By New Jersey Investigative Commission.
Executive Summary.
Stopping regularly in downtown Newark, the nondescript minivans drew a select clientele: homeless Medicaid recipients and drug addicts who had been told by flyers and wordof-mouth where to wait for a ride. Ten miles and 15 minutes later, they arrived at a strip mall “medical center” on Main Avenue in neighboring Passaic where a doctor licensed by the State of New Jersey quickly got down to the business of cursory examinations and bogus diagnoses.
Then he wrote prescriptions for powerful painkillers, sedatives and cough syrup, which his“patients” could use themselves or sell on the street, their choice. They also left with $10 cash gift cards as thanks for coming in. The bill for it all went to government health insurance, which funneled a fortune in fraudulent Medicaid reimbursements into the bank accounts of the hidden entrepreneurs the doctor fronted for – associates of Russian organized crime.
The flagrant and unbridled operation of this pill mill and others like it, the descent of sworn medical professionals into outright drug dealers, the intrusion of organized crime and other criminal elements into lucrative recesses of the health-care industry to feed an epidemic of demand for drugs: These are among the key findings of the State Commission of Investigation’s ongoing probe of illegal trafficking in and abuse of prescription painkillers and other addictive narcotics.
Even as law enforcement authorities, public-health officials, social workers, treatment counselors, schools and families redouble their efforts to combat the purveyors and consequences of this predatory scourge, it continues to evolve in ways that few could have imagined when the so-called war on drugs was launched more than four decades ago.
Staggering amounts of legitimate medicines manufactured by major pharmaceutical companies and intended for those needing relief from the pain of disease and injury have been diverted into criminal enterprises founded on drug abuse and addiction. What once was a menacing background narrative centered narrowly around subculture-based substances like opium, morphine and heroin has exploded into a mainstream horror story whose first chapter often begins with pill bottles in the average household medicine cabinet.
Some medical management companies with names that incorporate benign terms like “pain management” and “wellness” have transformed street-corner drug-dealing into an orderly and seemingly ordinary business endeavor, except for the hidden financial backing from individuals linked to organized crime, the multiple bank accounts for money-laundering, the expert help of corrupt physicians and the shady characters who recruit and deliver customers and provide security.Meanwhile, conventional drug dealers – those tied to criminal street gangs and similar criminal enterprises – exploit legitimate businesses like used car dealerships, clothing outlets, barber shops, bars and liquor stores to cover their illicit retail commerce.
They take advantage of advanced computers, communications and social networking technologies to facilitate criminal activities and thwart law enforcement. And they are finding new ways to profit from a market hungry for addictive drugs stretching well beyond New Jersey’s cities and into the outlying affluence of its suburbs and rural communities.
On the demand side, witnesses told the Commission during an unprecedented public hearing that, given the shared properties of pain-numbing, high-inducing substances known asopiates and opioids, the widening abuse of prescription pills containing Oxycodone and related chemical ingredients has triggered a new and sustained rise in use of the original opiate of choice – heroin.
Indeed, with high-quality heroin readily available on New Jersey streets today at roughly the same price as a pack of cigarettes – cheaper than painkilling pills of similar strength and effect – it should be no great surprise that the road to addiction has evolved full circle. And all too often ensnared in this harrowing, potentially lethal cycle – in many instances before they, or their families, even know it or suspect it – are adolescents, teenagers and twenty-somethings, young people on their way to becoming a new lost generation of what used to be called junkies.
Also, much of what used to take place “underground” in the drug milieu is now happening in plain sight. With the advent of instantaneous communication technology and suburban demand, a handful of pills or a bag of heroin is only a text message or cell-phone call away as many dealers now deliver product to customers waiting in shopping-mall parking lots. Former suburban high school students told the Commission that the depth of their prescription pill and heroin dependency played out in full view of teachers and other adults who they said did not seem to have a clue or even care when they nodded off and fell asleep in class, day
after day.
