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Five Top Federal Law Enforcement Achievements in 2013

 
 

Whitey Bulger

Steve Neavling
ticklethewire.com

Mob boss convicted: One of the nation’s most notorious mafia leaders, James “Whitey” Bulger, was sentenced to life in prison on Nov. 13 after a Boston federal jury found him guilty of racketeering, money laundering and extortion. Bulger was a violent, cold-blooded leader of the Boston Irish mob for decades. He had been on the run for 16 years.

Silk Road busted: In October, the FBI captured the elusive owner and operator of Silk Road – a website that sold drugs and other illegal items and services. The transactions were virtually untraceable because of a currency called bitcoins. The FBI seized $28 million worth of the bitcoins.

Bombs in Boston: A federal manhunt ended in the death of one suspect and the arrest of another in the Boston Marathon bombing in April. The suspects, 26-year-old Tamerlan Tsarnaev, and 19-year-old Dzhokhar Tsarnaev, are accused of placing a bomb at the finish line of the marathon on April 15. The blast killed three and injured more than 260 others.

Motor City corruption: Former Detroit Mayor Kwame Kilpatrick was sentenced to 28 years in prison for racketeering, extortion, bribery, fraud and tax charges in March. Kilpatrick, his father and a city contractor were running a criminal enterprise out of city hall.

Exploited children saved: In a nationwide sweep targeting underage prostitution in July, 105 juveniles were rescued and more than 150 alleged pimps arrested. The FBI coordinated with local, state and federal officials over three days to nab suspects in 76 cities.

FBI’s David Bowdich Named ticklethewire.com Fed of the Year for 2013

David Bowdich

By Allan Lengel
ticklethewire.com

David Bowdich, special agent in charge of counterterrorism for the Los Angeles Division, has been named ticklethewire.com Fed of the Year for 2013.

Bowdich, who is considered a rising star in the bureau, has been an agent since 1995.

Bowdich earns the award for a variety of reasons. He’s well respected among the troops and has shown strong leadership and support for his agents. He’s also a hard worker.

He was at the forefront of the fatal shooting of a TSA officer at LAX Airport, and was a key person involved in the probe into four California men who were busted for plotting to attack Americans and U.S. military bases overseas.

While in San Diego earlier in his career, he led a yearlong wiretap investigation that resulted in the first federal racketeering convictions ever to be brought against street gang members in the Southern District of California. He also  been involved in the past in cracking down on kidnappings on both sides of the U.S.-Mexican border.

In 2011, he was  entrusted to  handle the transition of a new FBI Director when it was thought Robert S. Mueller III was going to step down after his 10 -year term. Mueller eventually got a two-year extension.

Bowdich was named to the SAC post in Los Angeles in 2012.

Bowdich becomes the sixth recipient of the award. Last year, it went to the FBI’s John Perren.

Previous recipients have included Chicago U.S. Attorney Patrick Fitzgerald (2008), Warren Bamford, who headed the Boston FBI (2009), Joseph Evans, regional director for the DEA’s North and Central Americas Region in Mexico City (2010) and Thomas Brandon, deputy Director of ATF (2011).

 

Feds Mibehavin’ in 2013

By Allan Lengel
ticklethewire.com

Every day, thousands of federal law enforcement agents wake up, grab their gun and badge and a cup of java, orange juice or tea and go out into the world to protect the public and enforce the laws.

Unfortunately, every year, a few step over the line — way over the line — and break the law.

As the year draws to an end,  ticklethewire.com takes a look at some of the more interesting cases of Feds Misbehavin’ in 2013. As in the past, money and sex was involved in some allegations. And this year, unfortunately, so was death.

Too Much Booze: FBI agent Adrian Johnson got 18 months in prison this year after he was convicted of multiple charges including vehicular manslaughter after he drove drunk and crashed into a car in suburban D.C., in Prince George’s County. He killed an 18-year old and man and seriously injured the man’s friend in 2011.

Not So Secret Service: Secret Service agents are getting quite the rep for being serious party people. Supervisors Ignacio Zamora Jr. and Timothy Barraclough, aren’t doing much to change that image. The Washington Post reported in November that the two, who were managing security for the president, have been removed from that detail because of alleged misconduct involving women. 

