medications in 2019 alone.

#####  Operation Medicine  Drop 

 To encourage safe disposal of prescription medications such  as oxycodone, DECU launched Operation Medicine Drop in 2013 by providing secure  collection bins with the OMD logo to local law enforcement agencies, which  placed them in their lobbies, where the drugs could be easily and anonymously  discarded. 

 Twice a year, on National Take Back Days sponsored by the U.S. Drug Enforcement Administration (DEA), the  DECU agents collect the drugs and take them to an Environmental  Protection Agency (EPA) approved incinerator, which destroys them without  causing any environmental harm. Since it began, OMD has collected and  incinerated 207.2 million unused prescription and over-the-counter pills. 

 A collaborative program developed by the DECU and cosponsored  by Safe Kids North Carolina,  the DEA, the North Carolina Department of Justice,  the North Carolina Department of Insurance,  the North  Carolina National Guard Counterdrug Task Force, and the office of North  Carolina Attorney General Josh Stein, OMD is widely supported. One hundred and  thirty-six law enforcement agencies participated in 2019.

#####  Wide-Ranging Drug  Investigations

 In addition to collecting these medications, most of which  were legally acquired, the DECU investigates the illegal diversion of  prescription drugs by personnel in hospitals, nursing homes, and other  healthcare facilities, as well as their acquisition by individuals who commit  prescription fraud. 

 Drug diversion has multiple sources. It can involve the  dilution, substitution, or theft of medication from hospitals, pharmacies, and nursing  homes, including inside jobs by medical facility healthcare professionals. The  culprits can also be individuals who go “doc shopping” for multiple opioid prescriptions,  which they take to different pharmacies to receive multiple prescriptions at  the same time.

 The DECU conducts investigations of all of these crimes as  well as large scale or multijurisdictional prescription fraud cases, and also  follows up on suspicious deaths in healthcare facilities.

#####  Drug Diversion  Investigator Training for Local Law Enforcement 

 To expand investigative abilities within the state, the  unit has also developed a new training program that empowers local law  enforcement with a drug diversion certification and access to North Carolina’s  database of prescription drug information.

 In addition to teaching officers procedures such as how to  work a prescription fraud case or investigate overdose deaths, the Certified  Drug Diversion Investigator's class helps them develop valuable professional  relationships.

 Says Keane, “They get to know the DECU instructors and can  call us for advice on complex cases—for instance, a multijurisdictional  prescription fraud case in which several suspects are passing prescriptions,  using false identities, or paying homeless people to pick up the medication. It  can be hard to track down all the players.”  

#####  Enabling Access to  the State’s Prescription Drug Database

After completion of the three-day course, the officers receive  a state certification and are granted access to the state’s prescription monitoring  program, known as the Controlled Substance  Reporting System (CSRS) in the state of North Carolina. 

 Says Keane, “It’s an innovative, and I think somewhat  unique, course. We developed it in 2018, when our state legislature passed the Heroin  and Opioid Prevention and Enforcement (HOPE) Act, which allows a certified  diversion investigator to obtain electronic prescription records connected to  an active and bona fide investigation of licit controlled substances.”

#####  Addressing Privacy  and Confidentiality Concerns

 “Up until the HOPE Act, only DECU and the DEA Tactical  Diversion Squad had law enforcement access,” Keane notes. “This new capability  will greatly aid local law enforcement, and help us too, by enabling more  efficient and timely investigations of a greater number of cases, which can  directly mitigate the overdose death rate in North Carolina.”

 However, though it’s a very important tool for the investigation,  the database access comes with many confidentiality issues related to HIPAA  rules for safeguarding patient medical information. “Initially, there was a lot  of concern about giving local law enforcement direct access to the database, which  contains patient names, doctors, etc.,” says Keane. “But the state agreed to  allow it if our unit would teach the procedures and requirements in a certified  training program.”

#####  Supporting Multijurisdictional  Investigations

 Although the officers who completed the course have access  to the database, the DECU has oversight of their CSRS request. “We know what  they are querying,” he says. “If it’s a bona fide investigation, we approve the  request and provide a copy of the patient’s prescription profile to the  officer.” 

 Says Keane, “It can be hard to run down all the leads in  some cases, going to pharmacies and doctors’ offices across the state to get  documents. But with access to the CSRS database, local law enforcement can get  the information they need from anywhere in the state; and by partnering with  us, they also have ability follow up wherever the investigation leads.

 “It’s a force multiplier in that local agencies can now  handle many of the state’s diversion cases now,” adds Keane. “So far, we have  certified 70 detectives throughout the state. And because of confidentiality  issues, we also train their supervisors. They have to be able to know if their  officers are doing their investigations properly. We must guard against any misuse  of the system.”

#####  Seeing Results, Making  a Difference

 As a result of these programs, there have been numerous  drug seizures and arrests, reducing the use of prescription opioids in  communities across the state. To help support their continuing success, the  COPS Office awarded an Anti-Heroin Task  Force (AHTF) grant to the DECU in 2018, funding overtime pay for agents and  financial support for the certification training program.

 Noting the importance of Operation Medicine Drop in 2019,  North Carolina Attorney General Josh Stein described prescription opioids as “like a magnet to people struggling with addiction or young people looking to mess around,” adding that keeping unneeded prescriptions helps fuel the opioid epidemic.

 “But there is one thing each one of us can do to make a  difference and keep people safe in our communities: safely dispose of unneeded  medication and lock up any other prescriptions to ensure they will not get in the wrong hands.”   

 DECU’s programs are going a long way to reduce the misuse  of opioid medications in North Carolina, not just by keeping millions of them  out of the wrong hands, but by taking back those that have ended up there  despite all precautions. 

Faye C. Elkins          Sr. Technical Writer

**Further Reading****Prescription  Drug Fraud and Misuse, 2nd Edition******

**Building    Successful Partnerships between Law Enforcement and Public Health Agencies to    Address Opioid Use**

References:          1. “North Carolina: Opioid-Involved Deaths and Related Harms,” NIH National  Institute on Drug Abuse, last updated April 2020, https://www.drugabuse.gov/opioid-summaries-by-state/north-carolina-opioid-involved-deaths-related-harms.

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