Web only rx16 pharma-wed_330_1_shelley_2atwood-harless

transcript

Pharmacy Burglary,Robbery and Diversion

Presenters:• Tara O’Connor Shelley, PhD, Associate Professor, Center for

the Study of Crime and Justice, Colorado State University• Cheri Atwood, Director of Compliance, Mississippi Board of

Pharmacy• John Harless, Lieutenant, Mississippi Bureau of Narcotics

Pharmacy Track

Moderator: Chad C. Corum, PharmD, Co-Owner and Pharmacist, Corum Family Pharmacy, and Member, Operation UNITE Board of Directors

Disclosures

Cheri Atwood; John Harless; Tara O’Connor Shelley, PhD; and Chad C. Corum, PharmD, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.

Disclosures

• All planners/managers hereby state that they or their spouse/life partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months.

• The following planners/managers have the following to disclose:– John J. Dreyzehner, MD, MPH, FACOEM – Ownership interest:

Starfish Health (spouse)– Robert DuPont – Employment: Bensinger, DuPont &

Associates-Prescription Drug Research Center

Learning Objectives

1. Explain the trends in diverting pharmaceuticals, particularly in the form of pharmacy robbery and burglary.

2. Identify preventative measures to enhance security of pharmacies and the safety of their staff and customers.

3. Outline strategies to reduce pharmacy burglaries and robberies.

4. Provide accurate and appropriate counsel as part of the treatment team.

Pharmacy Robbery & Burglary: The Offender Perspective

Learning Objectives1. Explain the trends in diverting pharmaceuticals,

particularly in the form of pharmacy robbery and burglary.

2. Identify preventative measures to enhance security of pharmacies and the safety of their staff and customers.

3. Outline strategies to reduce pharmacy burglaries and robberies.

4. Provide accurate and appropriate counsel as part of the treatment team.

US Opioid Prescriptions Dispensed by US Pharmacies (NIDA, 2014)

Diversion• Definition: When legitimately manufactured

controlled substances are diverted from their lawful purpose to an illicit purpose (DEA, 2013).

• Trend: Diversion of prescription drugs on the rise since the 2000’s (most common type=pain relievers) (NDIC, 2011).

• Examples: Robbery/Burglary of Pharmacies; Fraud; Cargo Theft; Giving/Selling Drugs to Family/Friends.

• Data: “…data on pharmaceutical abuse and diversion are not reliable, comprehensive or timely.” (US GAO, 2003)

Data Sources on Pharmaceutical Diversion

• RxPatrol – Proprietary industry data;

law enforcement• National Incident Based

Reporting System (NIBRS)– Law enforcement;

publically available• DEA Form 106 data– Law enforcement

sensitive; DEA registrants

• National Drug Intelligence Center (NDIC) – Law enforcement

survey; discontinued• National Survey of Drug

Use and Health (NSDUH)

• Monitoring the Future Survey

Pharmacy Robberies for CPDs2006-2014

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

Rx PatrolDEANIBRS

Pharmacy Burglaries for CPDs 2006-2014

2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 20140

Rx PatrolDEANIBRS

Research Goals1. Understand the nature & extent of pharmaceutical

diversion that occurs as a result of robbery or burglary of retail pharmacies.

2. Interview convicted offenders to document their perspective about pharmacy crime.

3. Collect information to help prevent pharmacy crime & enhance pharmacy safety.

4. Explore relevance of criminological theories.a. Routine Activities Theory

Routine Activities Theory

• Cohen & Felson (1979); Felson (1994)

Suitable Target Desirable, Accessible,

Visible, Valuable, Vulnerable

Absence of Capable

GuardianPeople or official

social control agents

Motivated Offender

Those w/Criminal Inclinations

Methodology

• Semi-Structured Interviews w/48 Convicted Offenders in Two Hot Spot Locations – Ohio (32) & Florida (16)

• Interviews were transcribed verbatim & loaded into NVivo for analysis of open ended responses.

• Coded for general theoretical concepts associated w/Criminology and relied on an open coding strategy to identify other emergent themes.