In one instance in May, Zamora allegedly tried getting back into a woman’s room at the Hay-Adams hotel, near the White House, to get a bullet he had left behind. He was off duty and had removed the bullets from the gun while in the room, the Post reported. He had met the woman at the hotel bar and joined her in her room, the Post reported. The Post reported that the guest refused to let Zamora back in,  and he identified himself to hotel security as a Secret Service agent. The hotel alerted the White House about the odd behavior, the Post reported.

During an internal investigation, investigators also found that the two agents had allegedly sent sexually suggestive emails to a female subordinate, who is an agent.

Hands in the Cookie Jar: Oklahoma FBI agent Timothy A. Klotz confessed to dipping into the FBI cookie jar. Authorities allege that he embezzled $43,190 that was earmarked for confidential informants for tips on criminal activities from 2008-2011.  He acknowledged in a signed statement that he falsified 66 receipts during a scheme that went undiscovered for more than four years. He was sentenced earlier this month to six months in prison and three years of supervised released. He was also ordered to pay a restitution of $43,190.

Let The Dice Roll –– FBI agent Travis Raymond Wilson, 38, of Huntington Beach, Calif., apparently had a little gambling jones and didn’t want the big guys at the FBI to know. Unfortunately for him, he got busted. Wilson pleaded guilty to structuring financial transactions in violation of the federal Bank Secrecy Act.

The feds say between January 2008 and February 2013, Wilson regularly gambled at casinos in California, Nevada, Arizona, and West Virginia, authorities said. In total, Wilson structured more than $488,000 in cash.  Sentencing is set for March 3. 

Hookers, Cash and Luxury Travel: Human temptation. Need you say more. John Bertrand Beliveau Jr., 44, a special agent with the Naval Criminal Investigative Service (NCIS), apparently failed that test. He pleaded guilty earlier in December to participating in a massive international fraud and bribery scheme. He admitted sharing with a foreign Navy contractor confidential information about ongoing criminal probes into the contractor’s billing practices in exchange for prostitutes, cash and luxury travel, the Justice Department said in a press release. His case is part of a big scandal.

Ethics Still Applies When You Depart: Kenneth Kaiser, former head of the FBI’s Boston office, found that ethics still apply when you leave the bureau.  The choked up ex-agent appeared in court where he was fined $10,000 for violating an ethics charge. Kaiser was accused of meeting with former FBI colleagues about his company that was under investigation. Federal law prohibited him from having professional contact with former FBI colleagues within a year of leaving government service.

“I lost something I valued the most — my reputation,” Kenneth W. Kaiser, 57, of Hopkinton, Mass. said, according to the Boston Globe.

Helping the Wrong Side –  Border Patrol Agent Ivhan Herrera-Chiang took advantage of his position and helped smugglers bring meth, cocaine and marijuana into the U.S. He was sentenced in Phoenix in November to 15 years. He reportedly even helped smugglers find their way around underground sensors and lock combinations.

“You have done about the worst thing a law-enforcement agent could do, especially a Border Patrol agent, and that is passed confidential information,” U.S. District Judge Paul Rosenblatt said.

A Fatal Shot — FBI agent Arthur “Art” Gonzales of Stafford County, Va.  is charged with shooting  his estranged wife to death in April. He told dispatchers he was acting in self-defense when he shot his 42-year-old wife, Julia Sema Gonzales. He says his wife attacked him with a knife.

Gonzales was a supervisory special agent-instructor at the FBI’s National Academy at Quantico.  Court records show bond was granted. Trial has been set for March.

 

ICE Agent ICED:Veteran ICE agent Juan Martinez, 47,  has suddenly got a lot on his plate. He is accused of extortion and accepting bribes. Authorities alleged that he conspired with others to shake down a Colombian construction company. The group allegedly told the firm that it was under investigation, when it was not, and that the U.S. Treasury was about to add the company to a list known as Specially Designated Nationals (SDN). The designation by Treasury can result in the freezing of bank accounts and other action harmful to a business. Martinez’s group said it could keep the company off the list, and for that, it received more than $100,000. He is also accused of illegally bringing in people to this country, claiming falsely that they were witnesses in an ongoing narcotics investigation.   His attorney says the allegations are false.

Leaky Pipes: Plumbers aren’t the only ones who concern themselves with leaks. FBI agent Donald Sachteren who leaked information to the Associated Press was recently sentenced to more than three years in prison for possessing and disclosing secret information. Sachteren, 55, was accused of disclosing intelligence about the U.S. operation in Yemen in 2012. What made him a far less sympathetic character in this whole mess was the fact he was also sentenced to more than 8 years in prison for possessing and distributing child pornography in an unrelated case.

