Synthetic Drugs Action Plan National

NATIONAL SYNTHETICDRUGS ACTIONPLAN
TheFederalGovernmentResponsetothe Production,Trafficking,andAbuseofSynthetic DrugsandDivertedPharmaceuticalProducts
NATIONAL
SYNTHETICDRUGS
ACTIONPLAN
TheFederalGovernmentResponsetothe Production,Trafficking,andAbuseofSynthetic DrugsandDivertedPharmaceuticalProducts
EXECUTIVE OFFICE OF THE PRESIDENT

OFFICE OF NA TIONAL DRUG CONTROL POLICY
Washington, D. C.20503
October2004 TheUnitedStatesfacesanarrayofdrugsofabuse. Many,suchascocaine,heroin,and marijuanahaveconfrontedusfordecades. Wehavedevelopedprogramsandinitiatives tocombatthesedrugstopreventuse,treattheaddicted,anddisruptproductionand themarketplacefordrugs. Thesignificantthreattothenationposedbysyntheticdrugs, especiallymethamphetamineandMDMA,orEcstasy,isamorerecentphenomenon. Initialeffortstoconfrontsyntheticdrugsarealreadyshowingresults.Asdemonstrated bythefindingsofthemostrecentNationalSurveyonDrugUseandHealth(formerly knownastheNationalHouseholdSurveyonDrugAbuse)andthe2003Monitoringthe Futurestudy,whenwecollectivelypushback,thesyntheticdrugsthreatalsowilldecline. A relatedthreatisthegrowthinnonmedicaluseofpharmaceuticalcontrolledsubstances. DiversionoftheselegitimatedrugsisfueledinpartbyeasyaccessovertheInternet. The mostrecentNSDUHandotherdataindicatethatwecontinuetoconfrontincreaseduseof suchdrugs,notablypainrelieversandtranquilizers. Thisdocumentrecommendssome newapproachestoaddressthischallenge. ThisActionPlanisdesignedbothtoconveytheseriousnessofthechallengesposedby syntheticdrugsanddivertedpharmaceuticalsandtooutlinespecificstepsthefederal governmentwilltakeinthefuturetocapitalizeonrecentsuccessesandaccelerateour nationaleffortsagainsttheseharmfulsubstances.Throughtherecommendationsinthis ActionPlanandwiththeactiveengagementofourpartnersinstateandlocalgovern ment,weintendtomoveaggressivelyinthecomingyears. Tofacilitatefollowup,this ActionPlancreatesahighlevelinteragencyworkinggrouptoensurethattheserecom mendationsareimplementedaseffectivelyandrapidlyaspossible. ThisdocumentisaproductofthehardworkoftheDepartmentofJusticeCriminal DivisionsNarcoticandDangerousDrugSection,incooperationwiththeDrug EnforcementAdministrationandseveralotheragencies,andinconsultationwithvarious componentsoftheDepartmentofHealthandHumanServices. Wearegratefulfortheir efforts.TheActionPlanrepresentsanimportantstepforwardinournationseffortto controldangeroussyntheticdrugsandpharmaceuticalproductsand,moreover,inthe continuedachievementoftheobjectivessetforthinthePresidentsNationalDrug ControlStrategy.
JohnP.Walters Director OfficeofNationalDrugControlPolicy
JohnAshcroft AttorneyGeneral
TableofContents
I.Overview A.Introduction.........................................................................................................................................................1 B.PlanforImplementationofRecommendations...............................................................................................2 C.ListofRecommendations ..................................................................................................................................3 1.Prevention .....................................................................................................................................................3 2.Treatment ......................................................................................................................................................4 3.RegulationofChemicalsandDrugs............................................................................................................4 4.LawEnforcement..........................................................................................................................................6 II.NatureoftheProblem ...............................................................................................................................................11 A.ConsumptionTrends ........................................................................................................................................11 1.Methamphetamine .....................................................................................................................................11 2.MDMA/Ecstasy ...........................................................................................................................................14 3.OtherClubDrugs........................................................................................................................................16 4.OtherSyntheticDrugsandDivertedPharmaceuticals ...........................................................................17 B.TraffickingTrends ..............................................................................................................................................19 1.Methamphetamine .....................................................................................................................................19 2.MDMA/Ecstasy ...........................................................................................................................................23 3.OtherClubDrugs........................................................................................................................................24 4.OtherSyntheticDrugsandDivertedPharmaceuticals ...........................................................................25 III.ResponsetotheProblem .........................................................................................................................................27 A.Prevention..........................................................................................................................................................27
1.CurrentEfforts.............................................................................................................................................27 2.Recommendations......................................................................................................................................29 B.Treatment ...........................................................................................................................................................30 1.CurrentEfforts.............................................................................................................................................30 2.Recommendations......................................................................................................................................31 C.RegulationofChemicalsandDrugs................................................................................................................31 1.CurrentEfforts.............................................................................................................................................31 a.Introduction .........................................................................................................................................31
b.U.S.ChemicalControls .......................................................................................................................33
c.TheInternationalChallenge ...............................................................................................................35 d.ChemicalControlResults....................................................................................................................37
e.ControlofOxyContinandOtherDivertedPharmaceuticalProducts.............................................38 2.Recommendations......................................................................................................................................39 D.LawEnforcement ..............................................................................................................................................41 1.CurrentEfforts.............................................................................................................................................41 a.Methamphetamine:PlanningandCoordination..............................................................................41 b.MDMA:PlanningandCoordination ..................................................................................................42 c.Training .................................................................................................................................................43 d.Seizures,Investigations,andProsecutions .......................................................................................43 2.Recommendations......................................................................................................................................44 Appendices A.OutlineofanEarlyWarningandResponseSystemforEmergingDrugsofAbuse .....................................49
B.OverviewoftheNewDrugAbuseWarningNetwork(DAWN)SystemDesign&Implementation............53 C.DEAActionPlantoPreventtheDiversionandAbuseofOxyContin ...........................................................55 D.SchedulesandRegulatoryControlsApplicabletotheSubjectControlledSubstances .............................59 E.Sentencing .........................................................................................................................................................63 F.ExamplesofNotableStateLawswithRespecttoPrecursorChemicalControl ...........................................67
NATIONAL SYNTHETIC DRUGS ACTION PLAN
I.Overview
A. Introduction
Theillicitproductionofsyntheticdrugsishardlyanewprobleminthiscountry.Foryears, communityleadersandlawenforcementofficialshaveunderstoodthethreatandexpressedcon cernforthefuturebasedonthepotentialdangersofthesedrugs. Thatuncertainfutureisnowadisturbingreality.Inthepastfiveyears,theuseofsynthetic drugshasclimbeddramatically,afactthatlendsurgencytotheefforttocontrolthem.Recent drugconsumptionstudiesindicatethatsubstantialnumbersofAmericansareusingtheseharm fulsubstances.WhiletheuseofMDMAhasfallenoffsignificantlyamongyoungpeopleinthelast twoyears,itsuseremainsatunacceptablelevels.Thegradualexpansionintheuseofmetham phetaminemaybecontinuingaswell.Thesetwodrugsposethemostsignificantsyntheticdrug threatstothenation. TheexpansioninthedemandforthesedrugsisnotlimitedtotheUnitedStates.Severalcoun triesinEuropeandAsiaaresimilarlychallengedbythespreadofthesyntheticdrugtrade. Encouragedandemboldenedbythegrowingglobaldemandforthesedrugs,traffickersare exploitingeveryavailableopportunitytoproduce,export,andmarketawidevarietyofsynthetic drugs.Alargevolumeofprecursorchemicalsandsyntheticdrugsproducedoverseasisnow smuggledintotheUnitedStatestosupportdomesticproductionanddistributionaswell. ThepurposeofthisdocumentistoprovideablueprintforactionunderthePresidents NationalDrugControlStrategythatbringstogetherthevariousstrandsofdomesticandinterna tionaleffortsintoacoherentplanforattackinganddisruptingthetradeinthesedangerousdrugs. ThisActionPlanfocusesonillicitlymanufacturedsyntheticdrugs,includingmethamphetamine, amphetamine,MDMA,GHB,PCP,andLSD,whicharenotofprimarilyorganicorigin.Italsodis cussesselectedpharmaceuticalproductswhicharesometimesdivertedfromlegitimatecom merce,suchasketamineandoxycodone(particularlyintheformofOxyContin),andtheillegally importeddepressantflunitrazepam(tradenameRohypnol).Regardlessofthevenuesinwhich theyareused,theproblemsposedbylicitlyproducedpharmaceuticalproductsaredistinctfrom thosepertainingtoclandestinelyproduceddrugs,andtheapproachestopreventtheirillegaltraf fickinglikewisevary. Methamphetamineisthemostwidelyusedandclandestinelyproducedsyntheticdruginthe UnitedStatesand,thus,receivesthemostattentioninthisActionPlan.Althoughmethampheta mineismanufacturedlicitlyformedicalpurposes,thevastmajorityofillegallytrafficked methamphetamineisproducedillegallyinlaboratoriesbothhereandabroad.Therelatedsyn theticstimulantamphetamineistypicallytraffickedinterchangeablywithmethamphetamineand producedclandestinelybyasimilarprocess,andithasasimilareffectonusers. Whileallofthedrugsdiscussedinthispaperaresignificantdrugsofabuse,someofthesesub stancesnamelyMDMA(Ecstasy),GHB,Rohypnol,andketaminearedistinguishedasclub drugsbecausetheyarecommonlyencounteredatnightclubsandlatenightdancepartiescalled 1 ravesorcircuitparties. MDMA(3,4methylenedioxymethamphetamine)isastimulantwith
hallucinogenicpropertiesthathassurgedinuseinrecentyears.Gammahydroxybutyricacid(GHB) andRohypnolaredepressantswhichareoftenusedtoincapacitatevictimsinsexualassaults;the 2 instancesofGHBuseareincreasing,whiletraffickinginRohypnolappearstobedecreasing. Ketamineisadissociativeanestheticwhichhasalsobecomepopularamongraveandcircuitparty attendees.Furthermore,thereisavirtualalphabetsoupofdesignerdrugsthatarenotfrequently encounteredbylawenforcement,butwhichmayproliferateatravesandotheryouthorientedset tingsatanytime. Additionally,theuseofsyntheticopiates,especiallyoxycodone,isgrowing,andthedissociative anestheticphencyclidine(PCP)isstillbeingused.Thehallucinogenlysergicaciddiethylamide(LSD) hasseenmajordeclinesinyouthusetothelowestlevelssincesurveysbeganin1975.Noneofthese drugs,however,iscommonlyassociatedwithravesandcircuitparties. Syntheticdrugsnotonlyharmthebodiesandmindsofthosewhousethem,theyalsothreaten humanhealththroughthedamagetheyinflictontheenvironment.Forexample,theprocessofmak ingmethamphetaminerequirestheuseofhazardouschemicals,manyofthemflammable,corrosive, orexplosive.Moreover,methamphetamineismadeprimarilybyunscrupulouschemists,oftenoper atinginmakeshiftlabs,withlittleregardforpublicsafetyorenvironmentalhealth. Methamphetaminelabsproducetoxicbyproductsthatcommonlyendupinfields,publicparks,and 3 waterways.Someofthesechemicalscancausedisfigurement,illness,orevendeathoncontact. AsdiscussedintheNationalDrugControlStrategy,syntheticdrugsbytheirverynaturepresent specialchallengestotheagenciesandorganizationsworkingtostopthem.Becausethedrugsare madeinlaboratoriesandnotharvestedfromfields,therearenocropstoeradicateasinthecasesof marijuana,heroin,andcocaine.Instead,supplyreductioneffortsmustfocusonlimitingaccessto precursorchemicals,shuttingdownillegallabs,andbreakinguporganizedcriminalgroupsthatman ufactureanddistributethedrugs.Weneedtostrengtheninternationalanddomesticlawenforce mentmechanisms,emphasizinginformal,flexible,andrapidcommunicationsattheoperational level.Likethetraffickerswhofuelthemarket,wemustourselvesbecomemorenimble,developing policiesandmethodsthatallowustoadaptquicklyandseizeeveryopportunitytodisruptthetrade. ThisActionPlanbeginswithageneraloutlineofdemandandtraffickingtrendswithrespecttothe drugshighlightedabove.Next,itdiscussesthestatusofprevention,treatment,regulatoryandlaw enforcementefforts,andprovidesrecommendationsforfutureactionsineachoftheseareas.The ActionPlanalsoincludessixappendices.AppendixAisaproposedoutlineforanearlywarningand responsesystemtoidentifyandaddresstheimpactofemergingdrugsofabuse.AppendixBprovides anoverviewofthenewDrugAbuseWarningNetwork(DAWN)systemdesignandimplementation plans.AppendixCisaDrugEnforcementAdministration(DEA)ActionPlantoPreventtheDiversion andAbuseofOxyContin.AppendixDoutlinestheschedulesandregulatorymeasuresthatapplyto thesubjectcontrolledsubstancesandtheirchemicalprecursors.AppendixEsummarizestheappli cablesentencingguidelines.AppendixFsummarizesprecursorchemicalcontrollawsinMissouri andOklahoma.
B. PlanforImplementationofRecommendations
OverarchingresponsibilityforimplementingtherecommendationsinthisActionPlanwillreside inanewSyntheticDrugsInteragencyWorkingGroup(SDIWG),tobecochairedbytheOfficeof NationalDrugControlPolicyandtheDepartmentofJustice.TheSDIWGcan,atthediscretionof
thecochairs,referrecommendationstootherpreexistinggovernmentworkinggroups.TheSDIWG willmeetwithin30daysofthepublicationofthisreport,andthereafteronanasneededbasis.The groupwillsubmitawrittenimplementationupdatetotheDirectoroftheOfficeofNationalDrug ControlPolicyandtheAttorneyGeneralsixmonthsafterpublicationofthisActionPlan.
C. ListofRecommendations
1.Prevention
DevelopanEarlyWarningandResponseSystem ( NDIC,DOJ,HHS,ONDCP )
Establishacomprehensive,interagency,earlywarningandresponsesystemtodetecttheemergence
ofnewdrugsandtrends.AppendixAlaysoutthepossibleparametersofsuchasystemindetail,but
itshouldincludeincreasedresearcheffortstodevelopanddisseminateaccurate,reliable,andcost
effectivetestsforidentifyingnewsyntheticdrugusetrends.Particularfocusshouldbegiventoearli
eridentificationandroutinedetectionoflicitlyproduceddrugswithhighillicitusepotential.
EnhancePublicOutreachEffortsFocusingonSyntheticDrugs ( SAMSHA,DOJ,ONDCP )
Developamultimediaeducationcampaignontheconsumptionofsyntheticdrugs,focusinginitially
onmethamphetamine.Theprogramshould,asappropriate,incorporatemessagesabouttheenvi
ronmentalthreatandriskstochildrenfromclandestinelabs.Ensureadequatedisseminationofall
pertinentmaterialsandinformationonsyntheticdrugsthroughtheDepartmentofEducationsOffice
ofSafeandDrugFreeSchools.
ImproveEducationandTrainingonPharmaceuticals ( DEA,FDA,SAMHSA,ONDCP )
Ensureproductlabelingthatclearlyarticulatesconditionsforthesafeandeffectiveuseofcontrolled
substances,includingfulldisclosureofsafetyissuesassociatedwithpharmaceuticals.Developa
mechanismforthewiderdisseminationandcompletionofapprovedContinuingMedicalEducation
coursesforphysicianswhoprescribecontrolledsubstances.DevelopInternetpublicservice
announcementsregardingthepotentialdangersandillegalityofonlinedirectpurchaseofcontrolled
substances.
DevelopBestPracticestoAssistDrugEndangeredChildren (HHS,EPA,DOJ,DEA,ONDCP)
Developprotocolsforassistingdrugendangeredchildrenthatgenerallyaddressstafftraining;roles
andresponsibilitiesofinterveningagencies;appropriatereporting,crossreporting,informationshar
ing,andconfidentiality;safetyproceduresforchildren,families,andrespondingpersonnel;inter
viewingprocedures;evidencecollectionandpreservationprocedures;medicalcareprocedures;and
communityresourcedevelopment.
ResearchandDevelopTargetedPreventionPrograms ( NIDA,ONDCP )
Supportresearchontheinitiationofmethamphetamineuseandtheprogressionofuseleadingto
addiction. Programsshouldbedevelopedtotargethighriskgroupsorcommunitiesandtoincrease
communityinvolvementinpreventionefforts.
ImproveDataonAfflictedGeographicAreas ( NDIC,SAMHSA,DOJ,ONDCP )
BuildonexistingGeographicalInformationSystem(GIS)resourcesanddatabasestointegratefeder
allymandateddrugtestresults,crimelaboratoryevidenceanalysis,populationdemographics,and
othermeaningfuldatapertainingtosyntheticdrugsanddivertedpharmaceuticalsinamannerthat
supportsgeographicallybasedpreventionandinterventionefforts.
ExaminetheUseofPrescriptionNarcotics( NIDA,SAMHSA,FDA,NIJ,DEA )
Assessthescopeandmagnitudeofthelicitandillicituseofprescriptionnarcoticanalgesics,inpar
ticularOxyContin,includingthepursuitofadditionaldatasourcesincooperationwiththeFoodand
DrugAdministration(FDA),theNationalInstituteforJustice(NIJ),privateentities,andothers.
2.Treatment
IncreaseTreatmentCapacity( HHS )
Assesstreatmentneedsforsyntheticanddivertedpharmaceuticaldrugaddictionand,ifnecessary,
expandthatcapacityinthecommunityandincorrectionalfacilities.Particularemphasisshouldbe
giventothedevelopmentofadditionaltreatmentcapacityformethamphetamineusers,toinclude
followupservicesthataddresstheprotractedrecoveryperiodassociatedwithmethamphetamine
dependency.
ResearchTreatmentforSyntheticDrugAbuse( HHS,NIDA,SAMHSA,ONDCP)
Increaseresearchonthephysicalandpsychologicaleffectsofmethamphetamineandothersynthet
icdrugs,aswellasonthedevelopmentofeffectivetreatmentprotocolsforsyntheticdrugs.
DevelopGuidelinesforJuvenileDrugTreatment( NIDA,SAMHSA )
Fundresearchonandpursuethedevelopmentofguidelineswithrespecttothetreatmentofjuve
niles,whooftenarenotadequatelyservedinexistingdrugtreatmentprogramsdesignedforadults.
DevelopEarlyResponseTreatmentProtocols( NIDA,SAMHSA )
Developanddisseminateearlyresponseprotocolsaddressingrequestsfortreatmentofdependency
onemergingsyntheticdrugsanddivertedpharmaceuticals.
StudyOptionsforCriminalJusticeSystemTreatment( NIDA,SAMHSA,NIJ )
Investinadditionalstudiesontheefficacyofvariouscomprehensivetreatmentprogramsforsyn
theticdrugabuseandontheiradaptabilitytodiverseindividualandcommunityneeds,especially
thoseuniquetothecriminaljusticesystem.