Pharmaceutical Use• Of those who used pharmaceuticals, 90% were daily

• 78% had a prescription for drug of choice at some point

• Reasons for Initial Use

Doctors Seen/Doctor Shopping

• Of those w/Rx, 73% reported seeing more than 1 doctor/healthcare professional

• Reported Range of Doctors seen 1-100

Why They Do It: Pathways to Robbery

Prescription(s) – Legal & Fraudulent

Doctor Shopping & ER Visits

Street Purchases & Sales

Informal Networks (family, friends, acquaintances at clinics to float)

Robbery

Crime Tactics

• 76% Wore Disguise• 30% Jumped Counter • 23% Passed Note• 16% Use Distraction

Techniques• 89% Used or Implied a

Weapon

• Of Those Using Weapon– Gun (56%)– Knife (19%)– Explosive Device (6%)

• 22% Reported Physical Injuries Occurred

Today’s Customer is Tomorrow’s Offender

• 72% of offenders had been to the targeted pharmacy before…almost all to fill prescriptions

• They carefully watch procedures; volume of transactions; product delivery date & timeframes; some examine cars to differentiate between staff & customers

Geographic Tendencies: Commuters or Marauders

• 66% target a pharmacy in home city• Miles from home residence to pharmacy—0 to 120

miles. • 49% traveled 6 or fewer miles

Key for Results

• Red = Discourager/Deterrent

• Green = Encourager

• Blue = Does not Matter–WHY? Too dope sick or will work around it

“Suitable” Targets

Dimensions of Target Suitability Pharmacies are “suitable” targets…they have the

property that the offender desires, they are accessible, and have a high value (e.g., relief, financial).

Type of Pharmacy Targeted

4%4%Local Mom/Pop

National Chain

Grocery

Warehouses

Ideal Pharmacy Location: Stand Alone Parking Lot

36%Discourage

Encourage

Does Not Mat -ter

Worst Pharmacy Location: Grocery Store in Shopping Center

2% 20% Discourage

Encourage

Does Not Matter

Pharmacy Counter in Back

33% Discourage

Encourage

Does Not Mat -ter

Time Delay Safes

Discourage

Encourage

Does Not Matter

CAPABLE GUARDIANS

Three Staff Members in Pharmacy

25% Discourage

Encourage

Does Not Matter

Staffing in Pharmacy

10%Discourage

Encourage

Does Not Matter

One Staff Member Two Staff Members

Discourage

Encourage

Does Not Matter

Possible Interference from Staff

Discourage

Encourage

Does Not Matter

Possible Interference from Customers

Discourage

Encourage

Does Not Matter

MOTIVATED OFFENDERS

Developing Offender Typology• Pure Addict (46%)

• Few crime skills, don’t want to hurt people, unstable; don’t consider guardianship & target suitability.

• Hybrids (44%)• Criminals who are also abusers (sometimes addicts),

sometimes dealers, willing to harm as a last resort; do consider guardianship & target suitability.

• Entrepreneurs (10%)• Pure business, trafficking, rare for abuse, willing to

harm; meticulously consider guardianship & target suitability.

Addict• General View

• Target Suitability

• Guardianship

Hybrid• General View

• Guardianship

Entrepreneur• General View

• Guardianship

Concluding Remarks• Reduce Target Suitability

• Increase Guardianship

• Decrease Motivated Offenders

• Not all offenders are one in the same in how they perceive criminal opportunities.– Crime still occurred even when there were capable guardians

in place and/or target suitability was less than ideal.

Questions?

Tara O’Connor Shelley, Ph.D.B 264 Clark

Center for the Study of Crime and Justice Colorado State University

Fort Collins, CO USA80523

970-491-0714tara.shelley@colostate.edu

Burglary-Robbery-Diversion Prevention

Partners in Prevention

A Long Term Relationship

• MBN and MBP have worked together to prevent diversion since the early 1980’s. This partnership became much more active beginning in 1999 when MBP started registering pharmacy technicians.

• This frequent interaction created the perfect environment to foster a partnership for addressing pharmacy burglaries and robberies.