 

 

 

Author Elmore Leonard Created a U.S. Marshal Who Will Live On

 

Elmore Leonard signing 'Raylan' book, Jan. 2012/Photo by Alan Stamm

Alan Stamm
ticklethewire.com

 BIRMINGHAM, Mich. — Elmore Leonard, the acclaimed crime novelist who died Tuesday morning, imagined characters who behave and sound like believable law breakers and law enforcers.

His best-known plot stars include Raylan Givens, a deputy U.S. marshal on page and screen.

Leonard, who died at 87 in his suburban Detroit home from complications of a stroke he suffered a few weeks back,  was working on a book called “Blue Dreams” that would have been his 46th. “He was going to bring the character Raylan Givens into it,” son Peter Leonard tells Susan Whitall of The Detroit News.

Leonard introduced that federal marshal in “Pronto,” a 1993 book, and brought him back two years later in “Riding the Rap” and in a 60-page novella issued in 2011 as “Fire in the Hole.”

In “Justified,” a FX cable series that began in 2010 and returns next January, Timothy Olyphant portrays the tough lawman enforcing a beyond-regulations style of justice in eastern Kentucky’s hill country around Harlan.

When a real-life parole violator was arrested there last March, one headline said: Life Imitates Art, ‘Justified’ Edition: U.S. Marshals Hunt Down Fugitive in Harlan County.

But how closely does Leonard’s fictional marshal resemble the real deal?

In an effort to find out, a Cleveland Plain Dealer reporter last year watched the show’s pilot episode with second-generation Deputy U.S. Marshal Pete Elliott, who joined the service in 1987 and has been U.S. marshal for the Northern District of Ohio since 2003.

Until local journalist Mark Dawidziak popped in a DVD at Elliott’s federal courthouse office, he hadn’t seen “the heroic deputy marshal created by esteemed novelist and screenwriter Elmore Leonard.”

The actual badge-wearer admired the pilot’s realistic setup, which had Given assigned to Lexington, Ky., and being told he’d take on all kinds of assignments.

“Small offices tend to have less manpower, so that would be the case,” he says. “In a smaller office, a deputy marshal could be asked to do a little bit of everything: working warrants, prisoner transportation, witness relocation, fugitive task force. And it’s not uncommon for someone to be assigned to an area where they grew up. We’re one of the law enforcement agencies that will do that. And I think that’s a good thing.”

Elliott also was impressed by an offhand mention of Glynco, commenting: “That’s our training academy in Georgia. That’s right. Somebody did some research.”

Timothy Olyphant as Raylan Givens in "Justified"

Similarly, he gave a thumb-up to actor Olyphant’s generally casual wardrobe:

“You dress appropriately for court, but, if you’re apprehending fugitives and jumping fences, you’re in jeans.”

But overall, the Cleveland marshal found more unrealistic touches than accurate ones – starting with Givens’ frequent weapon use.

“I’ve never had to fire my gun in the line of duty. It does happen, of course, but every time a weapon is discharged, reports need to be filled out. With the amount of gunfire in this show, Raylan would be up to his ying-yang in paperwork. That’s all he’d be doing. . . .

“I know they want him to be a Lone Ranger type of hero with a lot of Clint Eastwood and John Wayne stuff. It’s not a bad show. It’s just not very representative of what we do.”

Raylan Givens’ creator was a show consultant, though dramatic script flourishes aren’t his.

The vivid characters and crackling dialogue Elmore Leonard put between book covers seemed so real that criminals “write to me and want to know if I’ve done time,” the author told Vice magazine in 2009.

That level of realism flowed partly from reading and other research, and mainly from an imaginative talent that assures his work will endure.

 

Ex-Prosecutor Turned Author Tries to Shield Her Parents from the Steamy Sex Scenes

Featured_leotta_7113
By Allan Lengel
Deadline Detroit

DETROIT — Allison Leotta, a Detroit native living in the D.C. area, likes to send her parents in Michigan a draft of her new novels — minus the chapters with the steamy sex scenes.

“I take out those chapters,” says Leotta, a Michigan State University graduate.

