Links

Columnists



Site Search


Entire (RSS)
Comments (RSS)

Archive Calendar

October 2022
S M T W T F S
 1
2345678
9101112131415
16171819202122
23242526272829
3031  

Guides

How to Become a Bounty Hunter



Uncategorized

The Role of Doctors in the Heroin

800px-Heroin

By Ross Parker

With the recent volume of media on the issue of the heroin epidemic, its overdoses and deaths, has come an effort to provide an easy explanation for the cause of and solution to this multifaceted problem. Much of the blame has been directed at doctors, who are charged with being either intentionally or negligently pill-happy with painkiller prescriptions. Their failures, it is charged, have made medical patients into addicts and, when the scrips became unavailable or too expensive, the patients were forced to turn to heroin and other opiates on the streets.

The tragic death of actor Phillip Seymour Hoffman who went from painkiller to heroin addiction and then to an overdose death is presented as a prime example for this explanation for the increase.

But the reasons for the current heroin upsurge are far more complex than the responsibility of a single group. Factors such as a failure of individual responsibility, insufficient education for kids, inadequate drug treatment resources, the emergence of Mexico as the dangerous big dog in shipping heroin up north, inadequate regulation and, yes, law enforcement, as well as a dozen other reasons contribute to the pandemic.

But doctors and their regulators do play an important role in this analysis and any feasible solution. It is not merely a coincidence that the country is in the midst of both a painkiller and a heroin overdose epidemic. The relationship between the two provide part of the cause.

The number of painkillers prescribed has quadrupled in recent years. Every day 44 people in the U.S. die from an overdose of painkillers. The number of deaths has skyrocketed from 4,000 to 16,000 annually. Experts from the health and law enforcement fields point to prescription drug abuse as a major cause of the epidemic. But they usually fail to add that 70% of these overdoses were by individuals other than the patient who obtained the prescription. Their access was from patients, many of whom legitimately needed the prescription, or from the street traffickers.

Which is not to say that medical profession doesn’t need to get its house in order.  Reforms need to be made even if doctors are not the only or even the primary culprit for the contagion.  It is true that a substantial percentage of physicians fail to find out about a patient’s history with controlled substances or their obtaining multiple scrips, even though this information is readily available. Plus many doctors lack the training and experience to identify opioid abusers and what alternative pain relief regimens could substitute for these drugs for patients at risk.

The February 2015 New England Journal of Medicine bemoans the absence of the use of proven medication treatment strategies both by physicians and drug treatment centers. The lack of insurance coverage, physician training, policy hindrances, and adequate resources are only part of the explanation for this failure.

Researchers of a study presented recently in the Clinical Journal of Pain found that many primary care doctors lacked an adequate knowledge base about opioid treatment and failed to appreciate the danger of diversion to non-patients. These two deficiencies often made the doctors prescribe them more often than necessary.

One part of the formula to battle this rampant epidemic is to work with doctors to strengthen the net that is supposed to limit painkillers to patients for whom there are no effective alternatives. Physicians have to receive training to be able to use an evidence-based pain management program and to be able to identify the dangers of misuse and overdoses. Checking up on drug-seeking patients should be mandatory and, if where it is not required, it should be the choice of every physician before a controlled substance is prescribed.

As was detailed in last week’s column, doctors should have the testicular tissue and foresight to make Naloxone available to family members, friends and first responders so that an addict in the throes of an overdose can get to the emergency room before his or her breathing shuts down.

[Two updates on that column: Kudos to the Macomb County Michigan Sheriffs’ Department who saved an overdosing person’s life last week because a month earlier they had the good sense to give every deputy Naloxone to use when confronted with an overdose. Second, thanks to the reader who posed the question, why isn’t Naloxone over the counter so it is readily available to first responders to provide a supply of this life-saving and harmless drug? Indeed, a good question.]

States have an important and related role in these reforms. As mentioned last week, every state should implement a mandatory Prescription Drug Monitoring Program. So far, although progress has been made in this endeavor, most states still make it voluntary by doctors and, as a result, well less than half utilize this database that tracks prescriptions and dispensing of controlled substances. In states which have recently made the program mandatory, results have been dramatic. In the last two years New York has had a 75% decline in patients seeking multiple scrips. Oregon and Tennessee have both had an immediate drop in overdoses.

