an intelligence assessment - get smart about drugs · 2019. 7. 2. · an intelligence assessment....
TRANSCRIPT
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DEA 360 Baltimore:An Intelligence Assessment
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2013, Week 47:The Arrival of our Deadliest Drug Epidemic Ever
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Imagine if, Everyday, a Plane Fell From the Sky
197 deaths ' per day in the
United States '
' 72,000 deaths- 2017 - CDC
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1990’s – Big Pharm & the 5th Vital Sign
2010 - Rapid Increase in Heroin Deaths
Mid 2013 - Fentanyl
How We Got Into This Mess
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U.S. Prescription PracticesStarting Addictions that Progress to Heroin Use
4/55% / 80% / 99% /30X
Ankle Sprains?92%; 10%
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Foreign Policy, Dec 2018Kathleen E. McLaughlin
Opinion: "China Killed Prince"???
• Fentanyl - Deadliest Export
• Fueled Unprecedented OD's
• U.S. Life Expectancy Lower
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Fast Forward from Toluca& the Cyber-underworld
160,000
Vast Chemical and Pharmaceutical industries - combined with lax regulation, low production costs, and government corruption
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The Pipeline Meets a Changing Drug Supply
• Cheaper, More Potent Drugs are Readily Available ...
• While More Treatment is Not
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Time for a Seismic Shift
Tough on Crime? Or, Smart on Crime!
It's a Treatable Brain Disease!
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Barriers to Substance Use Disorder Treatment
• Only 10% Get Specialty Addiction Treatment
• Treatment Options Don't Exist ...
• OR, If they Do Exist, are Unaffordable ... Or
• Have Long Waiting Periods
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Heroin: A Plant Based OpioidSource Regions
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Heroin Markets
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Heroin+: Sinoloa Cartel
Ivan Guzman
Alfredo Guzman
Ismael Zambada
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The Synthetic Storm: CJNG
Fentanyl is Now an Adulterant Found in Many Recreational Drugs!Nemesio Oseguera
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Fear of Adulteration Has Never Been Greater Case in Point: Cocaine
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Counterfeit RxModern-Day Russian Roulette
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Counterfeit RxModern-Day Russian Roulette, Part 2
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Street EconomicsIn 3 Easy Lessons
2 Pills= $160vs
4 Caps=$40
H= 3-4xvs
F= 16-24x
1 kg H= $25k to 60k+
vs1 kg F=
$4,000 to $60K
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Mexican Trampoline & Narco-Superhighways"Los Cincos"; "Los Dos Laredos"; "Traps, Mules & Ants"
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"Diablito","Comida China", "Fire", "Got Nyl?"
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31 - 10 Operation Fountainhead
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Heroin Mill & Tabletop:Baltimore Style
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Street Ready
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What Really Hurts the Cartels
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• Law Enforcement– It’s a Crime Scene Too– Protect the Scene, but also
Yourself– Next 3 Logical Steps– Use Opioids? Treatment
Works & Recovery is Possible• Public Health
– Continuing Med Ed Creds &Rounds
– Crisis Intervention Teams– Take-Down Protocol
• Community & Schools• Mapping
BRMLE, PH & Community Collaboration + Best Practices
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Situational AwarenessMapping - An Award Winning Best Practice
The 2015 Baker Public Health Impact Award Winner:
Making a difference in an epidemic of fentanyl deaths in Maryland - Geographic Information System (GIS) and Collaboration with the DEA
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Ok! So Now We're More Aware. What's Next?Better prevention, treatment & recovery servicesBetter data on the epidemicBetter pain management
Better targeting of overdose-reversing drugs
Better research on pain and addiction
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Scheduling: a CollaborationOperation Mike & Mike?
DEA SFL-1 Mike at DEA HQ
OCME in Baltimore DEA Baltimore Mike at US Embassy Beijing
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Best Practices
Use PDMP
Remove Effective Treatment BarriersBuprenorphine / Methadone
Discuss Risks & Benefits with Patients
Follow Best PracticesScreen for Substance Abuse / Mental Health IssuesPrescribe Lowest Effective Dose
What Can Doc's Do?
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TURN
THE
TIDE,!' PRESCRIBING OPIOIDS
FOR CHRONIC PAIN
ADAPTED FROM CDC GUIDELINE 00 Opioids can provide short-term benefits for moderate to severe pain. Scientific evidence is lacking for the benefits to treat chronic pain.
IN GENERAL, DD NOT PRESCRIBE OPIOIDS AS THE FIRST-LINE TREATMENT FOR CHRONIC PAIN (for adults 18+ with chronic pain> 3 months excluding active cancer, palliative, or end-of-life care).
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Best Practices
How will my pain be managed before, during and aftersurgery/injury?
How much discomfort is usually associated with thisprocedure/injury?
What non-narcotic pain control options do I have?What side effects can I expect?How will I manage long-term pain?
What Can Consumers Do?
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The 6 Key IndicatorsWhat Can Your State Do?
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Lagging Behind, But ImprovingMaryland's Report Card
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The Courage to Changevs Too Big to ail
Veterans AdministrationBaltimore, MD"Opioid Decision Taper Tool"
FDA"Rationalized Prescribing"
Johns Hopkins HospitalBaltimore, MD"20 Common Operations"
Sinai HospitalBaltimore, MD"Local Anesthetics & Nerve Blocks"
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• MAPPA’s 20 Years of Prevention Partnering
• Run In My Shoes
• U of MD & Yale re: Buprenorphine in ER
• Maryland’s PDMP is now Mandatory
• Peer Recovery Specialists
• Drug Treatment Court
More Good Things
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Questions?
Structure BookmarksFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigureFigure