Law Enforcement Track: Two Unique Approaches National Rx Drug Abuse Summit April 2-4, 2013 Dr. Gary Martin and Jason Parman

1. Two
Unique
Approaches
Dr.
Gary
Mar7n
Homicide
Detec7ve,
Palm
Beach
County
(FL)
Sheriff’s
Department
Jason
Parman
Assistant
U.S.
AJorney,
London,
KY
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

2. Lesson
Objec7ve
1. Outline
inves7ga7ve
priori7es
in
building
an
overdose
death
prosecu7on.
2.
State
the
benefit
of
building
strategic
coopera7on
between
federal
and
state
law
enforcement
agencies.
3.
Demonstrate
how
law
enforcement
can
work
together
with
community
preven7on
programs
in
inves7ga7ons.

6. Overdose
Suppression
Project:
A
Comprehensive
Response

7. • Law
Enforcement
• Public
Awareness
• Quan6ta6ve
Research

8. • Reviewing
each
overdose
death
inves7ga7on.
• Applying
all
relevant
statutes
to
the
circumstances.
• Forwarding
all
narco7cs
intelligence.
• 19.3
%
of
the
case
reviews
generated
narco7cs
intelligence.

9. • Overdose
and
poisoning
should
be
ruled
out
in
all
cases
of
non-­‐violent
deaths.

10. • Scene
Inves7ga7on
• Physical
Examina7on
of
the
Decedent
• Autopsy
Results
• Toxicology
Findings

11. If
a
person
dies
of
an
apparent
drug
overdose:
(1)
A
law
enforcement
agency
shall
prepare
a
report
iden7fying
each
prescribed
controlled
substance
listed
in
Schedule
II,
Schedule
III,
or
Schedule
IV
of
s.
893.03
which
is
found
on
or
near
the
deceased
or
among
the
deceased's
possessions.
The
report
must
iden7fy
the
person
who
prescribed
the
controlled
substance,
if
known
or
ascertainable.
Thereaeer,
the
law
enforcement
agency
shall
submit
a
copy
of
the
report
to
the
medical
examiner.
(2)
A
medical
examiner
who
is
preparing
a
report
pursuant
to
s.
406.11
shall
include
in
the
report
informa7on
iden7fying
each
prescribed
controlled
substance
listed
in
Schedule
II,
Schedule
III,
or
Schedule
IV
of
s.
893.03
that
was
found
in,
on,
or
near
the
deceased
or
among
the
deceased's
possessions.

12. • All
prescrip6on
drug
containers
(including
empty
containers)
should
be
photographed,
seized,
and
then
individually
described
on
a
property
receipt.
• All
unfilled
prescrip6on
authoriza6ons
“scripts”
should
be
photographed,
seized,
and
individually
described
on
a
property
receipt.
• All
illegal
drug
containers
(plas6c
baggies,
film
vials,
e.t.c.)
should
be
handled
in
such
a
way
that
poten6al
trace
evidence
could
be
extracted.
• Within
reason,
samples
of
drinking
fluids
discovered
within
the
immediate
area
of
the
suspected
overdose
death
should
be
collected.

13. Evaluate
physical
evidence
of
prescrip7on
drug
abuse
and
diversion
by
the
decedent:
• Appointment
cards
• Address/phone
books
• Cell
phones/caller
id
• Personal
computers
• Calendars
• Prescrip7on
vials
• Unfilled
scripts
• Pharmacy
receipts
• Drug
warning
documents

17. • Forging
coopera6ve
rela6onships
with
families
who
have
lost
loved
ones
to
drug
overdose
death.
• Providing
overdose
risk
awareness
programs
to
students
and
parents.
• Designing
a
mul6media
public
service
campaign
focusing
on
the
risks
associated
with
prescrip6on
drug
misuse
and
abuse.
• Seeking
legisla6ve
ac6on
to
discourage
doctor
shopping
and
prescrip6on
drug
diversion.

18. “All
Bets
Are
Off”

19. The
Cri7cal
Point

20. Ineffec7ve
Remedies
• Do
NOT
put
them
in
an
ice
cold
bath.
• Do
NOT
inject
them
with
salt
water
or
milk.
• Do
NOT
give
them
s7mulants
(like
cocaine,
methamphetamine,
or
Adderall).
• Do
NOT
give
them
food
or
water
or
induce
vomi7ng
(they
could
choke)
• Do
NOT
leave
them
alone.
• If
you
must
leave,
call
911
first
and
leave
them
in
the
recovery
posi7on.