There are many other fronts to this perplexing and complex battle to save lives, not the least of which is more study on why a half million people, especially young people from all socioeconomic backgrounds, are risking their lives every day for this momentary high even though they create a nightmare for their families.

One thing is clear, we need to stop stigmatizing addicts and looking for an easy fix. Only a broad based solution involving many disciplines and more resources will get the nation through this scourge.

Naloxone and the Surge of Fentanyl-Heroin Overdose Deaths

imgres

By Ross Parker
ticklethewire.com

A young woman from Michigan we will call Janice started using heroin in her early 20s. Her family stuck by her and financed several rounds of rehabilitation. Each of these was followed after a short period of time by a relapse and her family or friends rushing Janice to a hospital emergency room when she overdosed. Each time the ER docs were able to stop the overdose and stabilize her.

Then one night Janice shot up with what she thought was heroin but which had such an immediate effect that she went into respiratory arrest with the syringe still in her hand. The people she was with called 911 but could do little else. By the time she got medical help, it was too late and she died during the EMT transport.

Last week this column focused on the deadly effects that fentanyl-heroin combinations were having on opiate addicts in Canada and the United States. Since fentanyl is 30 to 50 times more potent than heroin, dealers are lacing low quality heroin with it to boost the effect without revealing this to their customers. Plus fentanyl is accessible and not expensive. Much of the fentanyl is obtained through prescription drug abuse from patients who are supposed to use the drug to combat serious pain, for example from cancer. The result has been deadly.

There is a drug that could save hundreds of lives of overdosing users. Its use in scattered projects and medical facilities around the country demonstrates that it is safe, effective and easy to administer. The problem is a lack of public education, resources and facilities with access to the life saving drug.

Naloxone Making a Difference

Naloxone blocks opioid receptor sites in the CNS, especially those in the brainstem which affect respiratory effort. It does not cure an overdose. What it does is enable the overdosing person to breathe for long enough to get her/him to medical facilities where their breathing can be secured more permanently. With the latest generation of fentanyl-heroin overdoses, this extra half hour or hour can mean the difference between life and death.

In a recent issue of the Journal of the American Medical Association, writer Bridget Kuehn described a project where the Naloxone is making a significant difference. Northwest North Carolina had the third highest death rate for opiate overdoses in the country. Project Lazarus has cut the death rate essentially in half by a program of providing access to Naloxone treatment kits and training on how to administer it to laypersons who are likely to be the first to observe the overdose.

Read more »

Fentanyl-Heroin Overdose Deaths Surge

imgres

By Ross Parker
ticklethewire.com

Three months ago the mother of an Ypsilanti Township man found her young son slumped over in his bed, dead, with a syringe still in his hand. He was one of the latest victims of the deadly combination of heroin laced with the prescription drug fentanyl.

Zachary Burdette is charged in U.S. District Court in Detroit with causing this death and two others resulting from a growing epidemic of combining heroin with this pharmaceutical drug.

Earlier this year Dennis Sica was convicted in New York with the same crime, again resulting in three deaths. He named the deadly heroin-fentanyl combination “Breaking Bad.”

Outside of law enforcement and medical circles, fentanyl is a little known synthetic opiate, the most potent one available for medical treatment. The rise in the use of heroin, especially by younger and more affluent buyers, has made fentanyl a particularly useful cutting agent to increase the potency of low quality heroin, and occasionally cocaine. Fentanyl is 30 to 50 times more potent than heroin. The deadly problem is that it achieves this purpose only too well, and the result has dramatically increased overdose deaths in the last two years.

Fentanyl is often sold on the street without identifying it, as for example a “fake Oxy” pill or “hybrid smack.” It also has a dozen analogues manufactured in clandestine labs often referred to as “China White.”

In March 2015 DEA issued a nationwide alert on this danger through the El Paso Intelligence Center (EPIC). The National Forensic Laboratory Information Service reports that the number of lab submissions containing fentanyl increased from 942 in 2013 to 3,344 in 2015. Those numbers are continuing to rise this year.

During the first five months of 2015 there were more than sixty deaths attributed to this combination in southeastern Michigan. California, New Jersey, and Pennsylvania report similar numbers. Overdose deaths involving fentanyl in Canada have surged the last year. Deaths from using fentanyl are twice as prevalent in Ontario as heroin deaths and account for one-fourth of the overdose deaths in British Columbia, up from just five per cent in 2012.

The other aspect that makes the drug so desirable to dealers is its accessibility through prescription drug abuse. Fentanyl has been used by doctors since the 1960s as a particularly effective anesthetic and pain reliever. Its rapid onset character is an effective pain reliever for cancer patients. It is prescribed in several forms, including transdermal patches, oral tablets, nasal sprays and lozenges on a stick (referred to as “lollipops”).

A study in the journal Pain found that one-tenth of the users of prescription painkillers end up addicted to them, and one-fourth of the prescribed drugs end up being misused or diverted out of accepted medical use. Some law enforcement officers consider fentanyl to be the new Oxycontin. It’s cheaper, easier to get access to with the recent restrictions on Oxy, and it produces more of the high that becomes so addictive for opiate users.

Dealers can readily use these forms to combine with heroin either for injection, smoking, or snorting. But fentanyl itself cannot be so easily diluted because it has a very quick absorption rate. Even in small quantities of a single dose, it can have a variety of dangerous side effects, including hallucinations, aphasia, and respiratory depression. Under the watchful eye of a physician, the drug can be a life saver. Uncontrolled on the street, it can be a life taker.

The other danger message sent by DEA about fentanyl is that it poses a special risk for law enforcement officers because it absorbs so readily. Exposure to the drug, for example in the execution of a search warrant or undercover, either by inhaling it or by skin contact can be perilous if the officer has an allergy to opiates.

Deadly, accessible, and on the rise, fentanyl poses the latest crisis for law enforcement.

 

Happy Birthday, Magna Carta

By Ross Parker
ticklethewire.com
Eight hundred years ago today, a group of rebellious English barons met with despotic King John at Runnymede near the Thames River and agreed to a peace treaty , the Magna Carta. Negotiated by the Archbishop of Canterbury, the charter was meant to settle an aristocratic uprising over the unpopular king’s tax levies. It lasted two months before it was annulled.

The fact that the Magna Carta failed in its initial purpose has not dimmed its eight century luster as an iconic symbol of freedom and the rule of law. Proponents of measures to assure the rights of individuals over the arbitrary authority of the governments have long relied on the document’s mythic status in Anglo American history.

For most of those eight centuries the Magna Carta has stood for the right of free men to a fair and free trial. What women got out of the charter was the right to inherit as widows and to not be compelled to re-marry against their wishes. All in all, not an insignificant step toward gender equality.

However, during the same centuries historians have questioned the authenticity and significance of the document as a basis for all the principles it has come to stand for. Lord Protector Oliver Cromwell referred to it as the “Magna Farta,” a tag that would be considered almost sacrilegious to the constitutionalists in Britain and the United States who reverently consider the document to be the very foundation of our individual liberties.

Nevertheless it remains fashionable to poke holes in the document as having been distorted in order to achieve the ends of centuries of legal reform. They point out that technically the overwhelming majority of its Latin clauses have been repealed, refined, and replaced by subsequent legislation. But these protests are largely ignored by the real world.

Perhaps no groups have relied on the Magna Carta more assiduously than the American colonists and, later, revolutionaries and Constitution drafters. To them the document was the common law basis of the guarantees of the Bill of Rights, habeas corpus, and trial by jury.

Perhaps its most far reaching provision is the one that promises: “no person shall be deprived of life, liberty, or property without due process of law.” Moreover, whether by myth or historical reality, the document has come to mean much more than its words and original purpose.

Chief Justice Roberts recently quoted the Magna Carta (“To no one will we sell, to no one will we refuse or delay right or justice.”) in support of the historical basis for the principle of judicial integrity. Williams-Yulee v. Florida Bar, 575 U.S. __ (2015) (upholding a Florida law which prohibited judges from personally soliciting campaign contributions).