ExpandDisseminationofTreatmentBestPractices( NIDA,SAMHSA,ONDCP,DEA )
Expandcapabilitiestodisseminatepertinentresearchresultsandbestpracticestrainingtechniques
aspartoftheoverallefforttoincreaseaccesstoeffectivetreatmentsfordependenciesonsynthetic
anddivertedpharmaceuticaldrugs.
3.RegulationofChemicalsandDrugs
SupportStrongerStateControlsonPrecursorChemicals( DOJ, ONDCP,DEA )
Statesthatfacesignificantlevelsofclandestinelabactivityandchemicaldiversionareurgedtocon
sidertheimpositionofmorestringentcontrolsthanthosecurrentlyinplaceatthefederallevel.
Severalstates,notablyOklahoma,haverecentlyenactedstrictretaillevelcontrols.(SeeAppendix
F). Additionalstatelevelcontrolscouldinclude,forexample:allowingonlylicensedpharmacists
andpharmacytechnicianstosellproductscontainingprecursorchemicals;placingsuchproducts
behindthesalescounterand/orinalockeddisplaycase;purchaselimitsimposedonatransaction
and/ormonthlybasis(withanappropriatetrackingmechanism);andrequirementsofcustomeriden
tificationsalesrecordkeeping.
RemovetheBlisterPackExemption( DEA,DOJ )
Supportlegislationthatremovestheblisterpackexemptionandeliminatesdistinctionsbasedonthe
formofpackaging,asrecommendedinDEAsNovember2001reporttoCongress.
RegulateChemicalSpotMarket( DEA, DOJ )
Asanextensionofexistingauthorityoverimports,lawenforcementshouldseekthelegislativeauthor
itytoregulatesalesofbulkchemicalsonthedomesticspotmarketbynotificationandapprovalofany
deviationsinquantityorcustomerfromtheimportdeclaration.
DetermineLicitChemicalNeeds( DEA,DOJ,ONDCP )
Incooperationwithindustry,commissionastatisticalanalysistoestimatethelegitimateneedsfor
pseudoephedrineandephedrineproductsincludingcombinationproductssuchasephedrinewith
guaifenesinbothnationwideandregionally.
EnableImportControlsonBulkEphedrineandPseudoephedrine( DEA,DOJ,ONDCP )
Seeklegislationthatwouldtreatthepostimportationhandlingofbulkephedrineandbulkpseu
doephedrineinasimilarmanner,forregulatorypurposes,asfederallawsnowtreatthepostimporta
tionprocessingofScheduleIandIIcontrolledsubstances.Imposesuchcontrolsonthesecritical
precursorsasareneededtolimitimportstothosenecessaryforlegitimatecommercialneedsandfor
maintenanceofeffectivecontroloverchemicaldiversion.
LimitOnlineChemicalSales( DEA,DOJ )
Continueongoingeffortstoadvisetheownersandoperatorsofmajoronlineauctionwebsitesofthe
useofprecursorchemicalsinclandestinelabs,andurgethemtoconsiderbanningthesaleofprecur
sorchemicalsovertheirwebsites.
StrengthenCooperationwithMexico( DEA,DOJ,State,ONDCP )
SolidifysignificantrecentadvancementsbyMexicotoincreasetheeffectivenessofbilateralchemical
controlwiththeUnitedStatesthroughcontinuedpartnershipandmeetingswiththepertinent
Mexicancomponents,includingtheirdrugintelligencecenter(CENAPI),theFederalInvestigative
Agency(AFI),thechemicalregulatoryentityintheMinistryofHealth(COFEPRIS),andtheHealth
Commission.
EnhanceCoordinationandInformationExchangewithCanada( DHS,ICE,CPB,DEA )
EnhanceongoingcoordinationwithCanadaCustomsandRevenueAgencyonborderdetection,tar
geting,andinterdictionefforts,andensureappropriatefocusbyCanadaU.S.jointIntegratedBorder
EnforcementTeamsontheprecursorchemicalandsyntheticdrugthreats.Furtherexpandtheongo
ingexchangeofinformationconcerningCanadianbusinessesinvolvedintheimportation,produc
tion,anddistributionofpseudoephedrineparticularlythosefirmswhoseproductshavefrequently
beendivertedorsmuggledintotheUnitedStates.
StrengthentheMultilateralChemicalControlSystem( DEA,DOJ,State,ONDCP )
Garnerinternationalsupportformakingexistingmultilateralchemicalcontrolsmoreuniversal,for
mal,andwellsupportedbyinternationalinstitutions,includingUNbodiessuchastheInternational
NarcoticsControlBoardandregionalbodiessuchastheOrganizationofAmericanStatesInter
AmericanDrugAbuseControlCommission(CICAD).WorktorealizethefullpotentialofProject
PRISM,andbuildsupportfortheapplicationofthe1988UNConventiontopharmaceuticalprepara
tionscontainingprecursorchemicalsthatcanbeeasilyrecoveredforuseinillicitdrugproduction.
ExchangeInformationwithChemicalProducingCountries( DEA,DHS,State,USTR )
Continueongoinginformationsharingeffortswiththecountriesthatproduceprecursorchemicals
usedtomakeamphetaminetypestimulants,particularlyChina,India,Germany,andtheCzech
Republic.
EducateStoreEmployees( DEA,DOJ )
Buildingoneffortsbeguninanumberofstates,worktodevelopamodeltrainingprogramforphar
macists,retailmanagement,andstoreemployeesconcerningsuspiciouspseudoephedrinepurchas
es,aswellassuspicioussalesofchemicalsanditemsusedinthemanufactureofmethamphetamine.
EncourageVoluntaryControlsbyRetailPharmaciesandStores( DEA,DOJ,ONDCP )
Seekthevoluntaryparticipationofmajorretailchainsinprogramstocontrolpseudoephedrine
productsthroughrestrictionsonthequantitythatcanbepurchasedatasingletime.Alsosupport
thevoluntarymovementofpseudoephedrineproductsfromstoresopenshelvestobehindpharmacy
countersorothermannedcountersinretailsettingswherepharmaciesarenotonsite.
WorkwithManufacturerstoReformulateAbusedPharmaceuticalProducts( DEA,FDA )
Continuetosupporttheeffortsoffirmsthatmanufacturefrequentlydivertedpharmaceuticalprod
uctstoreformulatetheirproductssoastoreducediversionandabuse.Encouragemanufacturersto
exploremethodstorenderproductscontainingkeyprecursorssuchaspseudoephedrineineffective
intheclandestineproductionofmethamphetamineandpaincontrolproductssuchasOxyContin
lesssuitableforsnortingorinjection.
SupportStatePrescriptionMonitoringPrograms( DEA,ONDCP )
Supportstatescreationofprescriptionmonitoringprogramsdesignedtodetectinappropriatepre
scribingpatternsandprescriptionfraud.Lawenforcementandregulatoryentitiesshouldhave
accesstoinformationincaseofapparentdiversionorinappropriateprescribingofcontrolledsub
stances,andsomeprovisionforstatetostatecommunicationofadverseinformationshouldbe
examined. Supportinglegislationshouldbeexplored.
4.LawEnforcement
TargetPseudoephedrineandIodineSmugglingtoandfromMexico( DEA,ICE,CBP )
Focuslawenforcementresourcesonstoppingtherecentlynotedflowofsuspiciousshipmentsofpre
cursorchemicals,notablypseudoephedrine,fromAsiatoMexico,apparentlydestinedforclandestine
methamphetaminelabsinMexicoandtheUnitedStates.Alsofocusonthesmugglingofiodinefrom
Mexico.Inallsuchcases,lawenforcementshouldidentifyandaggressivelypursuethepersonsand
firmsresponsible.
FocusonCanadianSyntheticsandChemicalSmugglers( DEA,ICE,DOJ )
ExpandjointU.S.Canadianinvestigationsintothesmugglingofchemicals,methamphetamine,
MDMA,andotherclubdrugsanddivertedpharmaceuticals.Assignhighprioritytoinvestigationsof
largeseizuresofpseudoephedrineandephedrinefromCanada,anddevelopprosecutablecases
againstrogueCanadiancompaniesandtheirprincipals.
InvestigateTiesbetweenCanadianandMexicanCriminals( DOJ,DEA,ICE,NDIC )
AnalyzelawenforcementreportingandintelligencewithrespecttoCanadianpseudoephedrineand
tiesbetweenCanadiansellersandMexicanlaboperatorsinCalifornia.Analysisoftheflowoffunds
generatedfromsalesofpseudoephedrineinCanadaandtheUnitedStatesshouldbecoordinatedby
theappropriateagencieswithintheconcernedDepartments.
InvestigateAsianandEuropeanSourcesofSyntheticDrugs( DEA,ICE,State )
WorkwithinternationallawenforcementpartnersandregionalgroupstoinvestigateAsiancriminal
groupsinNorthAmericaandinAsiathatincreasinglymaybeengagedinproducingandtrafficking
syntheticdrugsandtheirprecursorchemicals.EnhancebilateraleffortswiththeNetherlandsand
otherMDMAproducingcountriesinEuropetobuildinvestigations,shareinformation,andextradite
criminalswhereappropriate.
EnhanceMethamphetamineProfilingEfforts( DEA,DOJ,ONDCP )
IncreasethenumberofsamplesavailableforanalysisinDEAsmethamphetamineprofilingprogram
byincorporatingsamplesofthedrugseizedbystateandlocallawenforcementatsuperlabs,orfrom
shipmentsstronglysuspectedoforiginatingfromsuchlargescaleoperations.Alsoleverageinforma
tiononchemicals,adulterants,cuttingagents,andequipmentfoundatthesite.
ReviewLabCleanupResources( DEA,DOJ,EPA )
Ensureadequatefundingsourcesforclandestinelaboratoryanddumpsitecleanups,includingfund
ingforsufficientpersonneltosupportlaboratorycleanupsandhazardouswastedisposal,sothat
cleanupcostsarenotadisincentivetolaboratoryinvestigationsortakedowns.Federalofficials,in
collaborationwithstateagencies,shouldconductaneedsassessmenttoidentifypotentialprogram
improvementsandmakerecommendationsonthespecificsupportneededandthefundsrequired.
ApplyUpdatedClandestineLabCleanupGuidelines( DEA,EPA )
Disseminateandapplythelatestguidelinesforthecleanupofclandestinemethamphetaminelabs
and,wherenecessary,coordinateenvironmentalremediationbyappropriateentities.Theseproto
colsforadulterationanddestructionofprecursorandessentialchemicals,glassware,andmetham
phetaminewasteshouldbepartofclandestinelaboratorycertificationtraining.
IncreaseProsecutorandLEATraining( DOJ,DEA,CBP )
Recognizingtheuniqueissuespresentedbychemicalandmethamphetaminecases,theFederal
Governmentshould,asresourcespermit,offertrainingforcriminalandcivilprosecutorsandfederal,
state,andlocallawenforcementagentsmorefrequentlyandindifferentregionsofthecountry.
MakeFullUseofChargingandSentencingOptions( DOJ,DEA )
ProsecutorsshouldmakefulluseoffederalSentencingGuidelinesprovisions,whichsetasentencing
floor(of7087months)foranycaseinvolvingmethamphetaminemanufacturethatcreatesasubstan
tialriskofharmtohumanlife.Federalprosecutorsshouldalsomakegreateruseoftheenvironmen
talenhancementforclandestinedrugmanufacturinginvolvingunlawfuldischarge,emission,or
releaseintotheenvironmentofahazardousortoxicsubstanceorfortheunlawfultransportation,
treatment,storage,ordisposalofahazardouswaste.
IncreaseAccesstoCivilPenaltyCaseExperts( DOJ )
TheDepartmentofJusticeshoulddevelopanddisseminatealistofattorneyswhohaveexperience
incivilpenaltycasesundertheControlledSubstancesActandwhoareavailabletoassistU.S.
AttorneysOfficesindistrictswheresuchcaseshaveneverorrarelybeenreferredorpursued.
PreventExploitationofMailServices( DEA,CBP,ICE,State,NDIC )
WorkwiththeU.S.PostalServiceandprivateexpressmaildeliveryservicestotargetillegal
mailordersalesofchemicalprecursors,syntheticdrugs,andpharmaceuticals,bothdomestically
andinternationally.
ImproveIntelligenceEffortsRelatedtoSyntheticDrugs( NDIC,DEA,CIA,CBP,ICE,State )
Intensifyintelligencecomponentsfocusongatheringandsharinginformationregardingthenature
andscopeofsyntheticdrugstrafficking.MakefulluseofNDICsrealtimeanalyticaldatabasefor
bothpreandpostoperationlinkanalysisanddocumentexploitation.Strengthenmechanismsfor
sharingactionableintelligence,trendanalysis,andinformationoncriminalorganizationsamong
theUnitedStatesandconcernedWesternEuropeancountries.
TargetRavesWhereDrugUseisFacilitated( DEA,DOJ )
Focusattentiononthepromotersandoperatorsofraveeventsthatfacilitatethetraffickingand
abuseofMDMAandotherclubdrugs,makinginnovativeandeffectiveuseofthefederalcrack
housestatute,includingamendmentsintheRaveAct.
ConsiderNewLegislationonClubDrugs( DOJ,DEA )
Federalofficialsshouldcontinueeffortstodevelopadditionallegislationtoaddresslegalissuesthat
oftenarisewithrespecttoclubdrugsandravetypeevents.Forexample,thedistributionofimita
tioncontrolledsubstancescouldbeexplicitlycriminalizedatthefederallevel,andtheprovisions
governingcontrolledsubstanceanaloguesandcounterfeitscouldbeclarified.
StrengthenControlsonInternetSales( DOJ,DEA )
SupportlegislationthatregulatestheburgeoningbusinessofInternetsalesofdrugs,particularly
controlledsubstances,byprohibitingthedispensingofcontrolledsubstancesonlinewithoutavalid
prescription.Thenewlawwoulddefineavalidprescriptionasoneissuedforalegitimatemedical
purposeintheusualcourseofprofessionalpractice,andwouldrequireatleastoneinpersonmed
icalevaluationbytheprescribingdoctor.
IncreaseInternetInvestigations( DEA,DOJ,NDIC,ICE,FDA,State )
ExpandinvestigationsandprosecutionsofInternetbasedsyntheticandpharmaceuticaldrugdiver
sionandsales,toincludetheestablishmentoftaskforcesandcoordinationmechanismsdedicated
tothispurpose.AgenciesshouldworkwithInternetServiceProviderstoassisttheminlimitingchil
drensaccesstoillegaldrugsites.
TargetOxyContinandVicodinDiversion( DEA,DOJ )
Supporteffortstotargetindividualsandorganizationsinvolvedinthediversion,illegalsale,phar
macytheft,fraud,andabuseofOxyContinandotherdrugproductscontainingoxycodone,
hydrocodone,orhydromorphine,suchasVicodinandLorcet.
SeekUpdatedSentencingGuidelinesforClubDrugs( DEA,DOJ )
WorkwiththeU.S.SentencingCommissiontoreviewdataontheimpactandeffectivenessofcur
rentsentencesfortraffickinginketamine,GHBanditsprecursorsandanalogues,andotherclub
drugs,and,ifadvisable,proposeenhancedguidelinessentences.
ShareLawEnforcementBestPractices( DEA,DOJ )
BasedonthesuccessesachievedbylocallawenforcementinSouthernCaliforniausingreversebuy
investigationsandbycommunitiesintheMidwestthathavesetmorestrenuouspenaltiesandregu
lationsregardingsyntheticdrugs,establishamechanismforsharingbestpracticesamongfederal,
state,andlocallawenforcementaswellaswithinternationalpartnerswhoareconfrontingsynthetic
drugthreats.
II.NatureoftheProblem
A. ConsumptionTrends
Nationalindicatorshaveshownageneralincreaseoverthelastdecadeintheuseofcertainsyn theticdrugs,particularlyamongyouthandyoungadults.However,recentdataindicatethatthis trendmaybechangingforthebetteraspartofbroadreductionsinteendruguse.Hospitalstatistics reflectingtheadverseconsequencesofdruguseasmeasuredbythenumberofmedicalemergency mentionswerestatisticallyunchangedforallsyntheticdrugsexceptPCPfrom2000to2002,yet 4 longtermdatareflectsignificantincreasesinemergenciesinvolvinganumberofsyntheticdrugs. Furthermore,in2001individualsage25andyoungerwereinvolvedinadisproportionatenumberof suchemergenciesinvolvingMDMA,GHB,andLSD,andnearlythreeoutoffouremergencyroom 5 episodesinvolvingthesethreedrugsalsoinvolvedalcoholoranothermajorsubstanceofabuse. Moreencouragingnewsisfoundinthe2003MonitoringtheFuture(MTF)study,whichreporteda declineintheuseofillicitdrugsbyteenagers,includingthesecondconsecutiveyearofmajor 6 reductionsintheuseofMDMA,alongwithsubstantialdecreasesintheuseofLSD.
1. Methamphetamine
Figure1:Theappearanceofmethamphetaminevarieswiththeproductionprocess.Scientificandchemicaljournals list more than 150 processes for methamphetamine production, along with an undetermined number of processes developedbyclandestinechemists.Shownherearesomeofthemostcommonformsofillicitmethamphetamine.
Source: DrugIdentificationBible
11
Additional forms of methamphetamine found on the street. The photo at topleftshowsaformoftenreferredtoaschalk.Greenfoodcoloringhas beenaddedtothemethinthephotoatleft,eithertodisguisethedrugor identifyitwiththedistributorstrademark.
ThelevelofmethamphetamineuseintheUnitedStateshasbeenrisingamongadultsanddeclin ingamongadolescentsoverthelastseveralyears.Over12millionAmericanshaveusedmethamphet amineintheirlifetimes,accordingtothe2003NationalSurveyonDrug UseandHealth,includingan estimated1.3millionpastyearusers.Themeanageoftheapproximately326,000newmethampheta mineusersin2001was18.7,andabout50percentoftheuserswereundertheageof18.
PERCENTAGEREPORTINGMETHAMPHETAMINEUSE 2003NATIONALSURVEYONDRUGUSEANDHEALTH
Age 1217 1825 26+ 12+(Total) Lifetime 1.3% 5.2 5.7 5.2 Annual 0.7% 1.6 0.4 0.6 Past30Days 0.3% 0.6 0.2 0.3
Figure2: 2003NSDUHSurveyResultsforMethamphetamineUse
12
Accordingtothe2003MonitoringtheFuturestudy,therehasbeensignificantprogressagainst methamphetamineuseinthecriticalteenagesegmentofthepopulation.Theoveralldeclineinuse sincequestionsregardingmethamphetaminewerefirstaddedtothestudyin1999isunmistakable therateofpastyearmethamphetamineuse(alsoknownastheannualrate)droppedbetween1999 and2003from3.2percentto2.5among8thgraders,from4.6percentto3.3percentamong10th graders,andfrom4.7percentto3.2percentamong12thgraders.