But her mother, Diane Harnisch, of West Bloomfield, Mich., says at least with the last transcript, her daughter may have forgotten to excise those chapters. Not that it really matters. She says she reads the published books as well.

“I want to know exactly what she’s writing,” says Harnisch. “Of course as a mom, it makes me a little uncomfortable  at times. and wondering how in heavens name does she know that stuff.”

Her parents and grandmother are perhaps her  biggest fans, but certainly not the only ones.

Leotta, 40,  who is married and the mother of two young boys, is on fire in the literary world.

Described in the Providence Journal as a female John Grisham, the former D.C. sex crimes prosecutor will release her third novel “Speak of the Devil”, Tuesday.

It’s part of the ongoing series centering around a fictional sex crime prosecutor named Anna Curtis. On day of the debut, she’ll appear for a book signing at 7 p.m. at Books-A- Million on Southfield Road in Beverly Hills.

The third book isn’t her last.

Leotta recently signed a contract with Touchstone/Simon & Schuster to write two more novels as part of the series, she tells Deadline Detroit.

In her latest book, the main character, prosecutor Anna Curtis gets engaged. That’s the good news.

On the downside, one of her cases takes a vicious turn.  A criminal named Diablo — the Devil — leads an attack on a brothel. It results in an investigation into the dangerous  MS-13 gang, which has roots in El Salvador.  Curtis tries to keep her personal and professional life separate.  But the dangers of the job come to her doorstep.

Leotta says this book is a little darker than previous works, “but it’s a lot more suspenseful. People who have read it have been surprised by all the twist and turns.”

A  sex crimes prosecutor, she left the U.S. Attorney’s Office in D.C. in 2011 to write full time.

While working as a prosecutor she wrote her first novel “Law of Attraction.” As policy, the Justice Department had to review the transcript for any security breaches. Leotta wasn’t worried about that. What concerned her was having colleagues having read the sex scenes.

Leotta, who grew up in Franklin and Farmington Hills, and attended Harvard Law School, always can depend on two people to help generate interest in her book signings in Metro Detroit:  Her father, Alan Harnisch of Troy, who is  a former federal prosecutor, and her mother.

“They’re my biggest fans,” she says. “They never fail to pack the bookstore with friends whenever I’m there.”

Her mother says: “I couldn’t be more proud of her or in awe of her ability.”

Interestingly, Leotta says her grandmother has read the books as well — steamy scenes and all.

“With my grandma, she read the published  books, and she said she was shocked, and said ‘ how did you learn all that stuff?”

Besides writing books, Leotta has a blog, The Prime Time Crime Review, which evaluates crime shows for true-to-life  accuracy.

 

Column: The Unfair Treatment of Man Who Really Just Wanted to Be an FBI Agent

Herman Groman is a retired FBI agent whose work included investigating public corruption and organized crime.

Justin Slaby

 
By Herman Groman
For ticklethewire.com

I’m not one to easily pick up a cause. I’ve seen too many situations when after all of the hype and the dust settles, somehow the “cause” was found to be flawed.

So when I heard about FBI Agent trainee Justin Slaby being drummed out of the FBI training academy at Quantico, Virginia, I was certain after looking into it, there would be more to this story. It would all make sense.

You see Justin Slaby is a former US Army ranger and he served three tours of duty serving his country in Afghanistan and Iraq. He left the military only after his left hand was blown off by a grenade.

His life-long ambition was to become an FBI Special Agent, but with his amputated left hand it seemed unlikely his dream would be realized. Still, he was hopeful.

He got some encouragement along the way from an FBI recruiter he met, and decided as improbable as it might be, he would continue his quest. The first obstacle he faced however, wasn’t his missing hand. He had a state of the art prosthesis and could just about do anything he could before he lost his hand. He had to get a college degree.

So the married father went to college at night full-time and worked during the day. All the while he kept his sights on his dream to become an agent. Eventually, he landed a job with the elite FBI hostage rescue team as a support employee.

Not an easy accomplishment by itself, but he still wasn’t an agent. Fortunately, when it came to firearms, he was an expert shot and he was right handed. But knowing that the FBI firearms training required that some shooting be done with the “weak hand” (in his case his left hand with the prosthesis) he even learned to shoot with the prosthesis for this limited shooting. Eventually, his determination paid off.

After enduring the grueling application process, countless interviews and an extensive background investigation, he was offered a position as an FBI Special Agent trainee at Quantico Va.

Herman Groman

He was where he had dreamed of being since he was boy. Against all odds, he had made it to the FBI Academy. He was doing well in the academics, and the physical part of it was a cake walk given his Army Ranger training.

In firearms training he was doing well, but the technique he developed for shooting with his prosthesis in his “weak hand” wasn’t in conformance established FBI firearms guidelines.

It wasn’t pretty, but he got the job done. After several weeks into the training, he noticed that he would be called out of classes and summoned to the firearms unit. He was tasked to do things that the other trainees were not asked to do.

Things like draw a can of pepper spray and his weapon at the same time and pull  a 250-pound man around with one arm. One of the instructors even callously blurted out to one of his classmates, “What’s next? Guys in wheelchairs?”

Still, he was willing to endure whatever they asked of him in order to accomplish his goal of becoming a special agent.

After a few weeks, in spite of his satisfactory performance, he was dismissed from the FBI Academy because of his unconventional “weak hand shooting technique.”

He formally requested to be reinstated to the academy and his request was denied.

Slaby has filed a federal law suit and the trial is scheduled to begin on Monday July 29th in Stafford Va.

I for one hope he prevails. He has already demonstrated that he has guts, focus, drive and integrity: the qualities that make an outstanding FBI Special Agent.

Detroit’s U.S. Attorney Barbara McQuade Knew Feds Would Be Subject to Some Ridicule in Hoffa Dig

Featured_mcquade3_6597U.S. Attorney Barbara McQuade
By Allan Lengel
Deadline Detroit

DETROIT — Things haven’t been dull for Barbara McQuade.

Right after being sworn in as the Detroit U.S. Attorney in January 2010, she started dealing with the “Underwear Bomber” case involving Umar Farouk Abdulmutallab, who tried to detonate an explosive aboard a Detroit-bound plane on Christmas day.

Later that year, her office indicted ex-Detroit Mayor Kwame Kilpatrick.

This year, her staff scored a major victory, convicting Kilpatrick, his buddy Bobby Ferguson and his dad Bernard Kilpatrick.  She was involved in the decision that lead to the FBI digging for Jimmy Hoffa in June. And her prosecutors continue to investigate corruption in Wayne County government.

In a wide-ranging interview, McQuade, who has been a prosecutor in the office for 15 years,  sat down with Deadline Detroit to talk about public corruption, terrorism,  Hezbollah’s links to Metro Detroit,  Kwame Kilpatrick’s upcoming sentencing, the Hoffa mystery, the credibility of ex-mobster Tony Zerilli who provided the latest tip as to Hoffa’s whereabouts, and what went into the decision to dig for the legendary union leader recently in Oakland Township.

“We knew there’d be some ridicule, like ‘Oh my gosh, they’re digging for Hoffa again,” she says.

The following interview was condensed and the questions were edited for clarity.

DD: Can we expect more indictments out of City Hall?

McQuade: I don’t know about city hall per se. I guess I wouldn’t want to comment on that. The pension fund case is pending and we’ll go to trial early part of next year. It’s no secret that we’re currently investigating Wayne County government because that has all been very public despite our efforts to do our best make sure we protect the integrity of people involved in that investigation. I think there have been six defendants convicted to date in that investigation.

DD: I noticed in the paper that former U.S. Attorney Jeff Collins, who works for Bob Ficano, has asked you for a letter for Ficano saying he’s not a target of the investigation. Apparently he’s not gotten one. Is there a reason not to issue a letter?

McQuade: I don’t want to comment on that other than we are investigating all aspects of Wayne County and we don’t know yet where the evidence may lead us. So people should not infer anything positive or negative from that.

DD:  It’s unusual for a federal judge to detain a defendant in a white collar case before sentencing. Were you surprised Judge Nancy Edmunds detained Kwame Kilpatrick?

McQuade: We thought we had a reasonable chance of that outcome.  I don’t know I expected that outcome. I wasn’t stunned in light of the history he had in the state court with flouting court orders.

DD: Have you seen that before in a white collar case?

McQuade: From time to time people get detained in white collar cases. I agree with you that it is more rare. There was no argument that he was a danger to the community and more often, those are the kind of defendants who get detained.  This was more along the lines of risk of flight and a history of not complying with court orders.

DD: How involved was the Justice Department with the Kwame case and how worried were they about pulling the trigger and indicting?