In the long journey since the 13th Century, the rule of law has protected us from despotism on one side and anarchy on the other. Law enforcement officers and prosecutors, foot soldiers of the Constitution, can take pride in their important role in building our legal system, case by case, so that all individuals can enjoy fair adjudicative procedures and an equal application of the law. As is carved on the outside of the Justice Department building, “Where law ends, tyranny begins. Law alone can give us freedom.”

Whatever its historical anachronicity, the Magna Carta was a first step in the development of the rule of law, not rule of kings or even men, a process that continues today in every police department, federal law enforcement agency, prosecutor’s and U.S. Attorney’s Offices, in which charges and disputes are considered and resolved.

So if you are searching for a milestone to celebrate this week, you could do no better than to toast the enduring legacy of this ancient document.

 

The Double Steal — The Right and Wrong Way to Steal Trade Secrets

Bill Davidson

By Greg Stejskal
ticklethewire.com

It took about 5,000 years from the discovery of glass until a process was developed to economically mass produce flat glass, and only a few years before the technology was stolen.

Glass is one of the great fundamental inventions – not at the level of the wheel or fire, but up pretty high on the list. Glass is chiefly made from relatively common and inexpensive raw materials: sand, soda ash (sodium carbonate) and lime.

No one knows when glass was first invented or by whom. It does occur in nature when lightning strikes sand or sometimes from volcanic eruptions (obsidian). Its first use seems to have been as a glaze for ceramic vessels in about 3,000 BCE. It wasn’t until about 1,500 BCE that glass vessels were produced in Egypt (ultimately used to hold beer, one of my favorite inventions). The use of a pipe for blowing superheated glass wasn’t invented until circa 30 BCE.

Through the ages uses for glass have multiplied and are as diverse as flat glass to optical lenses which enabled the development of telescopes and microscopes. But this story is about the technology to produce flat glass, and why some people would go to great lengths to steal it.

Flat glass is used primarily for windows and doors on homes, buildings and vehicles. Until relatively recently there wasn’t an economical way to produce large quantities of quality flat glass.

Flat glass was originally made by blowing cylinders of glass that were cut open and flattened then cut into panes. Most window glass up until the early 1800s was made using the cylinder method. The cylinders were limited in size. They were 6-8 feet (2-3m) long and 10-14 inches (~30cm) in diameter, thus limiting the size of the panes that could be cut. Large windows had to be made of multiple panes.

In 1848 Henry Bessemer, an English engineer, designed a system that produced a continuous ribbon of flat glass by forming the ribbon of molten glass between rollers. This was an expensive process as the surface of the glass had to be ground and polished. This did overcome the size limitations of the cylinder method. Beginning in the 1920s, a continuous ribbon of glass was passed through a lengthy series of inline grinders and polishers, reducing glass loss and cost.

The major breakthrough in the production of flat glass didn’t come until the late 1950s. Sir Alastair Pilkington and Kenneth Bickerstaff of Pilkington Brothers, Ltd. in the UK developed the first successful commercial float glass process.

Bill Davidson

Float glass uses common glass-making raw materials. The materials are mixed with cullet (waste glass) in a furnace where it is heated to ~2,800 degrees F (1,500C). When the mixture becomes molten, it is allowed to pour onto a “tin bath,” a bath of molten tin about 2.3 inches (6cm) deep, 3-4 feet (3-4m) wide and 150 feet (45m) long.

The glass enters via a canal. The speed and volume of glass flow is controlled by a gate called a twill. The glass literally floats on top of the tin with uniform thickness. (The molten tin does not adhere to the glass, but an oxygen free atmosphere has to be maintained to keep the tin from oxidizing and adhering to the glass.) As the glass flows along the tin bath, the temperature is gradually reduced. At the end of the bath, the glass has cooled to approximately 1,100F (600C). At that temperature the glass can be lifted from the bath onto rollers. The glass ribbon is pulled by the rollers at a controlled speed. The speed at which the glass is pulled determines its thickness.

As the glass is pulled from the bath, it passes through a lehr (a type of kiln) where it gradually cools so that it anneals and does not crack from more rapid temperature change. After exiting the lehr, the glass is cut by machines.