PERCENTAGEREPORTINGMETHAMPHETAMINEUSE 2003MONITORINGTHEFUTURESTUDY
Grade 8thGrade 10thGrade 12thGrade Lifetime 3.9% 5.2 6.2 Annual 2.5% 3.3 3.2 Past30Days 1.2% 1.4 1.7
Figure3: 2003MonitoringtheFutureResultsforMethamphetamineUse
Thenumberofemergencyroomdrugepisodesinvolvingmethamphetamineincreasedfrom 13,505in2000to17,696in2002. Methamphetaminementionsoccurredinapproximately3percent 7 ofallemergencyroomdrugepisodesin2002. Previously,medicalexaminersparticipatinginthe 1999DrugAbuseWarningNetwork(DAWN)surveymentionedmethamphetamineinconnection with6percentofalldrugrelateddeathsand8percentofsuchdeathsinvolving1825yearolds,and between1994and1998participatingmedicalexaminersassociatedatotalof2,601deathswith methamphetamineuse.
EMERGENCYDEPARTMENTSYNTHETICDRUGMENTIONS (DAWN)
Year 1994 1995 1996 1997 1998 1999 2000 2001 2002 F 17,154 11,486 10,447 13,505 14,923 17,696 637 1,143 2,850 4,511 5,542 4,026 762 1,282 3,178 4,969 3,340 3,330 209 396 263 679 260 Methamphetamine 17,537 15,933 11,002 MDMA 253 421 319 GHB 56 145 638 Ketamine 19 81
Figure4: DAWNSyntheticDrugMentions, 19942002
13
Preliminaryfindingsfromurinalysistestsshowhighratesofrecentmethamphetamineuseamong adultarresteesinmanyurbanareasintheWestandMidwestin2002.Positivetestratesformetham phetamineuserangedbetween2031percentformalearresteesandbetween1242percentfor femalearresteesinDesMoines,Omaha,Phoenix,Portland,SaltLakeCity,SanDiego,andSanJose. 8 InmajorcitiesintheeasternUnitedStates,positivetestratesforadultarresteesweremuchlower.
ADULTARRESTEESTESTINGPOSITIVEFORMETHAMPHETAMINE(%) (ADAM)
PrimaryCity Male DesMoines,IA Honolulu,HI Omaha,NE Phoenix,AZ Portland,OR SaltLakeCity,UT SanDiego,CA SanJose,CA 18.6 35.9 11.0 19.1 21.4 17.1 26.3 21.5 2000 Female 20.5 47.2 13.2 24.1 23.5 28.9 28.7 40.0 Male 22.0 37.4 15.6 25.3 20.4 17.2 27.9 30.2 2001 Female 27.5 36.1 10.3 32.3 20.4 18.8 37.4 38.2 Male 20.2 44.8 21.0 31.2 21.9 21.9 31.7 29.9 2002 Female 24.0 50.0 12.0 41.7 22.7 37.7 36.8 42.8
Figure5: ADAMTestingResultsforMethamphetamine, 20002002
Althoughmethamphetamineuseisspreadingeastward,itisstillsomewhatregionallyconcentrat edintheWest,Midwest,andpartsoftheSouth.Insomestates,suchasHawaii,localtrendsoutstrip thewiderregionalandnationalnorms.Methamphetaminecurrentlystandsoutasthegreatestdrug threattosocietyinHawaii.TherearegrowingconcernsinHawaiiregardingcrystallizedmetham phetamine(calledice)addictionratesinparticular.Drugtreatmentfacilityadmissionsfor methamphetamineuseclimbedbymorethan300percentinHawaiifrom1993to2000. MethamphetamineusealsoshowsahighcorrespondencetothecommissionofcrimeinHawaii; morethan44percentofadultmalesand50percentofadultfemalesarrestedinHonoluluin2002 testedpositiveforthedrug.Moreover,therewere62methamphetaminerelateddeathsinHonolulu F 9 in2002,upfrom27in1998.
2. MDMA/Ecstasy
Figure6:AcloseupoftheimprintsonfourMDMAtabletsseizedin2001.Ecstasy manufacturers often stamp their products with familiar logos or other images designedtoenticeyoungpeople. Source: WyomingHighwayPatrol
14
MDMAuse,whichincreasedsharplybetween1995and2000,isdeclining.The2003National SurveyonDrugUseandHealthestimatedthat10.9millionindividualsage12andoverhadtried MDMAduringtheirlifetime.TheSurveyestimatedthat1millionindividualstriedMDMAforthefirst timein2002,asignificantdeclinefromthe1.7millionnewusersin2001and2000.
PERCENTAGEREPORTINGMDMAUSE 2003NATIONALSURVEYONDRUGUSEANDHEALTH
Age 1217 1825 26+ 12+(Total) Lifetime 2.4 14.8 3.1 4.6 Annual 1.3 3.7 0.3 .9 Past30Days 0.4 0.7 0.1 0.2
Figure7: 2003NSDUHSurveyResultsforMDMAUse
MDMAusebyhighschoolstudentsdeclinedforthesecondyearinarow,accordingtothe2003 MonitoringtheFuturestudy.TheMonitoringtheFuturehighschoolsurveyindicatedincreased annualMDMAusebetween1999and2001:from1.7percentto3.5percentamong8thgraders,from 4.4percentto6.2percentamong10thgraders,andfrom5.6percentto9.2percentamong12th graders.Incontrast,annualMDMAuseratesforhighschoolstudentsin2003were2.1percent among8thgraders,3.0percentamong10thgraders,and4.5percentamong12thgraders.These reductionswereaccompaniedbysignificantdeclinesintheratesofpastmonthMDMAuseacrossall threegradesin2003aswell,andthelifetimeuseofMDMAdropped32percent,from8.0percentto 5.5percent.
PERCENTAGEREPORTINGMDMAUSE 2003MONITORINGTHEFUTURESTUDY
Grade 8thGrade 10thGrade 12thGrade Lifetime 3.2% 5.4 8.3 Annual 2.1% 3.0 4.5 Past30Days .7% 1.1 1.3
2003MonitoringtheFutureResultsforMDMAUse
AccordingtoDAWNstatistics,thenumberofemergencyroomdrugepisodesinvolvingMDMA remainedrelativelystablebetween2001and2002,with5,542mentionsin2001and4,026mentionsin 2002. However,thenumberofmentionsin2001representsa95percentincreaseinthenumberof mentionssince1999andalmosta22foldincreaseovertheestimated253MDMAmentionsin1994. Althoughlessthanonethirdofallemergencyroomdrugepisodesin2002involvedpersonsage25or younger,approximately75percentofemergencyroomMDMAepisodesinvolvedsuchindividuals. The2002DAWNstatisticsalsoindicatethatmarijuanawasmentionedinnearly40percentofemer
15
gencydepartmentvisitsinvolvingMDMA, andtheCommunityEpidemiologyWorkGroup(CEWG) reportfromJune2002notedthattheannualnumberofdeathsassociatedwithMDMAmaybe 11 increasingaswell,althoughthemortalitynumbersremainlow.

10
9.2
10
PercentageReportingPastYearMDMAUse
9 8 7
6.2
8thGrade 10thGrade 12thGrade

4.4 4.5 5.6
6 5 4 3
3.5 3.0 2.1
2 1
1.7
1999
2000
2001
2002
2003
Figure8: 2003MonitoringtheFutureResultsandTrendsforMDMAUse
3. OtherClubDrugs
GHBistheclubdrugwhichismostoftenassociatedwithdaterape.Acapfulcanbeslippedunde tected intoabeveragetoincapacitateavictim.Therewere3,330GHBmentionsinemergencyroom drugepisodesin2002,afigurethatremainedstableincomparisonwiththe3,340GHBmentionsin 2001. HoweverthenumberofemergencyroomepisodesassociatedwithGHBin2002representsa onethirddecreasefromthe4,969mentionsin2000.Likeotherclubdrugs,GHBismostlyusedby youngpeople,asreflectedinDAWNstatisticsfor2002showingthatalthoughlessthanonethirdofall emergencyroomdrugepisodesthatyearinvolvedindividualsage25oryounger,approximately56 12 percentofemergencyroomGHBepisodesinvolvedsuchindividuals. Nonetheless,GHBuseamong highschoolstudentshasshownlittlechangesinceitwasfirstmeasuredintheMonitoringtheFuture surveyin2000.Annualprevalenceratesin2003forstudentsingrades8,10,and12areestimatedat 13 0.9percent,1.4percent,and1.4percent,respectively. Theuseofflunitrazepam(Rohypnol),whichisassociatedwithdrugfacilitatedsexualassault, appearstobeonthedecline.TheMonitoringtheFuturesurveyestimatespastyearRohypnoluse among8th,10th,and12thgradersin2003tobe0.5percent,0.6percent,and1.3percentrespectively. Rohypnoluseamong8th,10th,and12thgradersin2002was0.3percent,0.7percent,and1.6percent respectively. Ketamineretainsasmallbutpersistentholdasaclubdrugusedbyyoungpeople.TheMonitoring theFuturestudyestimatestheannualprevalenceofketamineusein2003for8th,10th,and12th
16
gradersat1.1percent,1.9percent,and2.1percent,respectively.Therehasbeenlittlechangeinthese figuressince2000,whenquestionsregardingketamineusewerefirstincludedinthesurvey.According toDAWNstatistics,therewere260ketaminementionsinemergencyroomdrugepisodesin2002. Althoughlessthanonethirdofallemergencyroomdrugepisodesin2002involvedpersons25and 14 younger,approximately68percentofemergencyroomketamineepisodesinvolvedsuchpersons.
Figure9: Rohypnol: AlthoughRohypnolisillegalintheU.S.,thedrugislegallyprescribedinsomefor eigncountries.GHB: GHBisfoundinbothpowderandliquidform. Ketamine: Ketamineisavailableas apowderandinliquidinjectibleform.Thedrugiscommonlystolenfromveterinaryclinics. Source: DEAMuseum
4.OtherSyntheticDrugsandDivertedPharmaceuticals
NonmedicaluseofaddictiveprescriptiondrugshasbeenincreasingthroughouttheUnitedStates atalarmingrates.AccordingtotheNationalSurveyonDrugUseandHealth,in2002,anestimated6.2 millionAmericansreportedpastmonthuseofprescriptiondrugsfornonmedicalpurposes.Nearly14 percentofyouthbetweentheagesof12and17haveusedsuchdrugs,whichincludepainrelievers, sedatives/tranquilizers,orstimulants,fornonmedicalpurposesatsomepointintheirlives. Emergencyroomvisitsassociatedwithnarcoticpainrelievershaveincreased163percentsince1995. TheAdministrationalreadyengagesFederal,state,andlocalofficials;themedicalcommunity;and businessesworkingintheareaofInternetcommercetopreventandstoptheillegalsale,diversion,and abuseofprescriptionpshychotherapeuticdrugs.However,increasedeffortsarerequiredinthisarea. Oxycodone,particularlyinthecontrolledreleaseformofOxyContin,isagrowingdrugproblem throughoutthenation.Althoughtherateofnonmedicaluseofoxycodoneisstillconsideredrelatively lowcomparedtomajordrugsofabuseonanationalbasis,thereisevidenceofanemergingproblemin
17
manycommunities,particularlyrurallocaleswithlimitedpublichealthandlawenforcement resources.Theestimatednumberofpersonsoverage12whohaveillicitlyusedoxycodonerosefrom 15 221,000to399,000between1999and2000. DAWNstatisticsforemergencyroomdrugepisodes involvingprescriptiondrugscontainingoxycodoneincreased22percentfrom18,409mentionsin 2001to22,397mentionsin2002. This2002figurealsorepresentsa107percentincreaseoverthe 10,825emergencyroommentionsin2000anda450percentincreaseovertheroughly4,000men 16 tionsin1994. MonitoringtheFuturesurveyedOxyContinusein2003andfoundannualprevalence ratesforgrades8,10,and12of1.7percent,3.6percent,and4.5percent,respectively. ThehallucinogenPCPcontinuestobeused,oftenmixedwithmarijuana,andisreportedatele vatedlevelsintheemergencydepartmentdataforcertaincitiesintheDAWNnetwork,including Chicago,LosAngeles,Philadelphia,andWashington,D.C.TheCommunityEpidemiologyWorking GrouphasalsofoundindicationsofincreasedPCPuseinPhoenixandTexasaswell.Theestimated 7,648PCPmentionsinemergencyroomdrugepisodesin2002representanincreaseofapproximate 17 ly109percentinthenumberofmentionssince1999. Ofthepersonsage12oroverwhofirstused PCPeachyearbetween1994and1999(estimatedat82,000in1994and151,000in1999),atleast60 percentwereage1217.Duringthatperiodthemeanageofinitiationdroppedfrom16.8to15.8as 18 well. The2003MonitoringtheFuturestudyestimatedanannualprevalencerateforPCPuseamong 12thgradersof1.3percent. Followingadeclineinuseinthe1970s,LSDusewaslevelinthelate1980sbutbegantoincrease between1991and1996.Overthelasttwoyears,however,LSDusehasfallensteeplytothelowestlev 19 elssinceMonitoringtheFuturedatacollectionbegan. Forexample,theannualprevalenceratefor 12thgraders,whichpeakedat8.8percentin1996,wasdownto1.9percentin2003;prevalencerates declinedfor8thand10thgradersaswell.LifetimeuseofLSDfell43percent,from6.6percentto3.7 percent.Moreover,thenumberofLSDmentionsinemergencyroomdrugepisodesin2002dropped to891from5,126mentionsin1999.DAWNstatisticsindicatethatalthoughlessthanonethirdofall emergencyroomdrugepisodesin2002involvedpersonsage25oryounger,approximately76percent 20 oftheemergencyroomLSDepisodesinvolvedsuchindividuals.
Figure 10: Pure PCP, as pictured here, is a white, odorless crystal with a metallic or bitter taste. Because of impurities resultingfrommakeshiftmanufacturingprocedures,thecolor ofmuchofthecrystalPCPonthestreetwillvaryfromtanto brown. Source: DrugIdentificationBible
Figure 11: LSD crystals next to the point of a needle. When exposed to air, light, or heat, LSD will degrade and darken, eventually turning black. Purer forms of LSD are white or semiclearincolor.
18
B. TraffickingTrends
1. Methamphetamine
21
FEDERALMETHAMPHETAMINESEIZURES
5000 4500 4000 3500 Kilograms 3000 2500 2000 1500 1000 500 0 1999 2000 2001 2002 2003 2004June
Figure12: FederalMethamphetamineSeizures AlthoughbothdomesticandU.S.Mexicoborderseizureshaveincreasedinthreeofthelastfour yearsandareacontinuingconcern,thesurgeindomesticlabseizuresisparticularlytroubling(see Figure13,nextpage).Methamphetamineaccountsforabout96percentofallclandestinedruglabo ratoryseizuresintheUnitedStates.Thenumberofreportsofdomesticmethamphetaminelab seizurescontinuedtorisein2003,withtheDrugEnforcementAdministrations(DEA)ElPaso IntelligenceCenter(EPIC)receivingreportsofmorethan10,000labseizures,comparedtothe9,193 22 seizuresreportedfor2002. EPICreportedalmost5,000labsseizedinthefirstsixmonthsof2004. Thegreatmajorityofmethamphetaminelabsover95percentin2002areseizedandinvestigated bystateandlocallawenforcement.Californiaremainsthestatewiththehighestmethamphetamine productionlevels.HundredsofclandestinemethamphetaminelabsareseizedinCaliforniaeach 23 year. Moreover,thelargesuperlabsinCalifornia,capableofproducingmorethantenpoundsof methamphetaminepercycle,areresponsiblefortheproductionofmostofthemethamphetamine traffickedillegallyintheUnitedStates,despiteadramaticincreaseinthenumberofsmaller,inde pendentclandestinemethamphetaminelaboratoriesoperatingintheMidwest.Missourileadsthe nationwithoveronethousandseizuresofthesesmallerlabsin2003,andthenumberoflabsseized inArkansas,Oklahoma,andTennesseetripledbetween2000and2003. ThemethamphetaminetradeiscontrolledlargelybywellorganizedMexicancrimegroupsthat operatewithinasystemofflexiblealliances.Indeed,mostofthelargesuperlabsinCaliforniaare runbyorganizationswithtiestoMexico.However,outlawmotorcyclegangsaregainingalarger shareofdomesticmethamphetaminetrafficking.Pricesformethamphetaminevarygreatlybylocali ty,rangingbetween$20$300pergramacrossthe48contiguousstates.
19
MethamphetamineLaboratoriesSeized
IncludingLabsOnly,MethOnly CalendarYear2003
612 54 334 50 25 65 71 53 851 233 295 651 89 158 482 27 2 1,076 350 137 685 684 214 268 61 20 185 38
DE2 MD2 MA1 RI1
70 24
180 49 151 49 492 413 592 75 55 23 9
Source:NationalClandestineLaboratoryDatabase Total:10,144/47StatesReporting Dates: 01/01/03to12/31/03
TotalsarebasedondatareportedtoEPICand enteredintotheCLSSasof05/28/04
Figure13: TotalofAllMethamphetamineLaboratoriesSeized, 2003. Highpurity,crystallizedicemethamphetamineremainsprevalentinHawaii,butlawenforce menthasnotedanincreasedmarketpreferenceforicemethamphetamineontheU.S.mainlandas well,andmoreisbeingproducedtomeetthisdemand.Thereareindicationsthaticemethampheta minemayalsobeflowingintotheUnitedStatesdirectlyfromAsiaandMexico.InHonolulu,ice methamphetaminesellsfor$200$400pergram. Thetraffickingofmethamphetaminecreates numeroushazardsforthecommunitieswhereitis produced.Officialsestimatethatforeverypoundof methamphetamineproducedinaclandestinelabora tory,approximately56poundsoftoxicbyproducts aregenerallyleftover,withasmuchastenpoundsof toxicwasteremaininginsomecases.
