Understanding Your Local Problem

The information provided above is only a generalized description of prescription drug fraud and misuse. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.

Stakeholders

The following groups have an interest in the prescription drug fraud and misuse problem and ought to be considered for the contribution they might make to gathering information about the problem and responding to it:

• Law enforcement agencies are an excellent source of data on the problem of prescription fraud and misuse, and at the national level, the Drug Enforcement Administration (DEA)'s Office of Diversion Control serves as a central source for national policy guidance, support, and the collection and sharing of intelligence information regarding pharmaceutical diversion issues.
• Healthcare providers can offer information on prescription drug trends they are experiencing and provide insight into training and current and future policies in the medical field.
• Pharmacists may have a wealth of insight - that has not been reported to police - regarding offenders, methods of operation, and prescription drug trends.
• Parents and educators may have experience in dealing with youth who are abusing drugs but have not yet come to police attention. Educators could also assist in conducting surveys in the schools to measure the extent of the problem.

In addition to the above, other key stakeholders are pharmaceutical companies and a variety of state and federal government agencies, such as pharmaceutical and medical licensing boards, public health agencies, the Environmental Protection Agency (for the safe disposal of unwanted or expired prescription drugs), and the U.S. Food and Drug Administration (FDA), which controls drug scheduling.

Asking the Right Questions

The following are some critical questions you should ask in analyzing your particular problem of prescription fraud and misuse, even if the answers are not always readily available. Your answers to these and other questions will help you choose the most appropriate set of responses later on.

Incidents

• How many police calls for service and cases involve some aspect of prescription fraud and/or misuse?
• What is the precise nature of these cases and calls for service? (Determining this might require some careful analysis of police reports, as the precise involvement of prescription drugs may be revealed only in the report narrative of a wide range of call and case types.)
• What is the cost to the community - in both monetary and nonmonetary terms - to respond to the problem of prescription fraud and misuse?

Victims

• Whom does prescription fraud directly victimize? Pharmacists (who are duped into dispensing drugs not legitimately prescribed)? Doctors (who unknowingly prescribe to doctor shoppers, whose prescription pads are stolen, or whose names are used for prescription call-ins or forgeries)? Insurance companies and Medicaid (who sometimes pay for fraudulent prescriptions)?
• Whom does prescription fraud and misuse indirectly affect (those who commit the fraud and are addicted and their loved ones)?

Offenders

• What are the offenders' characteristics (e.g., age, gender, profession)?
• Where do they live, go to school, or work? How do those locations correspond to fraud locations (e.g., are some pharmacies or doctor's offices more likely targets than others)?
• What is the pattern of offending? Is the fraud intermittent or regular? Is there a regular time span between fraudulent acts (e.g., based on how long it takes to exhaust a supply of drugs)?
• What are the offenders' motives? Are they addicted to prescription drugs? Are they selling the drugs on the black market? Both? (You can interview offenders to collect this information.ψ Undercover investigations, buys, and surveillance can reveal more about their practices.)
• Do offenders act alone or as part of a group?
• What are their preferred tactics?

ψ See Problem-Solving Tools Guide No. 3, Using Offender Interviews to Inform Police Problem Solving, for further information.

Locations/Times

• Where do prescription fraud and misuse occur? To detect patterns, you should conduct location analyses based on the tactic used (e.g., doctor shopping patterns will spatially differ from prescription call-in patterns). Location analyses can also help you determine which targets are most vulnerable. For example, fraud in specific areas may indicate where offenders live or work.
• In which specific locations do fraud and misuse offenses most commonly occur? Are certain doctors or pharmacies less likely to detect and report fraud? Are certain types of pharmacies (e.g., independent stores versus chain stores) more susceptible to fraud?
• What specific types of prescription drugs are diverted in your community or region? (The prescription fraud problem and types of drugs diverted can vary greatly from region to region.)
• When does prescription fraud occur (i.e., when do offenders try to have prescriptions filled)? What time of day? What day of the week? As with location analyses, temporal analyses should be tactic specific. Those who phone in prescriptions, for example, are more likely to do so during doctors' off hours, when pharmacies cannot verify the prescriptions.
• Do you have ongoing prescription drug "take-back" programs in your jurisdiction? If so, how do the locations where those programs operate geographically relate to your higher fraud locations or offender locations?

Current Responses

• Does your agency have policies and procedures specific to taking prescription fraud reports? If so, do you capture and analyze the data generated in those reports?
• Does your agency participate in local, state, or federal prescription drug "take-back" efforts?
• Does your agency work with healthcare professionals, the schools, or community organizations on prescription drug misuse and fraud prevention and education?
• What are the state and local laws relating to prescription fraud monitoring and enforcement?
• Does your state have an automated prescription drug monitoring system?