McQuade: Not much at all.  The Justice Department does get involved in certain kinds of cases with national implications. For example, the Abdulatalab case (Underwear Bomber), which was an international terrorism case. They were very involved in that and wanted to be kept apprised at every step of the way and we needed approval from them every step of the way.  The Kilpatrick case much less so. Really we were notifying them of significant events in that case.  But other than that, they really let us run that case on our own.

Featured_22_33_49_874_bernard_kilpatrickBernard Kilpatrick

DD: You indicted Bernard Kilpatrick, Kwame’s dad, who worked as a business consultant for city contractors. I know prosecutors sometimes worry the jury might be more sympathetic when they see a family unit on trial.  Was that something that was debated?

McQuade: I guess I don’t want to talk about specifics of what we debated. But you’re absolutely right that those are always the kinds of things that you think about: How does this affect the jury’s perception of the case? Are we overreaching in any way? But we felt very strongly about charging Bernard Kilpatrick because we thought the evidence against him was very strong. Ultimately, the jury was hung on him with respect to RICO charges but did convict him of the tax charges. There was wire tap evidence, video evidence, that we thought was very strong that (showed) he was just not a participant but a leader in this activity.

DD: Do you think in his case or others the laws involving lobbying and consulting are too vague?

McQuade: Well, sometimes the lines are unclear about what is permitted and what is not permitted. But the evidence we thought in this case was very strong that there was no gray matter, that this was misconduct. But as I said, reasonable minds can disagree.

DD: A lot of people were happy to see the indictment, but some supporters of his  wondered if it was racially motivated. Did you feel pressure if he walked that it would bolster his cries of racism?

McQuade: I wasn’t worried about it. Defendants always have some argument about why they’re being unfairly targeted.  That’s a fairly common tactic. Certainly it was an important case for the city of Detroit. And so we did feel strongly and had great hopes the jury would see it our way and convict him.  If he had not been held accountable I think it would have sent a terrible message to the entire city of Detroit and the entire community.

To read full interview click here.

An Analysis: The Illicit Prescription Drug Epidemic Just Keeps Getting Worse

Ross Parker was chief of the criminal division in the U.S. Attorney’s Office in Detroit for 8 years and worked as an AUSA for 28 in that office. He is the author of the book “Carving Out the Rule of Law: The History of the United States Attorney’s Office in Eastern Michigan 1815–2008″.
By Ross Parker
ticklethewire.com
 
The following are a few of the true stories from the cinema verite of America’s Prescription Addiction already playing in real life near you. Half of Americans received at least one prescription in the last month, and almost three billion prescriptions for 100 billion pills were dispensed last year. Both numbers are on a steady increase.

Scene #1 – In the early morning hours the “patients” are lined up out the door and around the block of the suburban Detroit clinic.  Each has a well rehearsed set of subjective symptoms that will produce a scrip for Xanax, Vicodin or another drug that they can sell on the street. Muted cheers as the doctor pulls up in his expensive European sedan, gives them a friendly wave, and then enters the side door of the office. By noon he will have completed his “treatment” of those in the line, and he will retire to the doctors’ lounge at a nearby hospital where he can check his stocks on his laptop.

Scene #2 – The federal prosecutor and case agent view the latest day’s video of a court-authorized Title III from a camera inserted into another doctor’s office, this time in the inner city. The investigation had shown that no “patients” ever entered this office. The doctor enters the office and, using the list of names and drugs given to him by his assistant, proceeds to write out dozens of prescriptions for patients he never sees. What is striking to the prosecution team is that he always puts on his starched white coat and checks his appearance in the mirror before sitting at his desk to complete his task.

Scene #3 – Fourteen year old Sally digs through her parents’ medicine cabinet before leaving the house to join her friends. She thought there was some Valium left from last week but decides to settle for a few of these OxyContins her father had left over from some back surgery. A friend would bring some alcohol to share with the group. Her parents would receive a call later that night from the hospital emergency room where she had been taken after she went into seizure at the party.

Scene #4 – Max was a good student at the state university, but this semester’s course load was a ball-buster, and his performance on final exams next week would determine whether he would keep his scholarship for the rest of the year. Fortunately he had a buddy down the hall who had been diagnosed as ADHD and who would always slide him a few Adderall to boost his concentration level.