Figure14:Iceisapurifiedformofmethamphet amine that is ingested by smoking. Frequently describedasresemblingbrokenglassorshattered ice,thedrugisessentiallyodorlessandhasahard texture. Its purity is generally very high, often exceeding90percent. Source: DrugIdentificationBible
Methamphetaminecooksburytheleftover chemicalwasteinthesoilordumpitintosepticsys temsorstreamsinruralareas,orintotheplumbing whenstayingathotelsorrentalhomes.Thetoxic wastedumpedintothesoilorstreamscanthenmake
20
itswayintothewatertable.Lawenforcementofficialsdiscoveredover3,600methamphetaminelab dumpsitesin2003alone.24 Thecleanupoperationfollowingthediscoveryofadumporclandestinelaboratorysiteistypical lyanextremelyexpensiveendeavor.Theinitialcleanupofasiteincludesremovingthechemicals andanyleftovercookingequipment.Thesecostsaretypicallycoveredbystate,local,orfederalgov ernmentandaveragealmost$2,700percleanupoperationinCalifornia;DEAfundedcleanupsaver ageroughly$1,900nationwide.Secondarycleanupentailsremovingcontaminatedsoilandrazing contaminatedbuildings,andfundingthejobisoftenlefttothelandowner.Insomestatesliensare alsoplacedonthepropertyuntilthecontaminationisremediated.Whencombinedwiththeoppor tunitycostofanaffectedpropertybeinglegallycondemnedordeemedcommerciallyoragricultur allyunusable,thecostincurredbythepropertyownercanrunintothemillionsofdollars. Theaveragecostofcleaningupa dumporlabsiteappearstobeescalat ingaswell.Californiaauthorities reportedperforming2,088initial cleanupsofclandestinelabsitesduring 2000atacostof$4.3million. Whilethe numberofcleanupsitesin2002was smaller(1,846sites),thetotalcostof performingthecleaningroseto$4.7 million. Theseshiftsareexplainedby methamphetaminecooksincreasing sophistication,whichenablesthepro Figure15:Thesefivegallonbucketsfromamethlabcontainared ductionofhigheramountsofdrugsata coloredreactionliquidandlyewater,astrongalkalisolutionthat willbeaddedtothereactionliquid. singlesite.Somelabsarenowableto Source: RiversideCounty,CA,SheriffsDepartment produce100poundsormoreof methamphetamineperproduction cycle.Thisincreasedproductivityleavesbehindincreasedamountsoftoxicwaste,whichcanpol lutethewatersupplyandmanifestitself inasyetunknownhealthandenviron 25 mentalconsequences. Small,independentoperators(some timescalledmomandpoplabsor smalltoxiclabs)thatproduceounce sizequantitiesofmethamphetaminefor localuseanddistributionaccountfor themajorityoftheclandestinelaborato ryseizuresintheUnitedStates.These labsinitiallyemergedasaproblemin theMidwestinthe1990s,usingtherela tivelysimpleBirchmethodorthe pseudoephedrine/iodine/redphospho rusmethodsofmanufacturingmetham phetamine.Theproliferationofthese smalllabswhichcanbelocatedin
Figure16:Makeshiftlaboratoryequipmentandchemicalsusedin asmallmethlab.Someofthemorecommonchemicalsfoundat methlabsincludesodiumhydroxide,methanol,acetone,isopropyl alcohol,ether(startingfluid),andcharcoallightingfluid. Source: DrugIdentificationBible
21
trailers,hotelrooms,orordinaryhomeshascreat edmanyproblems,includingadramaticincreasein hazardouswastecleanups.Theoperational,finan cial,andmanpowerresourcesneededtocombatthe thousandsofsmallclandestinedruglabsinmany partsofthecountryseverelytaxtheresourcesof localpoliceandsheriff'sdepartmentsinsmaller communities. Thus,whilethelargerlaboratoriesareofcon

cernduetotheamountofmethamphetaminethat
canbeproducedandtheconcentrationoftoxic waste,thesmallertoxiclabsareofconcernbecause theyaresowidespread.Furthermore,thepotential forthepublictobeexposedtothetoxicchemicalsfromthesesmallerlaboratoriesisalsomuch greater,sincetheyarecommonlyfoundineithertransienthousingfacilitiesorhomesinresidential neighborhoods.Thisfactalsohighlightswhatisprobablythedarkestsideoftheentiremethamphet amineproblem:drugendangeredchildren.In2003,morethan3,000childrenwerefoundonsite duringlawenforcementactionsrelatedtoclandestinemethamphetaminelaboratoriesnationwide. Fortyoneofthesechildrenwerereportedinjuredandonechildwaskilledbyexplosionsorfiresat 26 clandestinemethamphetaminelabs.
Year 2000 2001 2002 2003 MethamphetamineLab RelatedIncidents 9,311 13,839 16,238 16,506 ChildrenAffected 1,239 2,345 3,643 3,625
Figure16a:Ahomemadepunchusedbyalargevol
ume meth lab for removing overthecounter tablets containing ephedrine or pseudoephedrine from blis terpacks. Source: RiversideCounty,CA, SheriffsDepartment
Figure17: ChildrenAffectedinMethamphetamineLaboratoryRelatedIncidents, 20002003
2. MDMA/Ecstasy
MostoftheMDMAconsumedworldwideisproducedintheNetherlandsand,toalesserextent, 27 Belgium. TheUnitedNationsOfficeonDrugsandCrime(UNODC)reportEcstasyand Amphetamines: GlobalSurvey2003 statesthat75percentofrespondingcountriesindicatedthatthe sourceoftheMDMAseizedintheircountrywastheNetherlands.Belgiumwasthenextmostfre quentlymentionedcountry,appearingintheresponsesof31percentofthecountriessurveyed. Interpolreportsthatin2001,37millionMDMAtabletswereseizedworldwide.Ofthese,theDutch reportedthatover25million,orapproximately68percent,originatedintheNetherlands.UNODC reportsthattotalEcstasyproducedworldwidein2002wasapproximately113metrictonsayearor 1.4billiontablets.AccordingtolaboratoryseizuredatasubmittedtoEPIC,therehaveneverbeen 28 morethan13MDMAlabsseizedintheUnitedStatesinasingleyear. ManufacturersintheNetherlandsandBelgiumhaveassociatedwithorganizedcrimesyndicates fromotherEuropeancountriesandIsraelfordistribution,withsmugglersusingmethodssuchas 29 expressmailservice,commercialaircouriers,andair/seafreight. GroupswithtiestoSoutheastAsia
22
MDMASeizures
12,000,000
10,000,000
Tablets
8,000,000
TOTALU.S.
6,000,000
Arrival
4,000,000
2,000,000
0 2000 2001 2002 2003 2004June
Figure18: TotalU.S. &ArrivalZoneMDMASeizures, 20002004
havealsobecomeheavilyinvolvedintheMDMAtrade.ShipmentstotheUnitedStatestypicallycon tain10,000tabletsormore,but,consistentwiththepatternsofdeclininguseamongyoungpeople, thetotalamountofMDMAenteringtheUnitedStatesappearstobefalling.AsshowninFigure18, annualaggregateseizures,bothinthearrivalzone(borderarea)andtherestofthecountry,have 30 decreasedinthepastfewyears,reflectingthedeclineinusage. TheevershiftingroutesusedbyMDMAtraffickersrequireimprovedmeasurestomonitor changesintheMDMAmarket.In2000,63percentofMDMAtabletsseizedweresmuggledintothe UnitedStatesbyairline,27percentbyexpressmail,and10percentby shipping.ThedeparturepointsfortheseseizedMDMAshipmentswere theNetherlands(77percent),France(9percent),Belgium(8percent), 31 Germany(3percent),andSpain(3percent). Incontrast,in200326 percentofMDMAtabletweresmuggledintotheUnitedStatesbyairline, 19percentbymail,7percentbyexpressmail,8percentbyshipping,and theremaining40percentbyothermeans.Thedeparturepointsfor MDMAsmuggledintotheUnitedStatesweretheNetherlands(21per cent),Canada(18percent),theUnitedKingdom(11percent),France(6 percent),Germany(3percent)andBelgium(2percent). Thechemicalsandequipmentnecessarytomanufactureakilogram ofMDMAcancostaslittleas$500,buttheprocessrequiressignificantly 32 moreskillthanthemanufactureofmethamphetamine. Itcostsaslittle as25centstoproduceasingleMDMApillthattypicallyretailsfor$20 30,althoughpricesvarywidely.Retailpricesperdosageunitin2001 rangedfrom$10to$60,andwholesalepricesrangedfrom$5to$17.
Qualityandpurityalsovary,asMDMAisoftencutwithothersub stancessuchascaffeine,ephedrine,anddextromethorphan(DXM). Source:TexasDepartmentof Paramethoxymethamphetamine(PMA),asynthetichallucinogenwith PublicSafety potentstimulanteffects,isalsopackagedanddistributedascounterfeit orimitationMDMA. TheDEASourceDeterminationProgramsanalysis ofMDMAsamplesin2000revealedthat12percentofthesamplescontainedamphetamineor methamphetamine,butnotMDMA;5percentcontainednocontrolledsubstances;and3percent 33 weredeterminedtobeothersubstancesbutweresoldasecstasy.
Figure 19: Equipment for mixing glacialaceticacid,safrole,toluene, and other chemicals in a high volumeclandestineMDMAlab.
23
AccordingtoDEAsSystemtoRetrieveInformationonDrugEvidence(STRIDE)data,Florida,New York,andCaliforniaarethehighestMDMAtraffickingareasintheUnitedStates.Otherstatesthat havesignificantMDMAtraffickingincludeNewJersey,Illinois,Georgia,Texas,Massachusetts, 34 Virginia,andWashington,D.C. OneregionthatappearstohaveasubstantialconnectiontoMDMAtraffickingisDenver, Colorado.WhilemostMDMAinColoradocomesfromEurope(BelgiumandtheNetherlands),three 35 MDMAlabswereseizedinColoradoin2001. Lawenforcementofficialshavefoundthatdrugtraf fickingorganizationsareusingDenverasahubtoreachseveralMDMAmarketsacrossthecountry, incitiessuchasChicago,SanFrancisco,Detroit,andNewYork.Theorganizationsinvolvedhavecon nectionstotheMiddleEastaswellasEurope.In2001,interagencytaskforcesfromtheHigh IntensityDrugTraffickingArea(HIDTA)programtookdownanIsraelirunoperationintheDenver regionthatwasbelievedtoberesponsibleforpeddlingmorethan100,000MDMAtabletseach 36 month. AdangerousnewtrendidentifiedbytheEuropeanUnionsPoliceOrganization,Europol,isthe productionofsuperEcstasypillswithhigherMDMAcontentthannormal.Thesepillscarrythe normallogosandcanbefataltopeopleusedtonormaldoses.Theextraheavypillshavebeendis coveredintheNetherlands,Belgium,Denmark,andtheUnitedStates.
3. OtherClubDrugs
GHBisoftenmanufacturedclandestinelyusingrecipesandingredientsobtainedoverthe Internet.Mostoftenthedrugisconsumedorallyinliquidform(andrarelyinpowder,tablet,orcap suleform).IndividualsandorganizationsoperatingviatheInternetcommonlysellGHBanalogues suchasgammabutyrolactone(GBL)and1,4butanediolascleaningagentsinanattempttomask theirillicitactivities.In2001,aretaildoseofGHB(bythecapful,drops,etc.)soldfor$5$30. Flunitrazepam(Rohypnol),whichhasneverbeenapprovedformedicaluseintheUnitedStates,is smuggledfromcountriessuchasMexicowhereitislegalandwidelyavailable.Reportsofuse,how ever,rapidlydeclinedafter1996legislationthatincreasedpenaltiesfortraffickinginthesubstance. Ketaminepowderisnotmanufactureddomestically,butisimportedbyU.S.firmsfrom GermanybyfarthelargestsourcecountryaswellasfromColombia,China,andBelgium.U.S. firmsprocessandpackagethepowderinto10mg/ml,50mg/ml,and100mg/mlinjectabledosage forms.Ketaminereachestheillicitmarketbydiversionfromlegitimatepharmaceuticalsourcesoris obtainedthroughburglariesofveterinaryclinics(themostfrequentlyreportedsource).Lawenforce mentofficialshavenotencounteredclandestinelymanufacturedketamine,butketaminesmuggled 37 fromMexicohasbeenanothersignificantsourceofsupplytotheillicitmarket. However,thanksto coordinatedlawenforcementactionintheUnitedStatesandMexico,keyindividualswithintheketa minesmugglingorganizationhavebeenarrested,andthetraffickingofketaminefromMexico appearstobedecreasing. Licitketamineisusuallypreparedinliquidformulations,andliquidistheprimaryformofillicit ketamineseized.Lessfrequently,streetdosesappearincrystal,powder,and,increasingly,tablet forms.Powderketamineisobtainedfrompharmaceuticalketaminebyevaporatingofftheliquid, andissnortedin100mgdoses.Atypicalstreetpackageofketaminepowder(100200mg)sellsfor about$20. AccordingtodatacollectedfromstateandlocalforensiclaboratoriesbytheNational ForensicLaboratoryInformationSystem(NFLIS),therewere2,126casesassociatedwith,and1,387
24
drugitemsidentifiedas,ketamineduring2002(comparedto1,802itemsin2001and581itemsin 2000). In2002,thisconstitutedroughly12percentofallclubdrugexhibitsenteredintheNFLIS database.
4. OtherSyntheticDrugsandDivertedPharmaceuticals
Theillegaldiversion,theft,andmedicalmismanagementofprescriptiondrugs (particularlyopioidpainmedications)haveincreasedand,insomeareas,presentalargerpublic healthandlawenforcementchallengethancocaineorheroin.AccordingtothemostrecentNational SurveyofDrugUseandHealth,themisuseofpsychotherapeuticdrugspainrelievers,tranquilizers, stimulants,andsedativeswasthesecondleadingcategoryofillicitdrugusein2002,followingmar ijuana. Anestimated6.2millionAmericans(approximately2.6percentofthepopulationage12and older)hadusedapsychotherapeuticdrugfornonmedicalreasonsinthemonthpriortothesurvey. Thebulkofthisabuseinvolvesnarcoticanalgesicsanestimated4.4millionAmericansarepast month(socalledcurrent)nonmedicalusersofpainrelievers. ReportsofthediversionandabuseofoxycodoneinthebrandpharmaceuticalOxyContinhave spreadfromtheruralareasoftheEasttoallregionsoftheUnitedStates,basedonrecentemergency roomandlawenforcementdata.Commonmeansofobtainingoxycodoneincludeunscrupulous physiciansandpharmacists,doctorshopping,andfraudulentandalteredprescriptions.Thenum berofpharmaciesthathavebeenrobbedbycriminalsseekingOxyContinhasincreaseddramatically aswell. IllicitPCPisprimarilymanufacturedclandestinelyinSouthernCalifornia,withlimitedclandes tineproductionoccurringinIndianaand,morerecently,inMaryland.MostofthePCPproducedin SouthernCaliforniaisdestinedfordistributiontootherU.S.locations,primarilyalongtheEast Coast.NewYorkisoneofthelargestmidleveldistributionhubsforPCP. TheavailabilityofPCP appearstobesporadic,withhighlevelsofavailabilityrecentlyinPhiladelphia,Chicago,NewYork, LosAngeles,Texas,andWashington,D.C.Packaging,purity,andpricingvarygreatly;PCPistypically soldforuseincombinationwithmarijuana,alcohol,andotherlicitandillicitproducts.Accordingto datacollectedbyDEAneartheendof2002,PCPlacedcigarettessellforabout$530apiece;powder andliquidformssellforabout$2030pergram,andliquidouncessellfor$1251,000.Wholesale pricesforonegallonofliquidPCPare$6,5008,000inLosAngelesand$12,00020,000inNewYork. Historically,LSDhasbeenmanufacturedbyasmallnumberofchemistsoperatingclandestine laboratoriesinCalifornia,butaverylargelabwasdiscoveredandseizedrecentlyintheMidwest. LSDisavailableinalmosteverystate,andthecostofasingledose,commonlyreferredtoasahit, typicallyrangesfrom$1to$10.
5. InternetSalesofPharmaceuticals
Inrecentyears,pharmacywebsiteshaveproliferatedontheInternet;offeringbothcontrolledand noncontrolledsubstances.Whileinappropriateonlinesalesandmisuseofnoncontrolledsub stancesraisesignificantconcerns,thisActionPlanfocusesonthesaleandabuseofproductscon tainingcontrolledsubstances,notablythehighlyaddictivenarcoticshydrocodone(including Vicodin,onScheduleIII)andOxycodone(includingOxyContin,onScheduleII).Obtainingcon trolledsubstancesonlineisconvenienttooconvenient:Themajorityofonlinepharmaciesofferto dispensedrugswithoutvalidprescriptions,makingtheInternetahavenforillicitdrugseekers.
25
Figure20:Asmallglassvialcontainingabout3 ccsofliquidPCP.Smokingacigarettethathas beendippedinliquidPCPisthemostcommon wayofingestingthedrug. Source: DrugIdentificationBible
Figure21:MostLSDseenonthestreetisintheformof blotter paper. The sheets of absorbent blotter paper are perforated into small squares and dipped into LSD that has been dissolved and diluted in alcohol. The blotter paper is often stamped with the distributors trademark design. Source: DrugIdentificationBible
Manysitessubstituteasimpleonlinequestionnaire forafacetofaceexaminationandpatientsupervi sionbyahealthcarepractitioner. Inastudyreleasedinearly2004,theNational CenteronAddictionandSubstanceAbuse(CASA) documentedtheexplosionofillegaldistributionof prescriptiondrugsovertheInternet.Theexactnum berofonlinepharmaciesisdifficulttoascertain.Of 495websitesofferingprescriptiondrugsidentifiedby theCASAstudy,onlyonethirdwereanchorsites, LSD being ingested via blotter paper on the wherecustomersactuallypurchasethedrugs;therest tongue. Although the drug is almost always takenbymeansoforalabsorption,itcanalso wereportalsitesthatdirectcustomerstoanchor be injected, absorbed through the skin, or sites.Thereportfoundthat73%ofdrugsofferedon swallowed. thesewebsiteswereScheduleIIandIIIcontrolled Source: DrugIdentificationBible substances.Regardlessofthenumberofsuchweb sites,theirpredominantcharacteristicisthatvery few6%intheCASAstudyrequirecustomerstohaveaprescriptioninordertopurchasedrugs. Thesiteshavenomechanismtopreventchildrenfrompurchasingprescriptiondrugs.Abouthalf ofthesitesofferonlyanonlineconsultation,aninadequatesubstitutewhichtheAmerican MedicalAssociationhasfoundnottomeetappropriatestandardsofmedicalcare.