Read more »

President Obama Talks on NPR about “The Wire” and Crime

By Ross Parker
ticklethewire.com

If you haven’t viewed the NPR video of President Obama’s conversation with David Simon, the creator of the HBO series “The Wire,” on the subjects of drugs, criminal justice policies and law enforcement, it is worth watching. 

The President lauded the series as one of the greatest pieces of art in the last two decades, a view expressed by many in law enforcement of all possible perspectives.  The show follows the lives of drug dealers, school kids, teachers, and police officers in the worst sections of drug infested Baltimore.

Much of the discussion, I thought, had a lot of merit. The nation’s declining rate of violent crime arrests and increasingly long sentences for all levels of drug convictions, causes and effects, posed some insightful discussion. Both men recognized the effectiveness on public safety resulting from a shift in city police resources from street level arrests to more complex investigations of more culpable traffickers. Neither pointed out, however, the contribution and support for this trend from federal law enforcement.

The President did recognize the challenges for law enforcement, the dangers police face, and the need to engage prosecutors and the public, along with law enforcement, in discussions about the “environmental factors,” like the role of schools, counselors, mental health resources, and job availability to change the life directions of convicted drug dealers.

Other topics, however, activated my “squirm” factor.

The President noted the Attorney General’s efforts to convert USAOs away from thinking about effective prosecutions based on the length of the sentences obtained toward achieving justice in cases. He is apparently accomplishing this goal “administratively,” but it needs new legislation to compel this objective of re-orienting federal prosecutors.

Jeez, here I thought that this was what the overwhelming percentage of USAs and AUSAs have long been accomplishing in adherence to, but also sometimes in spite of, the policy dictates and requirements of Washington along with the array of crime and sentence legislation passed by a demagogic Congress to burnish their image as crime fighters.

The other issue was the lack of any mention of the need to support the priorities and resources of federal law enforcement, which has aimed to accomplish many of the exact changes in policy direction highlighted by the discussion.

For my money until the money issue popped up in state and federal governments, the absence of any political and policy discussion of important criminal justice and law enforcement issues has been deafening. As has the absence of political will and leadership to promote ways to evolve and innovate in this area, in tandem with adequately supporting the every-day responsibilities to enforce the law.

This complaint is aimed not only, or perhaps even primarily, at the Executive Branch, but can be shared with the Congress, as well as state governments. Perhaps most of all, the issue has unfortunately simply slid off the public and political wave length in the last decade. Think about how often you heard candidates discuss crime and law enforcement in their campaign speeches.

I know this is preaching to the choir for many ticklethewire.com readers and quibbling and unproductive finger pointing for others. The fact is that there is much to applaud in the President raising these subjects for discussion on the public agenda even in this limited forum. His reasons for optimism for a wider discussion in the future are encouraging for us all.

UK Study Shows High Potency Pot Users Have Triple the Rate of Psychosis

By Ross Parker
ticklethewire.com

A British study found recently that the risk of first time psychosis among users of high THC cannabis was three times greater than for non-users, regardless of the age of the user or the frequency of use. Frequent users were found to have more than five times the risk.

The study was conducted by a group of physicians and scientists at Kings College London, and the results were published in this week’s Lancet, one of the most highly regarded medical journals in the world. The study was funded by the UK National Institute of Health Research.

No psychosis risk increase was found comparing low potency users with non-users. However, recent studies show that the legalization trend has resulted in a steady increase in the THC content of marijuana available for use and sale in the US.

The study results add to the increasing body of medical research pointing out the increasing dangers of marijuana use, particularly among children and young adults. Ironically these studies are bucking the trend toward legalization of medical and recreational use in roughly half the states. This occurs at the same time that use, distribution, and cultivation continue to be federal crimes. This anomaly is nowhere more blatant than in the District of Columbia which legalized use and cultivation this week.

Nor does there appear to be any resolution in the offing of this conflict. The federal executive and Congressional branches seem to offer no leadership on the dilemma.

Meanwhile many state government leaders considering the issue seem to be focused on short term financial projections than on the health issues. And whatever medical research is made part of the debate is often from an earlier time when THC levels were a small fraction of today’s high potency pot being cultivated by enterprising agronomists.