During a three-week surveillance operation at several major intersections in downtown Trenton, Commission investigators observed a bustling open-air drug market daily during morning rush hour within blocks of New Jersey’s Statehouse. Law enforcement authorities are quite familiar with the spiking collateral damage from this disturbing trend: the thefts and violence, the burglaries, armed robberies, pharmacy holdups and worse. Elsewhere on the frontlines, drug treatment facilities are seeing record numbers of admissions for heroin and other opiate/opioid addictions.
The Commission undertook this inquiry pursuant to inquiry pursuant to its unique statutory responsibilities to examine public corruption and abuse, to ascertain whether adequate laws and regulations are being faithfully executed and effectively enforced and to inform the Governor, the Legislature, the Attorney General and the public at-large of the activities of organized crime in all of its facets.
The public-awareness component is particularly vital in the context of this investigation because of the nexus between the criminal underworld and matters that bear directly upon the health, safety and welfare of every man, woman and child in New Jersey. Government agencies already have taken the initiative to boost public education as an integral part of the effort to curtail pain pill diversion. The New Jersey Division of Consumer Affairs (DCA) employs a range of strategies to inform the public about proper use and handling of pain medications.
The State’s “Project Medicine Drop” enables consumers to dispose of unused or expired medications anonymously at secure drop-off boxes located at numerous local police departments. Moreover, the perils of non-medical use of pain medication were brought to light in a recent public service campaign, “The Right Prescription for New Jersey,” in which the SCI, along with the U.S. Drug Enforcement Agency (DEA), the Partnership for a DrugFree New Jersey and other entities, produced multi-media advertisements, including a radio message from a New Jersey woman who lost her son to a prescription-pill overdose.
More significantly, from an operational standpoint, DCA administers New Jersey’s year old Prescription Monitoring Program (PMP), part of a nationwide effort to track and control the volume of prescription-dispensed drugs subject to abuse, including controlled dangerous substances and human growth hormone. DCA’s statewide PMP database gathers information from pharmacies about the prescriptions they fill, prescribing physicians, patients and the names, strengths and quantities of the medication dispensed.
Pharmacies that fail to report are subject to fines and other disciplinary action by the New Jersey Board of Pharmacy. DCA administrators, licensed practitioners and law enforcement authorities are permitted to access the database under limited circumstances. Still, the findings of this investigation demonstrate that the challenges posed by drug abuse have taken on disturbing dimensions that call into question the conventional wisdom regarding gateway drugs and addiction, as well as the adequacy of current oversight and enforcement strategies.
We now live in a state where abuse of prescription pills serves increasingly as a primary route to the unlawful world of heroin, an intersection of the legitimate and the illicit that constitutes a crisis whose devastating consequences are plain for all to see. To address this crisis, the public discussion about establishing a sensible drug policy needs to be broadened and amplified. While considerable debate has attended such matters as legalizing marijuana for medical purposes,the ease of access to other drugs that already are legal – drugs that are highly addictive, potentially lethal and very much like heroin – raises far more complex
and troubling issues.
Thus, building upon actions already taken by and beyond the realm of government, the Commission offers a comprehensive set of statutory and regulatory reforms. Those responsible for policing physicians, pharmacists and others in the medical community should re-examine and strengthen oversight and disciplinary mechanisms to ensure appropriate professional standards and accountability.
Individuals and entities that operate businesses associated with or profiting from medical practices should be subject to more intense scrutiny to identify intrusion by elements of organized crime. The Prescription Monitoring Program should be strengthened, and law enforcement should have greater access to data and information collected through it in order to target illicit prescribers more effectively.
Tougher criminal penalties should be imposed for possession with intent to distribute heroin, and certain essential tools of the drug trade, including throwaway cell phones and hidden storage compartments in motor vehicles, should be more closely regulated. In sum, these and other measures set forth in greater detail at the conclusion of this report would establish potent disincentives against illicit pill diversion and heroin trafficking, while simultaneously providing regulators and law enforcement authorities with better weaponry and information to root out violators.
To continue reading this document: http://www.nj.gov/sci/pdf/PillsReport.pdf