26
III.ResponsetotheProblem
A. Prevention
1.CurrentEfforts
Demandreductionisacriticalcomponentofanysounddrugstrategy.Tobeeffective,drugpre ventionprogramsgenerallyshouldbelongtermandcomprehensive,withthegoalofpreventing anyillicitdruguse,notjusttheabuseofonedrugorclassofdrugs.Nevertheless,asevidencedby theincreasingillegaluseofcertainlicitlymanufacturedandcompoundsmanufacturedinclandes tinelaboratories,demandpatternscanchangequickly,oftenwithsignificantrisktopublichealth andsafety.Effectivepreventionthereforealsomustincludeearlywarningsaboutsuchemerging 38 drugthreatsandquickcommunityresponsethrougheducationandoutreachefforts. Scientificresearchsupportstargetedshorttermpreventioneffortsandmoregenerallongterm preventioneffortsbyidentifyingspecificdrugssubjecttoabuseandrelateddemographictrends. Thesetrendsincludepatternsofdruguseinitiationandprogression,motivationandriskfactors associatedwithdruguse,andfactorsthatprotectagainstdruguse.Preventionprogramsshouldbe basedonthisresearch,beginningwiththescientificcollaborationneededtoidentifyanddevelop testingmethodsandproductsforspecificsyntheticdrugs,andshouldaddressspecificcommunity needs,insomecasesfocusingeffortsononeormoreparticulardrugs.Furthermore,prevention programsshouldseekthevoluntaryparticipationofmanycommunitycomponentsindividuals, families,schools,religiousinstitutions,businesses,lawenforcement,socialserviceagencies,the media,andotherorganizationsinacoordinatedmanneraccordingtocommunityneedsand availableresources. Inresponsetotheriseintheuseofsyntheticdrugsanddivertedpharmaceuticals,morefocused datagatheringandpreventionprogramsarebeginningtoemerge.TheDepartmentofHealthand HumanServicesNationalInstituteonDrugAbuse(NIDA)whichfunds85percentoftheworlds researchondruguseandaddictionhasbeenaleaderinthisregard.ItsCommunityEpidemiology WorkGroup(CEWG)providesongoingmonitoringofemergingtrendsindruguse,includingthe mostuptodateinformationonsyntheticdrugsanddivertedpharmaceuticals.NIDAhasalso hostedconferencesfocusedonimportantpreventionissuesconcerningMDMA/EcstasyandGHB. Moreover,NIDAhaspartneredwithseveralnationalnongovernmentalorganizationsinaneduca tion,prevention,andresearcheffortregardingtheuseofmethamphetamine,MDMA,GHB,LSD, andRohypnol.Thispartnershipfundsresearchonthesedrugsaswellasamultimediapublicedu cationcampaignthatincludes:thedisseminationofaCommunityDrugAlertBulletin onClub Drugstoapproximately500,000healthcareandtreatmentproviders;thedistributionofaResearch ReportonMethamphetamineAbuseandAddiction;andthedevelopmentofteachingaidsforusein 39 elementaryandhighschoolclassrooms. TheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)intheDepartment ofHealthandHumanServiceshasalsoincreaseditsfocusonpreventingtheconsumptionofsyn theticdrugsanddivertedpharmaceuticals.SAMHSAhasundertakenaresearchbasedinitiativeto targethighriskgroupswithpreventionmessagesregardingclubdrugs,anditsCenterforSubstance
27
AbusePrevention(CSAP)maintainsanInternetsitededicatedtomodelpreventionprogramstarget ingyouth.CSAPfurtherfacilitatesthedisseminationofpertinentinformationonsubstanceabuse preventionresearchthroughitsNationalClearinghouse,whichisalsoavailableonline.Underthe CommunityInitiatedPreventionInterventionsprogram,SAMHSAhasfunded27grantsthatwill addresstheuseofMDMA,otherclubdrugs,methamphetamine,andinhalants,eitherthroughthe 40 developmentofpreventioninterventionmodelsorpreventioninfrastructureprograms. Inaddition,SAMHSAoverseesthedaytodayoperationofthecomprehensiveDrugFreeFederal WorkplaceprogramandtheNationalLaboratoryCertificationProgram(NLCP).TheNLCPprovides forthedevelopment,validation,dissemination,andongoingqualityassuranceofworkplaceforensic drugtestingmethods.TheuseofspecificdrugtestsinNLCPcertifiedlaboratoriesisrequiredforall federalagencies,theindustriesregulatedbytheDepartmentofTransportation,theNuclear RegulatoryCommission,privateindustry,and,increasingly,theDepartmentofHomelandSecurity. Underexistingregulations,testsarespecificallyrequiredtobecapableofdetectingmethampheta mineuse.NewfederalregulationsthatarenearingcompletionwillmandatetestingforMDMA,and testsforotherdrugs,includinganumberofhighabusepotentialsyntheticdrugs,arebeingconsid eredaswell.TheDepartmentofHealthandHumanServicesisalsofocusingonmethamphetamine throughitsTargetedCapacityExpansionGrantprogram,whichhasageneralmissiontoidentifyand respondtoemergingdrugproblems,andispromotingprogramsthattargetdruguseinfamiliesand 41 intheworkplace. TheOfficeofSafeandDrugFreeSchools(SDFS)intheDepartmentofEducationistheprimary vehicleofthefederalgovernmentforreducingdrug,alcohol,andtobaccouseandviolencein schools.TheSDFSadministers,coordinates,andrecommendspolicyforimprovingthequalityof programsandactivitiesthataredesignedtoprovidefinancialassistancefordrugandviolencepre ventionandtopromotethehealthandwellbeingofstudentsinelementaryandsecondaryschools andinstitutionsofhighereducation. Activitiesmaybecarriedoutbystateandlocaleducational agenciesandbyotherpublicandprivatenonprofitorganizations.Theofficealso:participatesinthe formulationanddevelopmentofAdministrationpoliciesrelatedtoviolenceanddrugprevention; coordinateswithotherfederalagenciesonissuesrelatedtocomprehensiveschoolhealth;andpartic ipateswithotherfederalagenciesinthedevelopmentofanationalresearchagendafordrugandvio lenceprevention. TheOfficeofNationalDrugControlPolicy(ONDCP)promoteseffectivepreventionactivities throughONDCPdirectedprogramssuchastheNationalYouthAntiDrugMediaCampaignand throughfederalgovernmentcoordinationefforts,suchastheInteragencyDemandReductionGroup. InAugust2000,theMediaCampaignbegananationwideradioandInternetinitiativedesignedto educatepeopleaboutthedangersofMDMAandaddressfaultyperceptionsthatthedrugis 42 harmless. Morerecently,theMediaCampaignrananextensive,$40millionadcampaigncalling attentiontothedangersofEcstasy. DEAisalsoheavilyinvolvedinprogramstopreventtheuseofsyntheticdrugsanddivertedphar maceuticals.Thirtythreefulltimespecialagentsarededicatedtoworkondemandreductionpro gramsthroughoutDEAfielddivisions.SinceanAugust2000internationalconferenceonclubdrugs, DEAhascosponsoredregionalconferencesalongwithcommunitycoalitionsandlocallawenforce mentinalmostallDEAfielddivisionstodisseminategeneralandscientificinformationonclub drugstolawenforcementpersonnel,medicalandtreatmentprofessionals,teachers,parents,and 43 communityorganizations. Inaddition,DEAsOperationXOutaddsastrongpublicawareness
28
componenttoitsenforcementfacetsthroughtownhallmeetingsfeaturingdiscussionsbetween localresidentsandpanelsoflocalandnationalexperts.DEAalsoprovidesseveralinformativepam phletsregardingsyntheticdrugsanddivertedpharmaceuticals,includingEcstasyandPredatory 44 DrugsandTipsforParents: TheTruthAboutClubDrugs.
2. Recommendations
DevelopanEarlyWarningandResponseSystem: (NDIC,DOJ,HHS,ONDCP) Establishacomprehensive,interagency,earlywarningandresponsesystemtodetecttheemergence ofnewdrugsandtrends.AppendixAlaysoutthepossibleparametersofsuchasystemindetail,but itshouldincludeincreasedresearcheffortstodevelopanddisseminateaccurate,reliable,andcost 45 effectivetestsforidentifyingnewsyntheticdrugusetrends. Particularfocusshouldbegivento 46 earlieridentificationandroutinedetectionoflicitlyproduceddrugswithhighillicitusepotential.
EnhancePublicOutreachEffortsFocusingonSyntheticDrugs: (SAMHSA, DOJ,ONDCP)
Developamultimediaeducationcampaignontheconsumptionofsyntheticdrugs,focusinginitially
onmethamphetamine.Theprogramshould,asappropriate,incorporatemessagesabouttheenvi
ronmentalthreatandriskstochildrenfromclandestinelabs.Ensureadequatedisseminationofall
pertinentmaterialsandinformationonsyntheticdrugsthroughtheDepartmentofEducations
OfficeofSafeandDrugFreeSchools.
ImproveEducationandTrainingonPharmaceuticals: (DEA, FDA,SAMHSA,ONDCP)
Ensureproductlabelingthatclearlyarticulatesconditionsforthesafeandeffectiveuseofcontrolled
substances,includingfulldisclosureofsafetyissuesassociatedwithpharmaceuticals.Developa
mechanismforthewiderdisseminationandcompletionofapprovedContinuingMedicalEducation
coursesforphysicianswhoprescribecontrolledsubstances.DevelopInternetpublicservice
announcementsregardingthepotentialdangersandillegalityofonlinedirectpurchasesofcon
trolledsubstances.
DevelopBestPracticestoAssistDrugEndangeredChildren: (HHS, EPA,DOJ,DEA,ONDCP)
Developprotocolsforassistingdrugendangeredchildrenthatgenerallyaddressstafftraining;roles
andresponsibilitiesofinterveningagencies;appropriatereporting,crossreporting,information
sharing,andconfidentiality;safetyproceduresforchildren,families,andrespondingpersonnel;
interviewingprocedures;evidencecollectionandpreservationprocedures;medicalcareprocedures;
andcommunityresourcedevelopment.
ResearchandDevelopTargetedPreventionPrograms: (NIDA, ONDCP)
Supportresearchontheinitiationofmethamphetamineuseandtheprogressionofuseleadingto
addiction. Programsshouldbedevelopedtotargethighriskgroupsorcommunitiesandtoincrease
communityinvolvementinpreventionefforts.
ImproveDataonAfflictedGeographicAreas: (NDIC, SAMHSA,DOJ,ONDCP)
BuildonexistingGeographicalInformationSystem(GIS)resourcesanddatabasestointegratefeder
allymandateddrugtestresults,crimelaboratoryevidenceanalysis,populationdemographics,and
othermeaningfuldatapertainingtosyntheticdrugsanddivertedpharmaceuticalsinamannerthat
47 supportsgeographicallybasedpreventionandinterventionefforts.
29
ExaminetheUseofPrescriptionNarcotics: (NIDA, SAMHSA,FDA,NIJ,DEA) Assessthescopeandmagnitudeofthelicitandillicituseofprescriptionnarcoticanalgesics,in particularOxyContin,includingthepursuitofadditionaldatasourcesincooperationwiththeFood andDrugAdministration(FDA),theNationalInstituteforJustice(NIJ),privateentities,andothers.
B. Treatment
1. CurrentEfforts
Whilepreventionprogramsareimportantforensuringthatindividualsdonotfallvictimtothelure ofillegaldrugs,treatmentinitiativesarecriticalforprovidingthosewhododevelopadependencywith anopportunitytoreclaimcontroloftheirlives.Treatmentisthereforeakeycomponentofour nationaleffortstoeliminatethescourgeofillegaldrugsfromsociety.Theresearchbasedeffortsof NIDAandSAMHSAformthefoundationforallfutureprogressinthetreatmentofsyntheticand divertedpharmaceuticaldrugdependencies. Inadditiontothemajorroleitplaysinpreventionbasedresearch,NIDAisalsoaleaderinstudies ofthepharmacologyandtoxicityofmethamphetamine,MDMA,andothersyntheticdrugs,andin developingtreatmentsfortheirabuse.Forexample,in2002,NIDAlaunchedaMethamphetamine ClinicalProgramtoimplementrecommendationsoftheMethamphetamineAddictionTreatment ThinkTank.NIDAhasalsoestablishedclinicaltreatmenttrialsandstudiesinvolvingbehavioralthera piesandmedicationalternativesformethamphetaminedependentpatientsinseveralcitiesplagued bythemethamphetamineepidemic(includingDesMoines,KansasCity,SanAntonio,LosAngeles,San Diego,andHonolulu).FollowinguponconferencesdedicatedtoGHBandMDMAin2000and2001 respectively,NIDAisnowassessingneedsandstrategieswithrespecttoMDMAandGHBabuse treatmentthroughvenuessuchasaclubdrugworkinggroup,apanelofexpertsfromacrossthe Institute.Moreover,asaresultofthemanyinsightsthathavebeendevelopedthroughtheresearch thatitsupportsrelatedtotreatmentsfordrugaddictions,NIDAhasproducedseveralhelpful pamphlets,includingPrinciplesofDrugAddictionTreatment: AResearchBasedGuide,whichoutlines theessentialcomponentsofeffectivetreatmentprograms. SAMHSAhasalsobeenactivelyinvolvedineffortsaimedatthetreatmentofsyntheticanddiverted pharmaceuticaldruguse.SAMHSAmaintainstreatmentrelatedonlinetoolsforfindingaqualified treatmentcenter(theSubstanceAbuseTreatmentFacilityLocator),exchanginginformationwith concernedStateagencies(theTreatmentImprovementExchange),andaccessingtheNational 48 ClearinghouseforAlcoholandDrugInformation. SAMHSAsCenterforSubstanceAbuseTreatment (CSAT)coordinatesseveralprogramsthathelpcommunitiesestablisheffectivetreatmentservicesfor emergingdrugepidemics,andhasrecentlytargetedtheexpansionofmethamphetaminetreatmentin certaingeographicalareas.CSAThasreleasedabooktitledTreatmentforStimulantAbuse aswell, whichoutlinesacomprehensiveseriesofbestpracticesguidelines,includingtreatmentapproaches withdocumentedsuccess,practicalapplications,andexplanationsoftreatmentissuesforspecial groupsandsettings. Additionally,CSATadministerstheProgramsofRegionalandNationalSignificance,whichprovide fundingtoincreasetheavailabilityandstudytheefficacyoftreatmentprogramsforsyntheticand otherdrugs,andtodisseminateinformationlearnedfromresearchontreatmentsofsubstance dependencies.Inparticular,theProgramshaveallocatedresourcesfordeterminingtheeffectiveness ofavailablemethamphetamineaddictiontreatmentsandthecosteffectivenessofthevarioustreat
30
mentapproaches.Forexample,CSAThasawardedgrantsfortesting,andacontractforconducting followupstudieson,a16weektreatmentplanformethamphetamineusedevelopedbyUCLAs IntegratedSubstanceAbusePrograms(ISAP)/MatrixInstitute.Duringthisvanguardthreeyearstudy, thegrantssupportedtrainingoftreatmentandresearchstaff,aswellasdevelopmentofadditional clinicalcapacitysupportingapproximately1,000clientsateightsites.Followonresearchcontinues.
2. Recommendations
IncreaseTreatmentCapacity: (HHS)
Assesstreatmentneedsforsyntheticanddivertedpharmaceuticaldrugaddictionand,ifnecessary,
expandthatcapacityinthecommunityandincorrectionalfacilities.Particularemphasisshouldbe
giventothedevelopmentofadditionaltreatmentcapacityformethamphetamineusers,toinclude
followupservicesthataddresstheprotractedrecoveryperiodassociatedwithmethamphetamine
dependency.
ResearchTreatmentforSyntheticDrugAbuse: (HHS, NIDA,SAMHSA,ONDCP)
Increaseresearchonthephysicalandpsychologicaleffectsofmethamphetamineandothersynthetic
drugs,aswellasonthedevelopmentofeffectivetreatmentprotocolsforsyntheticdrugs.
DevelopGuidelinesforJuvenileDrugTreatment: (NIDA, SAMHSA)
Fundresearchon,andpursuethedevelopmentof,guidelineswithrespecttothetreatmentofjuve
niles,whooftenarenotadequatelyservedinexistingdrugtreatmentprogramsdesignedforadults.
DevelopEarlyResponseTreatmentProtocols: (NIDA, SAMHSA)
Developanddisseminateearlyresponseprotocolsaddressingrequestsfortreatmentofdependency
onemergingsyntheticdrugsanddivertedpharmaceuticals.
StudyOptionsforCriminalJusticeSystemTreatment: (NIDA, SAMHSA,NIJ)
Investinadditionalstudiesontheefficacyofvariouscomprehensivetreatmentprogramsforsynthetic
drugabuseandontheiradaptabilitytodiverseindividualandcommunityneeds,especiallythose
uniquetothecriminaljusticesystem.
ExpandDisseminationofTreatmentBestPractices: (NIDA, SAMHSA,ONDCP,DEA)
Expandcapabilitiestodisseminatepertinentresearchresultsandbestpracticestrainingtechniques
aspartoftheoverallefforttoincreaseaccesstoeffectivetreatmentsfordependenciesonsynthetic
anddivertedpharmaceuticaldrugs.
C. RegulationofChemicalsandDrugs
1.CurrentEfforts a. Introduction
Regulatorymeasurestocontrolkeyprecursorandessentialchemicalsarecriticaltopreventingthe productionoftheclandestinelysynthesizeddrugsdiscussedinthisActionPlan.Effectivechemical controlhasincreasedthedifficulty,risk,andcostofmethamphetamineproduction.IntheUnited States,DEAhastheleadroleinthisendeavor.However,twoorganizationswithintheDepartmentof
31
HomelandSecuritytheBureauofImmigrationandCustomsEnforcement(ICE)andtheBureauof CustomsandBorderProtection(CBP)performintegralfunctionsontheimport/exportsideofthe chemicalcontrolsystem.AstheagenciessupervisingU.S.portsofentry,theseorganizationsmoni torcommercialimportsandexportsofchemicalstoensurecompliancewithDEAregistrationand permitrequirements.
CHEMICALSUSEDINMETHAMPHETAMINEPRODUCTION
CHEMICAL
Pseudoephedrine
HAZARDS
Ingestionofdosesgreaterthan240mg.causeshypertension,arrhythmia,anxiety,dizziness, andvomiting.Ingestionofdosesgreaterthan600mg.canleadtorenalfailureandseizures. Extremelyflammable,posingafireriskinandaroundthelaboratory.Inhalation/ingestion causesseveregastricirritation,narcosis,orcoma. Inhalationcancausesuddencardiacdeathorseverelungdamage.Corrosiveifingested. Inhalationcausesedemaoftherespiratorytractandasphyxia.Contactwithvaporsdamages eyesandmucousmembranes. Mayexplodeoncontactorfriction.Ignitesifheatedabove260 F.Vaporfromignited phosphorusseverelyirritatesthenose,throat,lungs,andeyes. ExtremelydangeroussubstituteforRedPhosphorus.Ifoverheated,deadlyphosphinegasis released.Posesaseriousfireandexplosionhazard. Extremelycaustictoallbodytissues.Reactsviolentlywithwaterandposesafireor explosionhazard. Acorrosiveacidwithvaporsthatareirritatingtotherespiratorysystem,eyes,andskin. Ifingested,causessevereinternalirritationanddamagethatmaycausedeath. Givesoffvaporthatisirritatingtorespiratorysystemandeyes.Solidformirritatestheeyes andmayburnskin.Ifingested,itwillcausesevereinternaldamage. Ingestionofgreaterthan75mg.causeshypertension,arrhythmia,anxiety,anddizziness. Quantitiesgreaterthan300mg.canleadtorenalfailure,seizures,stroke,anddeath.
o
Acetone/EthylAlcohol
Freon
AnhydrousAmmonia
RedPhosphorus
HypophosphorusAcid
LithiumMetal
HydriodicAcid
IodineCrystals
Phenylpropanolamine
Source: USDepartmentofJustice, InformationBulletin: ChildrenatRisk(7/2002)
Sincethechemicalindustryishighlyinternational,multilateralcooperationinchemicalcontrolis critical.TheUnitedStatesiscurrentlyinvolvedinseveralmultilateralinitiativestotrackchemicals usedinthemanufactureofamphetamine,methamphetamine,amphetaminetypestimulantssuch asMDMA,andothersynthetics,withthegoalofinvolvingChina,India,theNetherlands,Canada, Mexico,EasternEuropeannationssuchasPolandandtheCzechRepublic,andothercountriesin cooperativechemicalcontrolefforts.Thelegalframeworkforinternationalchemicalcontrolispro videdbyArticle12ofthe1988UnitedNations(UN)ConventionagainstIllicitTrafficinNarcotic DrugsandPsychotropicSubstances.ThisConventionestablishesobligationsandinternationalstan
32
dardsformembernationstocontroldomesticandinternationalchemicalcommerceandprevent thediversionof23specifiedchemicals.PartiestotheConventionpledgetocooperatewithone anothertowardthisobjective.Otherinternationalvehiclesthathavepromotedchemicalcontrol include:
TheJune1998UnitedNationsGeneralAssemblySpecialSession(UNGASS),atwhich
twoofthefiveactionplansadoptedaddressedprecursorsgenerallyandamphetamine typestimulantsandtheirprecursorsinparticular.