The psychosis study seems symbolic of this entire issue from a macro-examination perspective as well.

Legendary Tony Bertoni, Retired U.S. Marshal and Former Detroit Cop, Dies at 95

Tony Bertoni

By Ross Parker
ticklethewire.com

Anthony (Tony) Bertoni, a legendary law man both at the Detroit Police Department and as United States Marshal, died this past Sunday at the age of 95.

The Bertoni family grew up on the eastside of Detroit during the difficult years of post World War I and the Depression. Like many bright and capable young Irish Catholics of his day, Tony became a policeman in the Detroit Police Department. He was a courageous young officer who also had great people skills. He was well known for being able to solve problems for the people on his beat and precinct. His career was filled with awards and commendations for bravery and service.

His work ethic and recognized ability moved him steadily up through the ranks to the positions of Sergeant, Lieutenant, Captain, Inspector, Precinct Commander, and finally as Superintendant of the Department from 1973 to 1975.

In 1978 he was selected by President Carter to be the United States Marshal for the Eastern District of Michigan and was confirmed unanimously by the U. S. Senate. His selection was supported on a non-partisan basis as evidenced by his re-appointment for two terms by President Reagan. He served until 1990.

There were limited working ties between City and federal law enforcement systems at the time of his appointment, especially above the street level. One of his many accomplishments was to help bridge this gap and encourage cooperation, joint task forces, and constructive dialogue at the management and command level.

Tony quickly became the dean of the federal law enforcement leadership community. He helped U. S. Attorney Jim Robinson establish a Federal Law Enforcement Council, which met monthly to discuss common problems and resolve differences. He also was one of the first to help plan and participate in the Great Lakes Division of the Organized Crime Drug Enforcement Task Force.

At these and other forums, when Tony talked everyone listened, His counsel was pragmatic, never argumentative of self-aggrandizing, but always with generous common sense and a full understanding of the concerns of everyone involved.

One of his many attributes was a genuine respect for all with whom he came in contact, from the newest Deputy Marshal to every member of the federal bench. You never heard an unkind or critical word about Marshal Bertoni.

In some ways Tony stood for old fashioned morality and values. Ethics and principles were paramount to him, and he had little sympathy for those who had betrayed the public trust or were habitual slackers. Loyalty, hard work, dedication to the positive goals of his various endeavors—these were the unquestioned values in his public service.

But he also recognized the need to overcome historical inequities in law enforcement and to promote progress and more modern methods. Having lived through the events of the summer of 1967 in Detroit as a District Inspector, he supported the advancement of qualified African American officers and deputies.

Likewise, although always the chivalrous gentleman, he was as gender neutral on the job as the most progressive law enforcement managers of his generation. Female AUSAs in particular seemed to like to work with him. Of course, he was the best looking guy in the U. S. Courthouse.

Tony wasn’t all about work. Most of all, he loved his wife, Frances, and his large family of 6 children, 12 grandchildren, and 22 great grandchildren. Like all patriarchs, he fretted over their struggles and was proud of their accomplishments. He was an excellent fisherman and a day on the lake with a family member was a joy to him.

He also was a man of quiet faith and a proud Italian American, who enjoyed talking about their many accomplishments in helping to build the City of Detroit.

For the rest of us, nothing was more enjoyable than eating a slow lunch at Roma’s Café with him. It was common for politicians, businesspeople, and beat cops to stop at his table, pay their respects and share a story or two about the old days. But the best storyteller was always Tony, who had an encyclopedic memory of the people and events in Detroit during the 20th Century. The stories were an oral history of the City, always fun and illuminating. One left these lunches reluctantly but with the feeling that you had chosen right to be part of the law enforcement fraternity with someone like Tony.

It is fitting that Tony’s long and well lived life extended into 2015, the bicentennial year of the first U. S. Marshal in the Michigan Territory, Thomas Roland, appointed in 1815 by President Madison.

Tony Bertoni would have been a lion in any generation. We are so fortunate that he chose ours. He was the epitome of the best in law enforcement, the best counselor and the best friend.