Teamwork is the Key

• Mississippi utilizes a multi-disciplinary approach to reducing diversion via burglary and robbery

• Partners in this effort include pharmacy owners and employees, regulatory agencies and law enforcement

• These efforts are spearheaded by the Board of Pharmacy and the Bureau of Narcotics

Information Sharing

• Partnering with a law enforcement agency with a broad jurisdiction is important

• These agencies could include DEA Diversion, the state police, a multi-jurisdictional task force or metro departments

• Aligning regulatory agencies and law enforcement provides a united front

What’s our Goal?

• To prevent the illicit diversion of pharmaceuticals by creating a reduction in the burglary and robbery of pharmacies

How will we Accomplish this?

• Gain an increased awareness of current trends in pharmaceutical diversion

• Increase your awareness of how to physically protect your pharmacy and employees

• Enable your staff to decrease the diversion of pharmaceuticals

• Address any concerns you may have• Improve your ability to identify persons that

need substance abuse treatment.

Burglary versus Robbery

• Burglary – “entry into a building illegally with intent to commit a crime, especially theft” – normally a property crime

• Robbery – “taking the property of another, with the intent to permanently deprive the person of that property, by means of force or fear.” – always a violent crime

Burglary

Robbery

Organized Groups Versus Addict Burglars

• Organized groups often operate in multiple states and commit multiple burglaries for profit

• Addict burglaries are typically committed by one or two people for the purpose of feeding a narcotic addiction

Organized Groups

• “Trash Bag Gang,” “Bandana Group,” “Blue Tub Group,” “Interstate Group”

• These groups often commit multiple burglaries with commonalities ie targeting a specific chain

• The crimes typically happen in multiple jurisdictions

• Motive is most often financial

Addict Burglaries

• These are normally less sophisticated and target pharmacies which the addict is familiar with already

• A specific class of drug may be targeted.• Motive is typically addiction• Addict burglars often act in desperation and

act erratically

Internal Diversion or Theft

• This occurs when employees of medical facilities or pharmacies take drugs for distribution or personal consumption.

• Pharmacists, Techs or other employees• Report any suspected theft to the Board

immediately• Do not allow a problem employee to continue

their activities at another pharmacy

• Remember that you have a duty to report any loss to the Board and DEA

• Burglary, robbery or internal loss

• Report may be completed online

Board E-Mail

• LOSSES OF CONTROLLED SUBSTANCES• Article XXV, Paragraph 1., for the Pharmacy Practice

Regulations requires that if a facility has a loss of controlled substances by BURGLARY, that such incident shall be reported directly to the Board IMMEDIATELY. Investigations of these burglaries is a priority of the Mississippi Bureau of Narcotics. Please contact Lieutenant John Harless with MBN IMMEDIATELY ON DISCOVERY at 601-466-5471, day or night.

Board E-Mail continued

• Please contact the Board of Pharmacy as soon as possible at 601-899-8880. This does not preclude reporting of the burglary to your local law enforcement agency.

Responsibility of Pharmacist –In-Charge

• Each Pharmacist while on duty shall be responsible for the security of the Pharmacy, including provisions for effective control against theft or diversion of Drugs and/or Devices.

• The pharmacist-in-charge shall be responsible for adequate security being maintained on drugs in all areas of the permitted facility at all

Mississippi Pharmacy Practice Regulations

Responsibility of Pharmacist –In-Charge continued

• times and is responsible for reporting any loss or suspected loss of controlled substances or legend drugs directly to the Board immediately (this does not relieve any pharmacist who discovers a loss from the requirement of reporting the loss directly to the Board).

• It is the responsibility of the discovering pharmacist to report losses or suspected losses of controlled substances or prescription drugs directly to the Board.

(601) 899-8880

ARTICLE VACTION AGAINST PHARMACIST LICENSE

• Termination of employees suspected of theft of pharmaceuticals or merchandise contacting the Board prior to termination

• Failure to report directly to the Board, losses or suspected losses of controlled substances or medical devices from a permitted facility

ARTICLE V-ACTION AGAINST PHARMACIST LICENSE- CONTINUED

• Knowing or suspecting that a Pharmacist or Pharmacy Intern is incapable of engaging in the Practice of Pharmacy or that a Pharmacy Technician is incapable of assisting in the Practice of Pharmacy, with safety to the public, is diverting or abusing controlled substances or prescription drugs and failing to report any relevant information to the Board of Pharmacy.