TheMay1997UnitedStates/EuropeanUnion(EU)ChemicalControlAgreement,which
includedacommitmenttoconsultandinformparticipatingnationsonshipmentsof controlledchemicalsubstancesinordertopreventtheirdiversionfromlegitimatetoillicit purposes;aFollowUpWorkingGroupcontinuestosolidifyU.S.EUcooperationin chemicalcontrol.
TheannualmeetingsoftheUNCommissiononNarcoticDrugs(CND),whichhighlight
emergingchemicalcontrolconcerns.
b. U.S. ChemicalControls
ThelinchpinofU.S.effortstocurtailinternationalchemicaldiversionisa15dayadvancenotifi cationrequirementthatenablesDEAtoverifythelegitimacyofaproposedshipmentandsuspend 50 suspicioustransactions. In1995,DEAinitiatedaletterofnonobjection(LONO)processfor importsofephedrineandpseudoephedrinefromChina,theCzechRepublic,andIndia.Thissystem facilitatesinternationalcooperationunderthe1988UNConventionandmeetstheneedsofgovern 51 mentsinchemicalexportingcountriestoensurethatchemicalexportsareforlegitimatepurposes. ThehistoryofchemicalregulationandrelatedenforcementprovisionsintheUnitedStateshas followedacontinuingcycleofgovernmentactionandtraffickerreaction.Eachnewregulatory measuregivesrisetooneormorecountermeasuresbytraffickers,butthesystemoflawsandregu lationshas,onthewhole,madeitmoredifficultandcostlyfortraffickerstoprocurethechemicals theyneed. Followingisasummaryofmajorlegislation:
ComprehensivechemicalcontrolbeganinearnestintheUnitedStateswiththeChemical
DiversionandTraffickingActof1988,whichestablishedthebasicschemeofchemical regulationinplacetodayfor20chemicals,includingtwelveprecursorsandeight 52 essentialchemicals.
TheCrimeControlActof1990addedtwelvechemicalstothelistofprecursors.
53
TheDomesticChemicalDiversionandControlActof1993broughtoverthecounter
ephedrineproductsunderregulatorycontrol,requiredregistrationofhandlersofListI chemicals(mostofwhichwereformerlytermedprecursors),andincreasedDEAs flexibilityinapplyingthe15dayadvancenoticerequirementsforexportsandimportsof 54 specifiedlistedchemicalstospecifiedcountries.
TheComprehensiveMethamphetamineControlActof1996(MCA):(1)narrowedtheexemp
tionforsalesofcertaindrugproductscontainingmethamphetamineandamphetaminepre cursorchemicalsbyregulatingretailsalesof24gramsormore,althoughitcreatedablister packexemptiontothatrule;(2)requiredmonthlyreportingbymailorderfirmsthatsell
33
methamphetamineandamphetamineprecursorchemicals;and(3)addediodineand 55 hydrochloricgastothelistofregulatedchemicals.
Thenewestlegislationtargetingtheillicitmanufactureanddistributionofmethamphetamine
istheMethamphetamineAntiProliferationAct(MAPA),signedintolawonOctober17,2000. MAPAretainedtheblisterpackexemptionestablishedbytheComprehensive MethamphetamineControlActof1996.However,itamendedthatActbyreducingtheretail salerecordkeepingandreportingthresholdquantityofnonexemptpseudoephedrineand phenylpropanolamineproductstoninegramsinasingletransactionwithamaximumthree grampackagesize. Anincreasinglycriticallayerofchemicalcontroloccursatthestatelevel.Somestatesthathave feltthebruntoftheclandestinelaboratoryproblemnotablyintheWestandMidwesthave imposedrestrictionsonchemicalsalesthatsupplementfederallaw.AppendixFincludesashort descriptionoftherecentamendmentsintheOklahomaandMissouristatechemicalcontrollaws.In Oklahoma,productscontainingpseudoephedrinemaybesoldonlybyalicensedpharmacistorphar macytechnician,andpurchasersmustsignalogbookandpresentidentification.Thislaw,enacted inApril2004,alreadyappearstohaveledtoasharpreductioninlabactivityinthatstate.Aggressive chemicalcontrolschemesofthistypeareexamplesofstatesperformingafunctionhonoredby SupremeCourtdecisionsovertheyears,toservetheirroleaslaboratoriesforexperimentationto 56 devisevarioussolutionswherethebestsolutionisfarfromclear. Statesmaywellleadthenext waveofinnovationintheareaofchemicalcontrol,implementingapproachesthatcouldserveas modelsforotherstatesandevenfortheFederalGovernment. Thefederallegal/regulatorysystemremainsdynamic.AsDEAcontinuestotightenthesystem,the listofchemicalssubjecttocontrolhasexpanded.Inadditiontotheitemslistedinthesummary above,regulationseffectiveNovember16,2001maderedphosphorous,whitephosphorous,and 57 hypophosphorousacidListIchemicals. InconsultationwiththeDepartmentofJustice,DEAprom ulgatednewchemicalmixtureregulationstoclarifywhichcharacteristicsandconcentrationsof dietaryandnutritionalsupplementsmanyofwhichcontainephedrineandpseudoephedrinewill 58 fallunderthechemicalregulatoryscheme. However,theregulatorysystemismeaningfulonlyinsofarasitisenforced.DEAhasincreasedits scrutinyofbusinessesapplicationsforregistrationtodistribute,manufacture,import,orexportListI chemicals.Preregistrationscreeningismorerigorousthanever.Forexample,between2003and earlyJune2004,43firmssurrenderedtheirregistrations,threeregistrationswererevoked,19were denied,and358applicationswerewithdrawn.DEAhasalsointensifieditsadministrativelitigation againstregistrantsandapplicants.FromJanuary2003throughJune2004,DEAissued38ordersto showcausewhyregistrationsforListIchemicalsshouldnotberevokedorwhypendingapplications shouldnotbedenied. Ofthose38orders,threeinvolvedimmediatesuspensionbasedonathreatto publichealthandsafety.ThenumberofchemicalinvestigationsinitiatedbyDEAsinceFY1999has climbedfrom133casesinFY1999to528casesinFY2003. DEAhasincreasedscrutinyofmethamphetaminerelatedchemicalimportsinparticular.The tablesbelowshowtheamountsofrawmaterialandthenumberoftabletsofbulkpseudoephedrine andephedrinethatwereimportedintotheUnitedStatesduringcalendaryear2003andJanuary March2004,andhowmuchofithasbeenwithdrawn.Thelownumberofshipmentswithdrawnis significantandmaybeattributedtoseveralfactors:(1)closerscrutinyofpotentialimports;
34
(2)declineintheaffectedchemicalregistrantpopulationduetocriminalandcivilactionsagainst roguecompanies;and/or(3)successfuluseoftheordertoshowcauseprocessasacontrolmecha nism. DEAsabilitytovigorouslyinvestigatepotentialshipmentsforpossibledownstreamdiversion priortoimportintotheU.S.hasforcedimporterseithertocomplywithfederalregulationsorreduce theamountsoftheirimports.Often,importerswillwithdrawtheirrequestforanimportwhencon cernsaboutdownstreamdiversionareexpressedbyDEA,optingtoavoidapossibleDEAadministra tiveproceedingtosuspendasuspiciousshipment.

Raw&TabletPseudoephedrineImports Raw&TabletEphedrineImports
Year
Total Total Total Total Percent Percent Permitted Stopped Permitted Stopped Withdrawn Withdrawn (kilograms) (kilograms) (kilograms) (kilograms) 707,528.3 265,033.8 900 4,000 <1% <1% 208,815.6 79,492.27 4,297 500 <1% <1%
2003 2004 (March)
Figure22: RawandtabletPseudoephedrineandEphedrineImports, CalendarYear2003March200459
Animportantcomponentofchemicalcontrolislawenforcementspartnershipwiththeretailand 60 pharmaceuticalindustries. DEAofficialsintheOfficeofDiversionControlmetinSeptember2002 withrepresentativesofdistributorsandwholesalersoflistedchemicalproductsandinFebruary2003 withrepresentativesofretailers.Anationalchemicalindustryconferencewasheldinbostonin2004. Outsideofthesemeetings,somecompanieshavetakensignificantstepsontheirown.Someretail chainshavevoluntarilydecidedtolimitthesalesvolumesofpseudoephedrinepillsatlevelsbelow thoserequiredbystateandfederallaw.Additionally,somepharmaceuticalcompaniesareattempt ingtodevelopnewtechnologiesthatwouldhindermethamphetaminetraffickersabilitytousethe 61 pseudoephedrineinlicitpharmaceuticalproductsforillicitpurposes.
c. TheInternationalChallenge
ThesmugglingofpseudoephedrineproductsintotheUnitedStatesfromCanadaandother nationsposesamajorregulatory,lawenforcement,anddiplomaticchallenge.Sincemostraw(or bulk)pseudoephedrineisnotproducedintheAmericas(withtheexceptionoftwoU.S.firmsthat convertimportedephedrineintopseudoephedrine),Canadianfirms,likemostU.S.firms,import thesechemicalsinbulkquantities,processthemintodosageforms,anddistributethedrugproducts indomesticandinternationalcommerce.Untilrecently,Canadahadnocomprehensivechemical controllaworsystem.Thatshortcominghasundoubtedlyfacilitatedexcessiveimportsofbulk chemicalsbyCanadianfirmsfromoverseas,aswellasthediversionandsmugglingofpseu doephedrinepillsfromCanadatotheUnitedStates. U.S.lawenforcementagenciesseized236millionpseudoephedrinetabletsofCanadianoriginin 2002and206millionCanadiantabletsin2001.Lawenforcementauthoritieshavealsodiscovered 1,000and23,000countbottlesand80,000countbucketsofCanadianpseudoephedrinetabletsin largeWestCoastmethamphetaminelabsoperatedbyMexicobasedcriminalgroups.Additionally, recentseizureshaveyieldedunprocessedpseudoephedrinepowder,aswellasephedrinetablets,
35
whichareusedinterchangeablywithpseudoephedrinetabletsintheclandestineproductionof methamphetamine. In2003,Canadatookstepstowardamoreeffectivechemicalcontrolsystem.ThePrecursorControl Regulations,effectiveinJanuary2003,imposeregistration,licensing,andimport/exportpermit requirements,alladministeredbytheCanadianHealthMinistry,commonlyknownasHealth 62 Canada. Lawenforcementauthoritieshavenotedasharpdecreaseinseizuresofsomeprecursors fromCanada,particularlypseudoephedrine,sinceaseriesofarrestsweremadeaspartofOperation MountainExpress(discussedindetailintheLawEnforcementsection,below).ThenewCanadian PrecursorControlRegulationsmayhavealsocontributedtothispositivetrend. Concurrently,perhapsduetotheincreasedlawenforcementfocusonpseudoepehdrine,increases havebeenobservedintheamountofephedrineimportedintoCanadaandinephedrineseizures alongtheU.S.Canadaborder.ThissuggeststhatbulkpseudoephedrinemovementsfromCanada supportingmethamphetamineproductionmayhavebeenpartiallyreplacedbybulkephedrineship ments.Forexample,lawenforcementpersonnelintercepteda600poundloadofbulkephedrinenear DetroitinMay2003.AuthoritiesinCanadaandtheUnitedStateswillcontinuetomonitortheresults ofthelatestCanadianregulations. Nonetheless,traffickersmaybeshiftingtheirchemicaldiversioneffortsandmanufacturingopera tionssouthtoMexico.InMarchandApril2003,authoritiesmadefourlargeseizurestotaling22mil lionpseudoephedrinetabletsfromAsiadestinedforMexico,anddozensofsimilar,priorshipments wereidentified.Mexicanpressreportsofclandestinelabdiscoveriessignalanapparentincreasein methamphetamineproduction,especiallyintheMexicali/Tijuanaarea. SinceMay1996,theU.S.andMexicohaveworkedformallythroughaBilateralChemicalControl WorkingGroup,whichmeetsasneededtoexchangeinformationonregulatorysystemsandshipment data,todiscusspossiblejointinitiatives,andtosharecaseinformation.ThecurrentMexicangovern menthasshownrevitalizedinterestincooperationagainstthediversionofchemicalsaswellasphar maceuticaldrugs.DEAisnowworkingtohelpMexicanlawenforcementofficialstoidentifyandseize clandestinemethamphetaminelabs,andtoinvestigateandprosecutetheassociatedchemicaland drugtraffickers. Onthemultilateralfront,DEAhasencouragedinternationalconsensusforvoluntary,informal, flexible,andrapidsystemsofinternationalinformationexchangeonprecursorchemicalshipments. Forexample,undertheMultilateralChemicalReportingInitiative(MCRI),countriesreportchemical transactionsonasingleform,usingtheInternationalNarcoticsControlBoard(INCB),aUNbased body,asaclearinghouse.Inanefforttargetingsyntheticdrugsinparticular,ProjectPRISMwasinitiat edin2002inameetingsponsoredbytheINCBandhostedbytheUnitedStatesandEU.Thisopera tioninvolvessome38countriesthataremajormanufacturers,exporters,importers,ortransitcoun triesofchemicalsdivertedtosynthesizeamphetaminetypestimulants,suchasMDMA/Ecstasyand methamphetamine.Theinitiativeassistsgovernmentsindevelopingandimplementingoperating procedurestomoreeffectivelysupervisetradeintheprecursorsofamphetaminetypestimulantsin ordertopreventdiversion. DEAalsoconductsoneandtwoweektrainingseminarsonClandestineLaboratoryandPrecursor ChemicalDiversionInvestigationsandiscoordinatinganelevencountryinitiativewithcountriesin theFarEasttopreventthediversionofMDMAprecursorchemicals.Inaddition,DEAisworking directlywithhostnationsthroughtheirattachesinkeyFarEastlocations,includingChina,HongKong, andThailand. 36
Theplacementofinternationalorganizations,particularlytheINCB,inleadrolesinmultilateral chemicalcooperationencouragesparticipationbycountriesthatmightbereluctanttoparticipatein anoperationledbyanysinglecountryorgroupofcountries.TheannualmeetingoftheUN CommissiononNarcoticDrugsisthebest,andmostvisible,vehicleforencouragingtheINCBtotakea leadrole,toshapehowitperformsthatrole,andtopromoteparticipationbythemostrelevantcoun tries.Othermultilateralorganizations,suchastheOrganizationofAmericanStatesInterAmerican DrugAbuseControlCommission(OASCICAD),arealsoprovinginstrumentalinbuildingregionaland internationalcoordination,cooperation,andadoptionofharmonizedcontrolprocedures. Thecurrentinternationalchemicalcontrolsystemisnotwithoutshortcomings.Ithasevolvedon 63 anadhocbasis,drugbydrug,chemicalbychemical,operationbyoperation. Itisvoluntary;some countriesdonotparticipate,andtraffickersareavoidingcontrolsbyshippingtothosecountries.Also, somecountriesaremorediligentthanothersininvestigatingshipmentsafterreceivingpreexport notifications.Ingeneral,thesystem,whichisflexibleandinformalbydesign,wouldnowbenefitfrom becomingmoreuniversal,formal,andinstitutionalized. Inaddition,countriesapplythe1988UNConventionprovisionsvariably.Forexample,somechem icalimportingcountrieshavenotaskedtheUNforpreexportnotificationpursuanttoArticle12(10)of theConvention.Somecriticalexportingcountriesdonotimposelegalcontrolsonprecursorchemi calsthatarecontainedinpharmaceuticalpreparationsalapsewhichhaspermittedtheunnotified 64 exportationanddiversionofmillionsofpseudoephedrinepills. Anotherobstacletoeffectivenationalandinternationalchemicalcontrolisthatmanycountries placeresponsibilityforchemicalcontrolwithhealthorcommerceministries.Thenaturaltendencyof theseministriesistoconsiderchemicalcontrolahealthorcommercialissue,andnotalawenforce mentissue.Lawenforcementagenciesaremoreorientedtoexchangeinformationaboutchemical shipmentsandtoactonsuspiciousinformation.(IntheUnitedStates,DEAhasresponsibilityforboth chemicalregulationandenforcement). TheUnitedStateshasbeensuccessfulatconvincingourinternationalpartnersoftheimportanceof chemicalcontrol,stressingthefactthateffectivedomesticcontrolandinternationalcooperation requireaviableenforcementcomponent.Wehaveseenothercountriesbuildcooperationbetween theirlawenforcementagenciesandtheirhealthandcommerceministries.Diplomaticagreements havealsofacilitatedcooperationbetweensometimesbureaucraticandturfconsciousministries.For example,the1997chemicalcontrolagreementbetweentheUnitedStatesandtheEUhasbeeninstru mentalinfacilitatingourcooperationwithindividualEUmemberlawenforcementagencies,despite thefactthatresponsibilityforchemicalcontrolmayrestwithhealthorcommerceministries.
d. ChemicalControlResults
Chemicalcontrolhasbeenanareaoflargelyunheraldedlawenforcementsuccess.Takingtogether theinternational,federal,andstatemeasures,combinedwithvoluntaryeffortsbyprivateindustry, chemicalcontrolremainsapromising,proactiveapproachtodisruptingsyntheticdrugproductionand trafficking. Onewaytotracksuccess,inchemicalcontrolasinotherefforts,istomonitortheavailability,price, andpurityofsyntheticdrugs.Althoughdatavaryovertimeandbyregion,methamphetamineprices havegenerallyheldsteadywithinarangesince1998.In2003,methamphetaminesoldfor$3,000to $12,000perpoundand$270to$1,500perounce.Themarkettrendisdecidedlytowardstheiceor
37
crystalformofmethamphetamine;pricesforicehavealsobeensteadysinceabout2001,alittlehigh erthanthenoniceform.Methamphetaminepuritytrendspaintamoresoberingpicture,forpurity hasrisensteadilysinceabout1999,asshowninthefigurebelow.However,thedatainthischart, showingaveragepurityofdrugsamplesat60%forthebeginningof2004,shouldbekeptinperspec tive:puritylevelsarestillwellbelowthe1994averageof72%.