Scene #5 – Dr. Anderson gets a call as he is leaving the house with his family to see a Friday night movie. He has to take it because it is his turn to be on call. A desperate sounding patient of the clinic where he works is in a great deal of pain from a recent surgery. She needs a prescription for a pain killer called in to the pharmacy so that she can get through the weekend. Although he knows it will mess up the movie schedule, the doctor takes the time to check the Prescription Drug Monitoring Program database and discovers that the patient has been getting the same pain pills from two other physicians and an emergency room in the last month. He refuses the request and makes a mental note to address the issue with her regular physician.

 

Like most things, along with the use comes the abuse. Over one-fifth of Americans have taken prescription drugs for non-medical reasons. One-quarter of high school students have abused them, a 33% increase in the last four years. Six of the ten most popular illegal drugs used by 12th graders were originally obtained by prescription, and half of them came from mom and dad’s medicine cabinet.

The epidemic of illicit prescription drug abuse continues to gain speed.  Its use exceeds the combined use of cocaine, heroin, and all inhalants. Marijuana is the only illegal drug used more than pharmaceuticals.

Drug overdose deaths exceeded automobile accident fatalities last year, and most of these (about 24,000) involved prescription drugs, especially addictive painkillers such as OxyContin and Vicodin.

The annual health costs from non-medical prescription drug use exceed $100 billion, not including the cost of lost productivity. There has been a staggering increase in the number of newborns addicted to painkillers. Their period of withdrawal is long, costly, and painful for the infant.

The reasons for the epidemic are predictably complex, but a lot of it stems from the prevailing attitude that any adversity can be avoided, denied or at least ignored by popping a pill. Most adults and kids mistakenly believe that non-medical use of prescription drugs is not as dangerous as illegal drugs on the street. When the unwitting source of supply is that benign family doctor and the drugs have passed FDA inspection and come in that cute little pill, how serious can some recreational use be?

Place that misperception in the middle of a proliferation of prescription drugs manufactured in the United States and the dire results reported above are predictable. Enterprising pharmaceutical companies have conducted research that has saved lives and alleviated the pain of countless numbers. And they have profited handsomely and marketed the risky drugs relentlessly. Purdue Pharma receives more than $3 billion in revenue annually from sales of OxyContin. Pretty good considering that three of its executives pled guilty in federal court in 2007 for misbranding the drug with intent to defraud the public and the company paid $635 million in fines and penalties for falsely claiming that the drug was not addictive. Check out the CNN Money article for the fascinating full story.

That’s the demand side of the equation. On the supply side, the factors supporting the epidemic range from venal criminality to well meaning but under-trained physicians. Although they are the most flagrant, health professionals in the first category are responsible for only a small percentage of the prescription drugs being abused.

The doctors and pharmacists who operate “scrip mills” and “pill mills” for big bucks are like any other criminal enterprise and should be treated accordingly. The physician in Scenario #1 above is awaiting trial but is on bond and practicing in his office. The physician in Scenario #2 was convicted, sentenced to 10 years in prison. Afterwards, he’ll be deported back to Nigeria.

More prevalent on the criminal side are the rings that operate especially in metropolitan areas to send “patients” to see a series of primary care physicians for the purpose of obtaining prescriptions for the drugs of abuse. If successful in convincing the doctor of his/her need for pain killers, the prescription is filled at a pharmacy and the pills dropped off in exchange for a cash payment.

Additionally, some enterprising independents have carved out a profitable living by doctor shopping for whatever prescription drugs are selling on the street. Vicodins sell for $10 and up, OxyContin for from 50 cents to $1 per milligram. Called Oxy or Cotton or Blue, the 40 mg pills sell for around $30 and is the most popular illegal drug right now in many cities. Other prescription drugs that can be available on the street include Xanax, Dilaudid, Demerol, Valium and Adderall. The “Holy Trinity” of abused drugs is the combination, taken together, of OxyContin, Xanax, and Soma (a muscle relaxant).

One independent operating in a Detroit suburb, when confronted, proudly displayed her system of repeated prescriptions from a dozen different doctors. She kept a strict calendar of when the pills from each prescription were due to be used up. She never sought a renewal before that date and showed up in person to request another scrip. She was presentable, had the required pain symptoms and avoided all behavior which medical offices have learned to identify from “drug seekers.” The result was that she could count on making $5,000 to $10,000 a month.

Non-criminal suppliers like well intentioned doctors are also part of the problem. Not only do they sometimes fail to detect drug-seeking behavior, but in an abundance of caution they also resort to the most serious (and abused) pain killers even though other options exist.

The fact is that many doctors are uncomfortable with treating patients for pain. The extent of the patient’s suffering is often impossible to verify by objective test, and pain tolerance can vary greatly from patient to patient. Physicians feel like they are on a slippery slope of, on the one hand, wanting to relieve the patient’s suffering and, on the other, avoiding the problems of addiction, not to mention getting anywhere near conduct in which someone could accuse them of not having a demonstrable medical purpose. The observable distinction between a stoic patient in need of pain treatment and one who wants a medication to sustain his or her addiction (or, worse, for sale or recreation) can be pretty elusive.

The other difficult tension for physicians is that there have been many studies that have shown that doctors under-treat pain. Doctors of end-stage cancer patients have been known inexplicably to use less effective pain drugs in order to avoid the prospect of addiction. Patients with chronic, as opposed to acute, pain problems have particularly had difficulty getting adequate pain medication.  There is some indication that the medical establishment is starting to take steps to remedy this problem

However, a debate currently raging in the medical and professional community illustrates this dilemma. The debate is over the use of opioids for treatment of chronic pain. Some think that its efficacy is not sufficiently established or, at least, such drugs should be limited in terms of duration and the maximum daily dose. This caution stems from the dramatic increase of emergency room admissions and deaths from opioid use. One such group is called Physicians for Responsible Opioid Prescribing, or PROP.

A group with different views on the use of opioids for chronic pain patients calls itself PROMPT, Professionals for Rational Opioid Monitoring and Pharmacotherapy. Who says these geeky guys and gals don’t have fun with their medical acronyms?

All debate aside, the fact of the matter is that few doctors have received the training necessary to respond to this dilemma. Medical schools, residencies, and required continuing medical education have traditionally ignored the subject. Again, some medical education programs are now addressing the subject.

One development which has great promise in helping weed out drug seekers and in identifying and treating patients with the potential or reality of addiction is the Prescription Drug Monitoring Program (PDMP). Although the program has great potential, its use as a force to improve medical care and reduce abuse has been limited.

PDMP are statewide electronic databases which collect data on controlled substances dispensed and make that information available to authorized users. Although such programs undoubtedly could be important tools to identify and combat abuse, their present formulations have severe limitations. The primary one is that each state has legislated its own system with widely diverse requirements, data fields and formats.  Few states allow the information to be disseminated to anyone outside the state. Even if PDMP is utilized, patients can avoid detection by simply crossing state lines and seeing a doctor there.

Many states have essentially cut law enforcement out of the loop and do not provide either direct access or reports of suspicious behavior to police or drug diversion agencies. These reports would be a gold mine of data for investigative leads and evidence for the prosecution of abusers, as well as sources for administrative actions against offending doctors and pharmacists.

Another problem is that the use of the program is almost entirely voluntary. The great majority of doctors, pharmacists, and hospitals simply decline to use it. A patient’s history of obtaining drugs from multiple sources is, in most states, available by computer, but this extra step is considered just one more bureaucratic burden. Most physicians by far, like in Scenario #5, above would have authorized the prescription and gone to the movie on time. A handful of states, led by New York, are in the process of making PDRP checks mandatory, at least under some circumstances.

Other suggested reforms are catalogued in the extensive report, Prescription Drug Monitoring Programs : An Assessment of the Evidence for Best Practices, www.pdmpexcellence.org. Nowhere in the 100-page report does anyone suggest the obvious option that a single national program, mandatory to all controlled substances dispensers, be instituted. Nor has anyone else apparently suggested that such a solution be considered.

A national system would essentially halt doctor-shopping and drug seeking enterprises and greatly reduce the quantity of prescription drugs available for abuse. Perhaps the controversy over the Affordable Health Care Act makes such a proposal unworkable. However, the situation seems comparable to the realization not too many years ago that a nationally required system of lower speed limits and seat belts would save lives. Whatever initial objection to the nationalization of the solution to that problem has been eliminated by the proven results.

The illicit prescription drug epidemic is here and getting worse and is costing tens of thousands of lives. The proposals suggested here, better physician education, more resources and involvement by law enforcement, and an effective PDMP program, would not eliminate the problem, but it would have a significant impact. An impact that could improve medical care and save lives.