Public Education

• The Board of Pharmacy coordinates frequent training for pharmacists, pharmacy technicians and others with a vested interest in reducing diversion

• This training may cover state and federal law, regulatory changes and other subjects applicable to diversion prevention

Building Solutions Together

Burglary Prevention

• Take preventative action:• Cut hedges• Insure external and security lights work• Have the alarm system and all sensors checked –

vertical motion detectors• Utilize a cellular telephone backup for alarm• Insure all cameras are functioning and recording –

be wary of cameras that have been moved• Make sure all doors are secured

Burglary Prevention

• Avoid leaving bottles of popular drugs sitting out (ie 500 oxycodone on the front counter)

• Consider purchasing a gun/fire safe to store controls in overnight

• Verify who your alarm company calls first – preferably law enforcement

• Place height stickers or markers near doors to aid in identifying suspects

Burglary Prevention

• Be aware of unusual behavior of patrons ie “casing” the store

• Be wary of multiple “false” alarms within a few days – checking response time and how alarm works

• Pay attention to any strange questions such as weekend hours, opening or closing times, etc

• If outside workers are present at the pharmacy, request of identities

• If in doubt, contact MBN or other law enforcement to conduct a site visit and make recommendations

What to do if you are burglarized?

• Avoid tampering with any potential evidence – fingerprints, DNA, video

• Contact law enforcement and the Board• Conduct inventory and complete DEA form

106• Be cognizant that burglars will victimize the

same store multiple times if it is an easy target

Why contact MBN if my local law enforcement agency is there?

• MBN maintains information on all reported burglaries not only in Mississippi, but in adjoining states

• MBN analyzes information and looks for trends in burglaries that cross jurisdictional lines

• MBN attempts to identify organized groups and their methods

• MBN attempts to link other law enforcement agencies with each other if there is evidence that burglaries are connected

How to react to a robbery?

• Stay calm and remember that the safety of you, your employees and patrons is the priority

• Provide the perpetrator what he/she wants within reason

• If another employee reacts poorly because of fear, insure the bad guy that you will handle their demands

• Rather than being a hero, focus on being the best witness possible

• Observe and remember physical characteristics such as height, weight, race, gender, hair color, age, voice, mannerisms, etc

• Observe clothing, weapons, what they place the drugs into, anything that they touch

• Observe any vehicles that are used

• Avoid allowing anyone to leave with the suspect if at all possible

• Once the suspect(s) leave, secure the doors and contact law enforcement immediately

• Do not disturb any potential physical evidence• Be willing to provide or undergo any

appropriate follow up counseling

• In cases of addict robbery, do not treat a suspect in a less serious manner because you may be familiar with them from previous contact

• Addicts commit robberies in desperate times and are capable of unexpected actions

• After you have reported the burglary or robbery to local law enforcement, contact MBN Lieutenant John Harless at 601-466-5471.

• Be prepared to provide law enforcement with a copy of any security footage.

The Reality of Diversion

• The pharmacist is the “gate keeper” in the fight against diversion and prescription drug misuse.

• As medical professionals, you have a responsibility to do everything possible to insure that controlled substances are dispensed in the proper manner.

• An inter-disciplinary approach to the prevention of diversion by burglary and robbery can prove to be quite effective

• Law enforcement, regulatory agencies and pharmacy employees must improve communication and interaction to foster these relationships

• Do not be afraid to reach out to other vested partners with questions and ideas

Pharmacy Burglary,Robbery and Diversion

Presenters:• Tara O’Connor Shelley, PhD, Associate Professor, Center for

the Study of Crime and Justice, Colorado State University• Cheri Atwood, Director of Compliance, Mississippi Board of

Pharmacy• John Harless, Lieutenant, Mississippi Bureau of Narcotics

Pharmacy Track

Moderator: Chad C. Corum, PharmD, Co-Owner and Pharmacist, Corum Family Pharmacy, and Member, Operation UNITE Board of Directors

Web only rx16 pharma-wed_330_1_shelley_2atwood-harless

Health & Medicine