Capturing and Analyzing Data

Prescription fraud poses a unique challenge to local police because it is not typically captured in computer-aided dispatch or records management systems. Departments that have succeeded in measuring and analyzing prescription fraud in their jurisdictions have done so by creating a separate database for prescription fraud and other pharmaceutical diversion incidents. When considering creating a database, you should examine the questions above, and decide how to track each incident to best answer the most questions. In addition, there are several national data-collection efforts that provide state- and regional-level information on trends and patterns in substance abuse, including misuse of prescription drugs.

National Data Sources with State, Regional, and/or Local Data

Sponsored by the National Institute on Drug Abuse, the Community Epidemiology Working Group is a consortium of more than 20 researchers from major metropolitan areas who meet annually to report on local drug abuse patterns and trends. Local police agencies can consult the group's website. The site directs users to annual meeting reports and other publications on local trends in drug abuse and diversion.
The Arrestee Drug Abuse Monitoring(ADAM) program collects data through drug tests and self-reported drug use of adult male arrestees in 10 major metropolitan areas. ADAM data are particularly useful to local police in identifying shifts in regional trends in prescription drug abuse. Annual reports of ADAM data can be found on the White House Office of National Drug Control Policy's website. In addition, some other metropolitan areas (e.g., San Diego County through the San Diego Association of Governments) are collecting their own ADAM-type data.
The Treatment Episode Data Set, supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), reports admissions to hospitals by state and primary abused substance, enabling local police to identify statewide trends over time. The data set's website has a search engine enabling users to select data by year and state.
The Drug Abuse Warning Network (DAWN) reports deaths related to drug abuse by drug type and by state. These data are also available at the local level from several major metropolitan areas.
The Monitoring the Future Survey and the National Survey on Drug Use and Health are both excellent sources for examining trends in youth and U.S. population substance use respectively.

State Data Sources

Most states (39 to date) have implemented prescription drug monitoring programs (referred to as PMP or PDMP). These programs are designed to aid in detecting prescription-drug diversion while also preventing it by increasing the risk of identifying and apprehending offenders. PMPs document all retail sales of certain prescription drugs. Police can analyze this data to identify unusual sales volumes by retailer, healthcare provider, and drug type. You may contact your state data collection entities to gain access to the data, which can illustrate the types of prescription drugs that are dispensed, the degree to which certain medical prescribers appear to be overprescribing, and other statewide patterns of potential misuse and diversion.α

α More information on prescription monitoring programs can be found on the Bureau of Justice Assistance website.

Local Data Collection

The above sources are limited to data at the state or metropolitan area level, but they may not tell the local story. Police agencies that have tackled the problem of prescription fraud and misuse typically create their own data collection tools in order to capture the true local context and underlying causes of the problem. The Reno (Nevada) Police Department, for example, conducted surveys of area pharmacists and doctors and also reviewed and revised the way the department coded reported incidents of prescription fraud and misuse to enable the agency to isolate those cases from other drug-related crimes.61

Measuring Your Effectiveness

Measurement allows you to determine to what degree your efforts have succeeded, and suggests how you might modify your responses if they are not producing the intended results.
You should take measures of your problem before you implement responses, to determine how serious the problem is, and after you implement them, to determine whether they have been effective. All measures should be taken in both the target area and the surrounding area. For more detailed guidance on measuring effectiveness, see Problem-Solving Tools Guide No. 1, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers and Problem-Solving Tools Guide No. 10, Analyzing Crime Displacement and Diffusion.
The following are potentially useful measures of the effectiveness of responses to prescription fraud and misuse. Process measures show the extent to which responses were properly implemented. Outcome measures show the extent to which the responses reduced the level or severity of the problem.

Process Measures

• Changes in arrest patterns for drug possession and sales in your and neighboring jurisdictions
• Changes in types of prescription fraud and misuse (e.g., if you curtail phone-ins, offenders might change tactics)
• Changes in locations of prescription fraud and misuse
• Changes in types of drugs obtained through prescription fraud and misuse
• Changes in the number of prescriptions filled for certain target drugs, such as oxycodone

Outcome Measures

• Reduced number of reported prescription fraud and misuse cases
• Reduced number of police calls for service related to illicit prescription drugs
• Reduced number of motor-vehicle crashes in which prescription drug intoxication was a contributing factor
• Reduced number of overdoses from prescription drugs
• Reduced number of people seeking treatment for prescription drug addiction
• Reduced availability of illicitly obtained prescription drugs
• Increased price of illicit prescription drugs (an indication the drug is harder to obtain or riskier to sell and buy)

It is important to remember that some of these measures may be misleading, depending on the types of responses your department applies to the problem. For example, if you launch a public education campaign for pharmacists and doctors, you may find that the incidence of prescription fraud - as measured by crimes reported and calls for police service - increases, which is desirable in the short term, but which should subsequently decline as prevention measures take effect.