21. Recovery
Posi7on

22. • A
Drug
Overdose
Interven7on
Strategy.
• Offers-­‐limited
immunity
from
criminal
prosecu7on
for
person(s)
who,
in
good
faith,
seek
medical
aJen7on
during
a
drug-­‐related
medical
crisis.
• Intent-­‐reduce
the
number
of
drug
overdose
deaths
by
removing
the
fear
of
arrest
as
a
barrier
to
seeking
emergency
medical
assistance.

23. 911
Good
Samaritan
893.21
Drug-­‐related
overdoses;
medical
assistance;
immunity
from
prosecu6on.
• (1)
A
person
ac7ng
in
good
faith
who
seeks
medical
assistance
for
an
individual
experiencing
a
drug-­‐related
overdose
may
not
be
charged,
prosecuted,
or
penalized
pursuant
to
this
chapter
for
possession
of
a
controlled
substance
if
the
evidence
for
possession
of
a
controlled
substance
was
obtained
as
a
result
of
the
person’s
seeking
medical
assistance.
• (2)
A
person
who
experiences
a
drug-­‐related
overdose
and
is
in
need
of
medical
assistance
may
not
be
charged,
prosecuted,
or
penalized
pursuant
to
this
chapter
for
possession
of
a
controlled
substance
if
the
evidence
for
possession
of
a
controlled
substance
was
obtained
as
a
result
of
the
overdose
and
the
need
for
medical
assistance.
• (3)
Protec7on
in
this
sec7on
from
prosecu7on
for
possession
offenses
under
this
chapter
may
not
be
grounds
for
suppression
of
evidence
in
other
criminal
prosecu7ons.
• This
act
shall
take
effect
October
1,
2012.

24. • Collec7ng
extensive
demographic
and
circumstan7al
data
from
each
overdose
death
inves7ga7on.
• Designing
a
prac7cal
overdose
death
database.
•
Exposing
overdose
correla7ons
and
trends.

25. Case
Examina6ons
• 353
overdose
death
cases
• Palm
Beach
County,
Florida
• Selected
by
chronological
occurrence
• Data
derived
from:
 Police
and
paramedic
reports
 Autopsy
and
toxicology
findings
 Family
and
friend
interviews
 Medical
records

29. Decedents’
Average
Age
40.08
Years

30. • Age
breakdown

38. • White
• Male
• Approximately
40
years
old
• High
School
Diploma
or
GED
• Employed

39. • History
of
substance
abuse
• History
of
drug
related
arrests
• History
of
substance
abuse
treatment
• History
of
mental
health
treatment
• History
of
non
fatal
drug
overdose
• Under
physician’s
care
at
7me
of
death

40. • Died
at
home
• Discovered
by
family
member
• Last
act
is
sleeping
• Found
unconscious
• Others
present
at
death
scene
• Other
recognized
distress
• Died
from
accidental
mul7ple
drug
toxicity
• Most
likely
combina7ons
are
alprazolam,
oxycodone,
cocaine,
and
methadone.

41. Detec7ve
Gary
Mar7n
Violent
Crimes
Division
–
Homicide
Unit
Palm
Beach
County
Sheriff’s
Office
West
Palm
Beach,
Fl
33406
561-­‐688-­‐4058
mar7ng@pbso.org
Or
Gary
Mar7n,
Ed.D.
Associate
Dean
For
Student
Life
Lynn
University
Boca
Raton,
Fl
33431
561-­‐237-­‐7157
gmar7n@lynn.edu

42. Two
Unique
Approaches
April
2
–
4,
2013
Omni
Orlando
Resort
at
ChampionsGate

43. Learning
Objec6ves
• 1.
Outline
inves7ga7ve
priori7es
in
building
an
overdose
death
prosecu7on.
• 2.
State
the
benefit
of
building
strategic
coopera7on
between
federal
and
state
law
enforcement
agencies.
• 3.
Demonstrate
how
law
enforcement
can
work
together
with
community
preven7on
programs
in
inves7ga7ons.

44. Disclosure
Statement

45. Controlled
Substances
Act
covers
overdose
deaths
21
USC
841(A)(1):
1.
Knowing
distribu7on
of
controlled
substance
2.
Death
results
from
use
of
controlled
substance
21
USC
846:
1.
Two
or
more
people
must
conspire
to
distribute
a
controlled
substance
2.
Death
results
from
use
of
controlled
substance

46. Inves7ga7ve
Priori7es
What caused the death? Who did it?
• Medical
examiner’s
report
essen7al
–
• Witnesses
who
observed
drug
work
to
develop
rela7onships
with
distribu7on
to
the
deceased?
coroners
• For
prescrip7on
overdoses,
tracking
the
• Toxicology
report
helpful,
but
not
disposi7ve
paper
trail
is
useful
• Do
NOT
have
to
prove
intent
to
kill,
• Standard
drug
inves7ga7ons
is
recklessness,
foreseeability,
or
other
important
parallel
mental
state
rela7ve
to
the
death
• The
element
that
must
be
proven
is
“Did
death
result
from
the
use
of
the
controlled
substance?”
• Distributed
drug
does
not
have
to
be
exclusive
or
primary
cause
of
death,
only
had
to
have
played
a
part.

47. “Tradi7onal”
TARGETS
Sponsors,
Brokers,
Direct
Distributors
• Developing
sources
of
informa7on
/
cooperators
key
• Establish
rela7onships
between
targets
rela7ve
to
date
of
distribu7on
• Was
target
in
the
chain
of
distribu7on
that
led
to
the
death
• Tracking
the
line
from
the
end
user
to
the
drug
source
reveals
poten7al
targets
(All
in
the
chain
are
poten7al
defendants
as
long
as
distribu7on
to
end
user
was
reasonably
foreseeable)

48. POTENTIAL
TARGETS
Doctors
/
Pharmacists
• Need
to
show
target
prescribed
/
filled
medica7on
without
legi7mate
medical
purpose
outside
the
usual
course
of
professional
treatment
• PaJern
of
pa7ents
help
to
establish
unlawful
distribu7on
• Cash
only
clientele
• Superficial
examina7ons
• Expert
review
of
records
• Cooperators
beneficial
• Conspiratorial
rela7onship
between
providers
(warning
pa7ents
where
to
or
not
to
fill
scripts)

49. “Death
Resul7ng”
Penal7es
Statutory
Penal6es
Sentencing
Guidelines
21
USC
841(b)(1)(A)-­‐(C)
U.S.S.G.
§
2D1.1
• Mandatory
Minimum
20
years
• Deaths
from
Schedule
I
or
II
with
prior
with
Life
max
convic7on
for
trafficking
with
similar
drug
is
43
(360
–
life)
• Applies
to
all
Schedule
I
and
II
• No
prior
convic7on
is
38
(235-­‐293)
Controlled
Substances
(oxycodone,
methadone,
etc.)
• Deaths
from
Schedule
III
and
IV
(ie:
hydrocodone,
alprazolam)
start
at
30
(97-­‐121)
with
prior
convic7on
and
26
(63-­‐78)
without
convic7on
• All
ranges
assume
no
criminal
history
• Ex:
Criminal
History
I
with
a
38
(235-­‐293)
is
(360
to
life)
with
a
Criminal
History
VI

50. United
States
v.
McIntosh
DEA
inves6ga6on
with
State
partnerships
Result
?
• What
made
it
work?
• McIntosh
sentenced
to
327
• First
responders
treated
call
as
a
months
for
distribu7on
resul7ng
crime
scene
vs.
an
accident
in
death
(guideline
range
of
• Autopsy
that
established
oxycodone
292-­‐327)
Lowest
criminal
history
as
a
contribu7ng
factor
in
the
death
category
• DEA
later
implicated
McIntosh
in
a
Who
collaborated?
large
oxycodone
conspiracy
through
• Kentucky
State
Police
cooperator
statements
and
local
law
• Local
Law
Enforcement
enforcement’s
street
level
buys
• Crucial
leads
in
the
inves7ga7ve
• County
Coroner
report
from
10
months
prior
• State
Medical
Examiner
• Knew
the
Who,
What,
When
and
• DEA
Where
and
it
was
documented

51. Benefits
to
“death
resul7ng”
prosecu7ons
“Tradi6onal”
Drug
Dealers
“Professional”
Drug
Dealers
• Dealing
is
ul7mately
a
decision
• Doctors,
Pharmacists,
etc.
• “The
nega7ve
has
to
outweigh
the
• Enormous
profit
margins
for
pain
clinic
posi7ve”
owners,
doctors,
pharmacists
• Reality
is
Rx
diversion
is
a
profitable
• $100,000
cash
in
one
day,
for
example
revenue
plan
for
many
• Violate
your
duty,
responsible
for
the
• These
prosecu7ons
send
a
simple,
consequence
powerful
message
• Given
the
harm
produced
from
prescrip7on
diversion,
must
target
• Distribute
prescrip7on
drugs,
you
will
those
with
“keys
to
the
castle”
be
held
responsible
for
the
• Treats
the
source
=
to
a
drug
dealer
consequence

52. Ques7ons/Comments
Jason
D.
Parman
United
States
AJorneys
Office
Eastern
District
of
Kentucky
606-­‐864-­‐5523
Ext.
117
Jason.Parman@usdoj.gov