70
60
50
40
30
20
10
0 CY1999 CY2000 CY2001 CY2002 CY2003 CY2004
Figure23: Bargraphofaveragemethamphetaminepurityfrom1999through March2004inseizedsamples. Source: DEASTRIDEseizuredata Onamoreencouragingnote,chemicalpricesontheillegalgraymarkethaveriseninawaythat continuestoindicatescarcity.Atraffickermightpayasmuchas$4,800foracaseof144bottlesof pseudoephedrinethathasalegitimatemarketof$1,000.Redphosphorous,usedtomakehydriodic acidintheephedrinereductionmethodofmethamphetamineproduction,sellsforapproximately $500perpound(approximately450grams)onthestreet,comparedtoitslicitmarketpriceofapproxi mately$34for500gramsinlegitimatecommerce.Redphosphorousalsosellsforabout$1pergram atInternetauctionsites. Overall,thepriceandpuritydatasuggestthataggressivenewapproachesmaybeneededonthe regulatoryfrontifthenationistomakeadditionalheadwayagainsttheproblemofmethampheta mineproduction.
e. ControlofOxyContinandOtherDivertedPharmaceuticalProducts
Controllingthediversionofpharmaceuticalproductscontainingcontrolledsubstances,including OxyContin,isasharedfederalstateresponsibility.Federallawsfocusontheimport,export, manufacturing,anddistributionlevels.Forexample,therearefederalrequirementsfortracking transactionsfromdistributorstotheretailpharmacyorhospitallevelandforreportingeventsthat compromisetheclosedsystemofcontrolledsubstancedistribution(suchastheftsorsignificant losses). Statelawsfocusonthedispensinglevel,mostlyinpharmacies. Controlofprescriptionsanddispensingisprimarilyastateresponsibility.Prescriptionmonitoring programscanenablestatestoexercisegreatercontrolinthisareabyfacilitatingthecollection,analy sis,andreportingofinformationontheprescribing,dispensing,anduseofpharmaceuticals.This
38
datacanbeusedtoalertlicensing,regulatory,orlawenforcementofficialstocasesofinappropriate prescribingordispensingofcontrolledsubstances. Theeffectivenessoftheseprescriptionmonitoringprogramshasalreadybeendemonstrated,as explainedinthe2004NationalDrugControlStrategy.OneyearafterNevadaestablisheditsprescrip tionmonitoringprogramin1997,forexample,thenumberofnarcoticdrugdosesdispensedtosus pectedabuserswascutby46percent.TheStrategyalsopointsoutthatin2002thefivestateswith thelowestnumberofOxyContinprescriptionspercapitaallhadprescriptionmonitoringprograms, whilethefivestateswiththehighestnumberdidnot. Twentystatescurrentlyhavesomeformofprescriptionmonitoringprograminplace,andseveral othershaveprogramsunderdevelopment.Allremainingstatesshouldbeurgedtodevelopprescrip tionmonitoringprogramsoftheirown.TheNationalAllianceforModelStateDrugLaws(NAMSDL) hascreatedseveralmodelprogramsandcanprovidesupportfortheevaluationandinitiationofdrug monitoringprograms.
2. Recommendations
SupportStrongerStateControlsonPrecursorChemicals: (DOJ,ONDCP,DEA)
Statesthatfacesignificantlevelsofclandestinelabactivityandchemicaldiversionareurgedtocon
sidertheimpositionofmorestringentcontrolsthanthosecurrentlyinplaceatthefederallevel.
Severalstates,notablyOklahoma,haverecentlyenactedstrictretaillevelcontrols.(SeeAppendixF.)
Additionalstatelevelcontrolscouldinclude,forexample:allowingonlylicensedpharmacistsand
pharmacytechnicianstosellproductscontainingprecursorchemicals;placingsuchproductsbehind
thesalescounterand/orinalockeddisplaycase;purchaselimitsimposedonatransactionand/or
monthlybasis(withanappropriatetrackingmechanism);andrequirementsofcustomeridentifica
tionsalesrecordkeeping.
RemovetheBlisterPackExemption: (DEA,DOJ)
Supportlegislationthatremovestheblisterpackexemptionandeliminatesdistinctionsbasedonthe
65 formofpackaging,asrecommendedinDEAsNovember2001reporttoCongress. RegulateChemicalSpotMarket: (DEA,DOJ) 66 Asanextensionofexistingauthorityoverimports, lawenforcementshouldseekthelegislative authoritytoregulatesalesofbulkchemicalsonthedomesticspotmarketbynotificationand 67 approvalofanydeviationsinquantityorcustomerfromtheimportdeclaration.
DetermineLicitChemicalNeeds: (DEA,DOJ,ONDCP)
Incooperationwithindustry,commissionastatisticalanalysistoestimatethelegitimateneedsfor
pseudoephedrineandephedrineproductsincludingcombinationproductssuchasephedrinewith
guaifenesinbothnationwideandregionally.
EnableImportControlsonBulkEphedrineandPseudoephedrine: (DEA,DOJ,ONDCP)
Seeklegislationthatwouldtreatthepostimportationhandlingofbulkephedrineandbulkpseu
doephedrineinasimilarmanner,forregulatorypurposes,asfederallawsnowtreatthepostimporta
tionprocessingofScheduleIandIIcontrolledsubstances.Imposesuchcontrolsonthesecritical
precursorsasareneededtolimitimportstothosenecessaryforlegitimatecommercialneedsandfor
68 maintenanceofeffectivecontroloverchemicaldiversion.
39
LimitOnlineChemicalSales: (DEA,DOJ)
Continueongoingeffortstoadvisetheownersandoperatorsofmajoronlineauctionwebsitesof
theuseofprecursorchemicalsinclandestinelabs,andurgethemtoconsiderbanningthesaleof
precursorchemicalsovertheirwebsites.
StrengthenCooperationwithMexico: (DEA,DOJ,State,ONDCP)
SolidifysignificantrecentadvancementsbyMexicotoincreasetheeffectivenessofbilateralchemi
calcontrolwiththeUnitedStatesthroughcontinuedpartnershipandmeetingswiththepertinent
Mexicancomponents,includingtheirdrugintelligencecenter(CENAPI),theFederalInvestigative
Agency(AFI),thechemicalregulatoryentityintheMinistryofHealth(COFEPRIS)andtheHealth
Commission.
EnhanceCoordinationandInformationExchangewithCanada: (DHS,ICE,CPB,DEA)
EnhanceongoingcoordinationwithCanadaCustomsandRevenueAgencyonborderdetection,tar
geting,andinterdictionefforts,andensureappropriatefocusbyCanadaU.S.jointIntegratedBorder
EnforcementTeamsontheprecursorchemicalandsyntheticdrugthreats.Furtherexpandthe
ongoingexchangeofinformationconcerningCanadianbusinessesinvolvedintheimportation,pro
duction,anddistributionofpseudoephedrineparticularlythosefirmswhoseproductshavefre
quentlybeendivertedorsmuggledintotheUnitedStates.
StrengthentheMultilateralChemicalControlSystem: (DEA,DOJ,State,ONDCP)
Garnerinternationalsupportformakingexistingmultilateralchemicalcontrolsmoreuniversal,for
mal,andwellsupportedbyinternationalinstitutions,includingUNbodiessuchastheInternational
NarcoticsControlBoardandregionalbodiessuchastheOrganizationofAmericanStatesInter
AmericanDrugAbuseControlCommission(CICAD).WorktorealizethefullpotentialofProject
PRISM,andbuildsupportfortheapplicationofthe1988UNConventiontopharmaceuticalprepa
rationscontainingprecursorchemicalsthatcanbeeasilyrecoveredforuseinillicitdrugproduction.
ExchangeInformationwithChemicalProducingCountries: (DEA,DHS,State,USTR)
Continueongoinginformationsharingeffortswiththecountriesthatproduceprecursorchemicals
usedtomakeamphetaminetypestimulants,particularlyChina,India,Germany,andtheCzech
Republic.
EducateStoreEmployees: (DEA,DOJ)
Buildingoneffortsbeguninanumberofstates,worktodevelopamodeltrainingprogramforphar
macists,retailmanagement,andstoreemployeesconcerningsuspiciouspseudoephedrinepurchas
es,aswellassuspicioussalesofchemicalsanditemsusedinthemanufactureofmethampheta
69 mine.
EncourageVoluntaryControlsbyRetailPharmaciesandStores: (DEA,DOJ,ONDCP)
Seekthevoluntaryparticipationofmajorretailchainsinprogramstocontrolpseudoephedrine
productsalesthroughrestrictionsonthequantitythatcanbepurchasedatasingletime.Alsosup
portthevoluntarymovementofpseudoephedrineproductsfromstoresopenshelvestobehind
70 pharmacycountersorothermannedcountersinretailsettingswherepharmaciesarenotonsite.
WorkwithManufacturerstoReformulateAbusedPharmaceuticalProducts: (DEA,FDA)
Continuetosupporttheeffortsoffirmsthatmanufacturefrequentlydivertedpharmaceuticaldrugs
toreformulatetheirproductssoastoreducediversionandabuse.Encouragemanufacturersto
40
exploremethodstorenderproductscontainingkeyprecursorssuchaspseudoephedrineineffective
intheclandestineproductionofmethamphetamineandpaincontrolproductssuchasOxyContin
lesssuitableforsnortingorinjection.
SupportStatePrescriptionMonitoringPrograms:(DEA,ONDCP)
Supportstatescreationofprescriptionmonitoringprogramsdesignedtodetectinappropriatepre
scribingpatternsandprescriptionfraud.Lawenforcementandregulatoryentitiesshouldhave
accesstoinformationincaseofapparentdiversionorinappropriateprescribingofcontrolledsub
stances,andsomeprovisionforstatetostatecommunicationofadverseinformationshouldbe
examined. Supportinglegislationshouldbeexplored.
D. LawEnforcement
1. CurrentEfforts
FollowingthereleaseoftheNationalMethamphetamineStrategyinApril1996,federallaw enforcementagencieshavelaunchedseveralinitiativestocombatthemethamphetamineproblem aswellasthreatsposedbyothersyntheticdrugsanddivertedpharmaceuticals.Someobstacles continuetohamperfullyeffectiveenforcement:lackofproperlytrainedpersonneltoconduct chemicalandlabinvestigationsandseizures;limitationsinfundingtosupportsuchpoliceworkand forcleanupoflabsites;andreluctanceofsomefederalandstateprosecutorstohandlechemical andsmalllabcases.Stepshavebeentaken,however,torectifyallofthesechallenges. DEAhasintensifieditsinstitutionalfocusonmethamphetamineandothersyntheticdrugsof abuse,establishingmethamphetamineinparticularasoneofitsfivepriorityareas.Anew DangerousDrugsandChemicalsSectionhasbeenformedatDEAHeadquarters,andmoremetham 71 phetaminetargetedteamsofagentsanddiversioninvestigatorsnowworkinfieldoffices. Through thePriorityTargetSystem,DEAprovidesfundingandoperationalassistancetochemicalandclub druginvestigationsthataredesignatedprioritytargetswithintheirrespectivefielddivisions. Ofparticularrelevancetoinvestigationsofclubandpredatorydrugs,DEAhasrecentlyestab lishedtwonewunitstosupportInternetbasedinvestigations.Overall,DEAhasimplementeda multifacetedinitiativetocounterthethreatposedbyclubandpredatorydrugsthroughraising publicawarenessandstrengtheninglawenforcement.Thisinitiative,OperationXOut,wasstart edinNovember2002,andisongoing.Itisexpectedtoincreasethenumberofclubandpredatory druginvestigationsnationwideandraisepublicawarenessoftheMDMAproblem.
a. Methamphetamine: PlanningandCoordination
TheNationalMethamphetamineChemicalsInitiative(NMCI),alongwithitscomponentregional groupsincludingtheCaliforniaPrecursorCommittee,theTriStatePrecursorCommittee(Arizona, NewMexico,andNevada),andtheMountainStatesPrecursorCommittee(Colorado,Montana, Utah,andWyoming),isanactivecoordinatingandtrainingmechanism.NMCIbringstogetherfed eral,state,andlocallawenforcementofficers,chemists,andintelligenceanalysts,aswellascriminal andcivilprosecutorstodiscusslegalandregulatoryissues,trends,andsuccessfulstrategiesthattar 72 getroguefirmsandviolatorsthatfunnelchemicalstoclandestinelaboratories. Overthepastfouryears,theNMCIhasestablishedworkinggroupstoaddressimportantissues, includingCanadianpseudoephedrine,thedomesticiodinediversionproblem,iodinesmuggling
41
fromMexico,theneedtoregulateredphosphorousandrelatedchemicals(whichhasbeenaccom plished),andvoluntaryinitiativeswithindustrytoreducediversionfromstores.Asaresultofthe recentarrestsofanumberofpeopleassociatedwithatreatment,storage,anddisposalfacilityin Arizona,theNMCIcreatedataskforcecomposedoffederal,state,andlocalofficialsinmultiple 73 statestoaddressthepotentialdiversionofhazardouschemicalsfromhazardouswastecontractors. TheNMCIhasalsosupportedthecreationanddisseminationofatrainingvideoforlawenforce mentandutilitypersonnelthatexplainsthehazardsassociatedwithclandestinedruglabs. HIDTApartnershipsarealsoresponsivetomethamphetaminetraffickingconcerns.Inparticular, theMidwestHIDTAfocusesontheinvestigationandreductionofmethamphetamineproduction anddistributioninanareacoveringsixstates(Iowa,Kansas,Missouri,Nebraska,NorthDakota,and SouthDakota).HIDTAfundsalsosupportNMCIactivities. Localagencieshandlethemajorityofsyntheticlaboratoryinvestigations,andsomestatesare performingtheirowncleanups.IntheappropriationsfortheDepartmentofJusticeinboth2002 and2003,DEAwasallocated$20milliontohelpstateandlocallawenforcementcleanupclandes 74 tinelabs. DEAisimplementingcontractsnationwidetoprovidecleanupservicesforDEAaswellas stateandlocallawenforcementagencies.DEAandtheEnvironmentalProtectionAgency(EPA)are alsoworkingtogethertoredraftguidelinesforcleaningupclandestinedruglaboratories.
b. MDMA: PlanningandCoordination
TheDepartmentofHomelandSecuritysBureauofImmigrationandCustomsEnforcement establishedtheNationalEcstasyTaskForcetoserveasacommandandcontrolcenterforcoordi natingMDMAinterdictionandinvestigationefforts,andalsotocollectactionableintelligenceon developingpatternsandtrendsfordisseminationtothefield.Increasedborderinterdictionefforts haveresultedintheidentificationandinvestigationoflargescaleMDMAsmugglingorganizations intheUnitedStatesaswellasinEurope.ConductedjointlybyDEA,foreignlawenforcemententi ties,andstateandlocalagencies,theseinvestigationshaveresultedinsignificantseizuresofMDMA andothersyntheticdrugsandcurrency,bothatandawayfromborderareas,andhaveledtothe arrestoforganizationmembersatalllevels. Inaddition,the28HIDTAregionalpartnershipsbetweenfederal,state,andlocallawenforce mentofficialsareevaluatingtheMDMAthreatintheirrespectiveregions.IncaseswheretheMDMA threatisjudgedtobesignificant,appropriateshiftsinenforcementstrategiesarebeingmade. Ontheinternationallevel,bilateralmeetingsinMarch2003betweentheUnitedStatesandthe Netherlandsyieldedanactionplanforenhancinglawenforcementandjudicialcooperationon drugs,crime,andterrorism.Thetwocountriesarenowworkingactivelyandcooperativelytoimple menttheseplans.ResultshaveincludedtheexchangeofinformationonU.S.andDutchjudicial systems;collaborationwithU.S.lawenforcementagenciesonmoreinvestigations;exchangeof informationonMDMAseizures;Dutchdevelopmentofariskindicatorandprofilesfortargeting traffickers;creationofabilateraldiscussiongroupondemandreduction;andcooperationinterna tionallyintheframeworkoftheINCBProjectPrism.
c. Training
Trainingeffortshavegoneforwardonseveralfronts.TheNMCIhasconductedtrainingonthe topicsofchemicalsinvestigationandprosecutionforhundredsoffederalcriminalandcivilprosecu
42
tors,intelligenceanalysts,andfederal,state,andlocalofficials.TheDepartmentofJusticesBureau ofJusticeAssistancehasalsofundedmethamphetaminerelatedtrainingprogramsforstateand localofficials.DEAhasintensifieditsdomestictrainingeffortsbyofferingClandestineLaboratory SafetySchoolsandOSHAcertifiedtrainingtofederal,state,andlocallawenforcementofficers. Since1998,DEAhasprovidedOSHAcertifiedlabtrainingtoover4,174policeofficersthroughout thenation,alongwithapproximately$2,500inequipmentforeachtrainee.Aspartofthebasicdrug trainingcourse,allnewDEAandFBIagentsreceivetrainingconcerningMDMAandotherclub andpredatorydrugslikeGHB.MDMAisalsocoveredinthetrainingthatDEAofferseachyearto approximately300stateandlocalinvestigatorsattheDrugUnitCommandersAcademyandto about150lawenforcementexecutivesattheFBINationalAcademy.Inaddition,DEAsChemical ControlSectionhastrainedhundredsofforeignofficialsinmorethantwodozencountriesonthe 75 diversionandsmugglingofallchemicalsusedinillicitdrugproduction.
d. Seizures, Investigations, andProsecutions

ThereadyavailabilityofpseudoephedrinefromCanadalargelymitigatedanytemporaryscarci tiesandhighergraymarketpricesforpseudoephedrineandillicitlyproducedmethamphetamine. DEAledenforcementinitiativesagainstroguechemicalfirms,particularlyOperationMountain Expressinthesummerof2000,havebeenextremelyeffectiveatcounteringthisillicitchemical flow.AfollowonOperationMountainExpresstargetedtraffickerswhoillegallysmuggledpseu doephedrinefromCanada,andculminatedinJanuary2002withthearrestsofover130defendants andtheseizureof35.8tonsofpseudoephedrine. InApril2003,anotherjointinvestigationOperationNorthernStarresultedinthearrestsof, amongothers,sixexecutivesofthreeCanadianchemicalcompaniesthatmanufacturedbulkpseu doephedrineinMontreal.ThedrugswerestockpiledinOttawa,thensmuggledacrosstheborderto methamphetaminemanufacturersintheUnitedStates.TheRoyalCanadianMountedPoliceand DEAweretheleadagenciesinthisinvestigation,whichultimatelyproducedarrestsin10citiesand 76 chargesagainstthethreeCanadianchemicalcompaniesinvolved. TheprogressofCBPandICEborderseizureinitiativesalsocontinues.AuthoritiesattheU.S. Mexicoborderseizedtwotonsofiodineinboth2001and2002.Similarseizurerateswerereported in2003aswell. Moreover,theDepartmentofJusticehasenhancedprosecutioneffortsforallsyntheticdrugs, particularlymethamphetamineandclubdrugs.ThenumberofOrganizedCrimeDrugEnforcement TaskForce(OCDETF)casesfocusingonmethamphetaminehasincreasedinrecentyears,bothin absolutenumbersandasapercentageofallOCDETFcases.Lawenforcementagenciesaredevoting moreresourcestoclubdruginvestigationsaswell.Oneprominentinvestigation,Operation Webslinger,wasamultiagencyefforttargetingtheillegalInternettraffickingofGHBanditsana logues,GBLand1,4butanediol.CulminatingonSeptember19,2002,theoperationledtothearrest ofmorethan130defendantsinover100citiesandtheseizureofmorethan25milliondosageunits. DEAagentsmorethantripledtheirworkhoursonclubdrugcasesbetween1999and2001(toover 250,000)andalsomademorethanthreetimesasmanyarrestsforclubdrugoffensesin2001(1,929 arrests)asin1999(577arrests). ThenumberofdefendantssentencedonfederalMDMAtraffickingchargeshasalsoclimbed from117defendantsin1999to372defendantsin2001,whichisthelastyearforwhichdataare 77 available. However,therehavebeenanumberofnotablefederalMDMAcasessincethebeginning
43
of2001. InAugust2001,55peoplewerearrested,includingtheleaderofapolydrugring,inconnec tionwiththedistributionofgreencloverMDMAtabletsinColorado;oneofthetabletscausedthe widelypublicizeddeathofa16yearoldgirl. AnMDMAandmethamphetaminelabinCalifornia capableofproducingmillionsoftabletswasseizedinOctoberof2001,and20peopleassociated withtheorganizationwerearrested.SeverallargescaleMDMAtraffickersfromIsrael,includingthe leaderoftheworldslargestMDMAsmugglingring,werearrestedin2002.Inaddition,anMDMA smugglingringoperatedbyDominicannationalsinNewYorkandtheNetherlandswasdisruptedin 78 November2002throughthearrestof20traffickerswithintheorganization. Mostrecently, OperationCandyBox,ajointU.S.Canadaeffort,nettedarrestsinMarch2004ofmorethan130peo pleassociatedwithalargeorganizationthatmanufacturedandtraffickedMDMAandmarijuana. Federalauthoritieshavealsohadsuccesspursuingravevenuesandpromotersunderthefederal 79 crackhousestatute forconductthatfacilitatesthetraffickingofclubdrugs.In2000aDEAinves tigationandraidoftheStatePalaceTheaterinNewOrleanscontributedtoa90percentdropin MDMAoverdosesinthatcity.InvestigationsintheBoise,Idaho,areaintothesaleofMDMA,keta mine,andotherdrugsledtoconvictionsof30peopleontraffickingcharges,includingaravepro moterwhopleadedguiltytocrackhousecharges.ANewYorkstateravepromoterwasalsocharged underthecrackhousestatuteinNovember2002. Finally,locallawenforcementpersonnelhavediscoveredthatconductingreversebuysofprecur sorchemicalsfromsuspectshaslimitedtheamountofpseudoephedrineonthestreets.Inthese cases,undercoverofficersuseconfiscatedpseudoephedrineandattempttoengageprecursortraf fickersandmethamphetamineproducersinbuyingtheproductforillicitpurposes.Arrestsand leadsallowlawenforcementtocontinuetobuildupontheseinvestigationsbylocatingsynthetic labs.SouthernCalifornialawenforcementagenciescreditthistacticwithbringingabouttherecent reductioninthenumberoflocalsyntheticdruglabs.
2. Recommendations
TargetPseudoephedrineandIodineSmugglingtoandfromMexico: (DEA,ICE,CBP)
Focusresourcesonstoppingtherecentlynotedflowofsuspiciousshipmentsofprecursorchemicals,
notablypseudoephedrine,fromAsiatoMexico,apparentlydestinedforclandestinemethampheta
minelabsintheU.S.andMexico.AlsofocusonthesmugglingofiodinefromMexico.Inallsuch
cases,lawenforcementshouldidentifyandaggressivelypursuethepersonsandfirmsresponsible.
FocusonCanadianSyntheticsandChemicalSmugglers: (DEA,ICE,DOJ)
ExpandjointU.S.Canadianinvestigationsintothesmugglingofchemicals,methamphetamine,
MDMA,andotherclubdrugsanddivertedpharmaceuticals.Assignhighprioritytoinvestigationsof
largeseizuresofpseudoephedrineandephedrinefromCanada,anddevelopprosecutablecases
againstrogueCanadiancompaniesandtheirprincipals.
InvestigateTiesbetweenCanadianandMexicanCriminals: (DOJ,DEA,ICE,NDIC)
AnalyzelawenforcementreportingandintelligencewithrespecttoCanadianpseudoephedrineand
tiesbetweenCanadiansellersandMexicanlaboperatorsinCalifornia.Analysisoftheflowoffunds
generatedfromsalesofpseudoephedrineinCanadaandtheUnitedStatesshouldbecoordinatedby
theappropriateagencieswithintheconcernedDepartments.
44
InvestigateAsianandEuropeanSourcesofSyntheticDrugs: (DEA,ICE,State)
WorkwithinternationallawenforcementpartnersandregionalgroupstoinvestigateAsiancriminal
groupsinNorthAmericaandinAsiathatincreasinglymaybeengagedinproducingandtrafficking
syntheticdrugsandtheirprecursorchemicals.EnhancebilateraleffortswiththeNetherlandsand
otherMDMAproducingcountriesinEuropetobuildinvestigations,shareinformation,andextra
ditecriminalswhereappropriate.
EnhanceMethamphetamineProfilingEfforts: (DEA,DOJ,ONDCP)
IncreasethenumberofsamplesavailableforanalysisinDEAsmethamphetamineprofilingprogram
byincorporatingsamplesofthedrugseizedbystateandlocallawenforcementatsuperlabs,or
fromshipmentsstronglysuspectedoforiginatingfromsuchlargescaleoperations.Alsoleverage
informationonchemicals,adulterants,cuttingagents,andequipmentfoundatthesites.
ReviewLabCleanupResources: (DEA,DOJ,EPA)
Ensureadequatefundingsourcesforclandestinelaboratoryanddumpsitecleanups,includingfund
ingforsufficientpersonneltosupportlaboratorycleanupsandhazardouswastedisposal,sothat
cleanupcostsarenotadisincentivetolaboratoryinvestigationsortakedowns.Federalofficials,in
collaborationwithstateagencies,shouldconductaneedsassessmenttoidentifypotentialprogram
improvementsandmakerecommendationsonthespecificsupportneededandthefundsrequired.
ApplyUpdatedClandestineLabCleanupGuidelines: (DEA,EPA)
Disseminateandapplythelatestguidelinesforthecleanupofclandestinemethamphetaminelabs
and,wherenecessary,coordinateenvironmentalremediationbyappropriateentities.Theseproto
colsforadulterationanddestructionofprecursorandessentialchemicals,glassware,andmetham
phetaminewasteshouldbepartofclandestinelaboratorycertificationtraining.
IncreaseProsecutorandLEATraining: (DOJ,DEA,CBP)
Recognizingtheuniqueissuespresentedbychemicalandmethamphetaminecases,theFederal
Governmentshould,asresourcespermit,offertrainingforcriminalandcivilprosecutorsandfeder
al,state,andlocallawenforcementagentsmorefrequentlyandindifferentregionsofthecountry.
MakeFullUseofChargingandSentencingOptions: (DOJ,DEA)
ProsecutorsshouldmakefulluseoffederalSentencingGuidelinesprovisionswhichsetasentencing
floor(of7087months)foranycaseinvolvingmethamphetaminemanufacturethatcreatesasub
80 stantialriskofharmtohumanlife. Federalprosecutorsshouldalsomakegreateruseoftheenvi ronmentalenhancementforclandestinedrugmanufacturinginvolvingunlawfuldischarge,emis sion,orreleaseintotheenvironmentofahazardousortoxicsubstanceorfortheunlawfultrans 81 portation,treatment,storage,ordisposalofahazardouswaste. IncreaseAccesstoCivilPenaltyCaseExperts: (DOJ) TheDepartmentofJusticeshoulddevelopanddisseminatealistofattorneyswhohaveexperience incivilpenaltycasesundertheControlledSubstancesActandareavailabletoassistU.S.Attorneys Officesindistrictswheresuchcaseshaveneverorrarelybeenreferredorpursued.
45
PreventExploitationofMailServices: (DEA,CBP,ICE,State,NDIC,FDA)
WorkwiththeU.S.PostalServiceandprivateexpressmaildeliveryservicestotargetillegalmail
ordersalesofchemicalprecursors,syntheticdrugs,andpharmaceuticals,bothdomesticallyand
internationally.
ImproveIntelligenceEffortsRelatedtoSyntheticDrugs: (NDIC,DEA,CIA,CBP,ICE,State)
Intensifyintelligencecomponentsfocusongatheringandsharinginformationregardingthenature
andscopeofsyntheticdrugstrafficking.MakefulluseofNDICsrealtimeanalyticaldatabasefor
bothpreandpostoperationlinkanalysisanddocumentexploitation.Strengthenmechanismsfor
sharingactionableintelligence,trendanalysis,andinformationoncriminalorganizationsamong
theUnitedStatesandconcernedWesternEuropeancountries.
TargetRavesWhereDrugUseisFacilitated: (DEA,DOJ)
Focusattentiononthepromotersandoperatorsofraveeventsthatfacilitatethetraffickingand
abuseofMDMAandotherclubdrugs,makinginnovativeandeffectiveuseofthefederalcrack
housestatute,includingamendmentsintheRaveAct.
ConsiderNewLegislationonClubDrugs: (DOJ,DEA)
Federalofficialsshouldcontinueeffortstodevelopadditionallegislationtoaddresslegalissuesthat
oftenarisewithrespecttoclubdrugsandravetypeevents.Forexample,thedistributionofimita
tioncontrolledsubstancescouldbeexplicitlycriminalizedatthefederallevel,andtheprovisions
82 governingcontrolledsubstanceanaloguesandcounterfeitscouldbeclarified.
StrengthenControlsonInternetSales: (DOJ,DEA)
SupportlegislationthatregulatestheburgeoningbusinessofInternetsalesofdrugs,particularly
controlledsubstances,byprohibitingthedispensingofcontrolledsubstancesonlinewithoutavalid
prescription.Thenewlawwoulddefineavalidprescriptionasoneissuedforalegitimatemedical
purposeintheusualcourseofprofessionalpractice,andwouldrequireatleastoneinpersonmed
icalevaluationbytheprescribingdoctor.
IncreaseInternetInvestigations: (DEA,DOJ,NDIC,ICE,FDA,State)
ExpandinvestigationsandprosecutionsofInternetbasedsyntheticandillegalpharmaceuticaldrug
diversionandsales,toincludetheestablishmentoftaskforcesandcoordinationmechanismsdedi
catedtothispurpose.AgenciesshouldworkwithInternetServiceProviderstoassisttheminlimit
ingchildrensaccesstoillegaldrugsites.
TargetOxyContinandVicodinDiversion: (DEA,DOJ)
Supporteffortstotargetindividualsandorganizationsinvolvedinthediversion,illegalsale,phar
macytheft,fraud,andabuseofOxyContinandotherdrugproductscontainingoxycodoneor
hydrocodone,suchasVicodinandLorcet.
SeekUpdatedSentencingGuidelinesforClubDrugs: (DEA,DOJ)
WorkwiththeU.S.SentencingCommissiontoreviewdataontheimpactandeffectivenessofcur
rentsentencesfortraffickinginketamine,GHBanditsprecursorsandanalogues,andotherclub
drugs,and,ifadvisable,proposeenhancedguidelinessentences.
46
ShareLawEnforcementBestPractices: (DEA,DOJ)
BasedonthesuccessesachievedbylocallawenforcementinSouthernCaliforniausingreversebuy
investigationsandbycommunitiesintheMidwestthathavesetmorestrenuouspenaltiesandregu
lationsregardingsyntheticdrugs,establishamechanismforsharingbestpracticesamongfederal,
state,andlocallawenforcementaswellaswithinternationalpartnerswhoareconfrontingsynthetic
drugthreats.
47
AppendixA:
OutlineofanEarlyWarningand ResponseSystemforEmergingDrugsofAbuse
Participantsinallaspectsofdrugabusecontroleffortswhetheronthedemandorsupply sidehavesometimescomplainedofbeingcaughtoffguardbytheapparentlysuddenemergenceof newdrugabusetrendsintheUnitedStates.RecentexamplesincludeMDMA(Ecstasy)andGHB(one ofthedaterapedrugs).Thisphenomenonoccursdespitetheexistenceofseveralsophisticatedand comprehensivedatasystemsbywhichdrugabuseismeasuredacrossthecountry.Thisoutlineofan earlywarningtemplateandameansoffirstresponseisanefforttoaddressthisproblem. ThemodelportrayedinthisAppendixisnotintendedtodictateanyspecificagencyaction,but rathertogivestructuretothegovernmentssystemofdetectingandrespondingtonewtrends. Consistentwiththeirrespectivemissions,manygovernmentalagencies,actingindividuallyandin collaboration,alreadyundertakeseveraloftheactivitiesdiscussedinthisoutline. I. Identificationofanemergingdrugproblem.(Howdoweknowtheresaproblem?) StepA. Intensive,selectivesamplingofspecificdatasourcesismostlikelytoyieldareliableearly warningofanewdrugthreat. Discussionofdatasystems:
Theobjective:Asystemthatyieldsrapiddatawithascopeascomprehensiveaspossible. Currentnationaldatasystemstendtoemphasizeaccurate(cleaned)andcompletedataover
speed,solagtimeisexcessiveforanearlywarningalarm.
Theideabehindthequantitativeandqualitativedatagatheringactivitiesoutlinedbelowisto
produceaquicklookorsentinelproducttosupportearliergovernmentinterventionifwar rantedbyselectedtrendinformation.Theformatandprocessoftransmittingsuchinformation couldtaketheformofbrief,informal,periodic(e.g.,quarterlyormidyear)reports.
Thetypesofdatathataremostpertinentforanearlywarningsystemincludedataon:
(a) currentuse(versustreatmentvisits,drugdeaths,perceivedharm) (b) neworgrowingdrugsofabuse(versuscocaine,heroin,etc.) (c) groupsmostlikelytousenewdrugs(e.g.,youngpeopleandmarginalgroups) Recommendations: Existingdatagatheringeffortsshouldbehonedtoselectivelyharvestthe 83 mostusefulearlywarningdata.Inthisregard,thefollowingdatasourcesshouldbeexplored:
Quantitative: Samplethefollowingdatasourcesmoreintensivelyandfrequentlyyetmore
selectively,bothintermsofgeographicdistributionanddrugsofinterestforsignsofemerging drugabuse: Tapintostate/localandfederal(DEA)forensiclabdata.Therearetworealtimeforensic datasystems.TheNationalForensicLaboratoryInformationSystem(NFLIS)collects
49
resultsofdruganalysesfromstateandlocalforensiclabsacrossthecountry.Thefeder 84 alequivalentistheDEASystemtoRetrieveInformationfromDrugEvidence(STRIDE). Itwouldbeusefulifalllabswereencouragedtoanalyzesamplesofnoncontrolledsub stances,whichmightwarrantDEAschedulingasdrugsofabuse. SelectivelyexpandcollectionofADAMdata.TheDOJ/NIJadministeredArresteeDrug AbuseMonitoringprogram(ADAM)reachesthehighriskdrugpopulationofpeople arrestedandbookedinNIDAdatasites,butdataarelimitedtothefivemostcommonly useddrugs.Selectedsitescouldexpandinterviewsandurinalysestocaptureother drugsandtrendinformation. EmergencyRoom(ER)data.TherecentlyredesignedDAWNholdsparticularpromise inprovidingearlywarningfordrugsofabuse.Itwillincludethecapacityforrealtime accessandonlinequeriesofDAWNdata;othersophisticatedapproachestodetection andinformationdeliveryareplanned. CDCdata:TheCenterforDiseaseControlisdevelopingamethodologytoidentifyinci dentsofpoisoning. Partofthiseffortistomonitorregionaltrendsofconsumptionof certaintypesofoverthecountermedications.Thisinformationcouldbeusedasone tooltoindicatesurgesintheabuseofcertaincommonlyavailabledrugsorthediversion ofproductssuchaspseudoepehdrineformethamphetamineproduction. Highschoolsurvey.Forexample,therecouldbeawaytoadvancethesurveyprocess anddataanalysisofselectedschoolsintheMonitoringtheFuturesurvey.
Qualitative:
SeekpublicinputthroughanInternetbasedvehicle,e.g.,bylinkingareportingwebsite withthewebsitesofprofessionalorganizationsforemergencyroomandaddictionsper sonnel,lawenforcement,andteachers.(SeeS.151323(108thCong.),authorizinga cybertipline) Regularlyculldatafrom...
Internetchatrooms Ethnographerswhohavecontactwithdrugusers Collegecampushealthclinics Faithorganizationswithafocusoncitiesandtownswhichhaveinthepastproven

tobeharbingersofemergingdrugproblems.
85
StepB. Reportfindingstoadesignatedinteragencyearlywarningcommittee.Twointerdisci plinaryentitiescurrentlyserveanearlywarningfunction;eithercouldbeadaptedtosuitthisrole moreeffectively.
TheInteragencyCommitteeonDrugControl(ICDC)meetsmonthlytodiscussemergingdrug
problemsandconsiderresponses.TheICDCinvolvestheONDCP,NIDA,FDAandDEA.The frequencyofitsmeetingscommendsthisgrouptobeingtheearlywarningcoordinationbody, butitmayneedtobeexpandedandstaffedtoperformthisfunctionbetter.
TheCommunityEpidemiologyWorkingGroup(CEWG)meetssemiannuallytoassimilate
drugrelatedquantitativeandqualitativedatafrommultiplesourcesandprovidecurrent descriptiveandanalyticalinformation.
50
II. Rapidanalysisoftheproblemandfollowuponinitialdiscovery.(Nowthatweknowtheressome thingnewoutthere, howdowedeterminehowbigitisandhowweareequippedtoaddressit?) Discussionofrapidanalysisstage: Somefurthereffortstoanalyzetheproblempresentedbya newlydiscovereddrugthreatarecritical;however,theseshouldnotbeundertakenatthe expenseofconsideringappropriateresponses.Themostcriticalstepsareincludedhere. StepA. Dowehavethecapacitytomeasure theproblem?
Dataproblems:Dowehavetherightsurveyandothertoolstomeasurethisdrugproblem?
Ifnot,cantheybeadapted?(Example:Ifitisprimarilyadrugusedbytheruralworkingpoor, doweneedtorampupameansofmeasurement?)
Detectionproblems:Canthedrugbedetected;bywhatmeans;andarethosemeans
adequate? Ifcurrenttestingmeansareinadequate,fosterthedevelopmentandvalidationofnewdrug detectiontestsandtools;disseminatemethodsandmaterials.Secureassistanceandexpertise fromgovernment,academia,assayandinstrumentmanufacturers,clinicalandforensicpatholo gy,toxicologyandtheirsupportlaboratories. StepB. Whatisourfirsttakeonthemaincharacteristics oftheproblem?
Demographicsofabuse:age;gender;raceorethnicgroup;socioeconomicgroup;geographic
impact;urban,suburban,orrural
Degreeofdangertopublichealthandsafety
short,medium,andlongtermphysiologicalandpsychologicaleffectsand dependenceprofile relatedsocialharmorcriminalconduct(e.g.,drugseekingcrime,domesticviolence, orsexualassault) gatewaypotential
Sourcesofthedrug;domesticandforeignmanufacturingprocesses,includingchemicalsused;
smugglingmethods;distributionroutes;diversionfromlicitpharmaceuticalsupplies Production/traffickingorganizationsandtheirfinancialstructures Publicawarenessandattitudes Treatmentprotocols Arethereuniqueandpressingresearchneedsinanyoftheseareas? III. Response(Nowthatweknowtheresaproblemandhaveanideaofitsscopeanddimensions, what arewegoingtodoaboutit?) StepA. Assessresponseandstructureofcurrentsystemtoaddressproblem. StepB. Recommendadditionalornovelapproaches.
Forbothsteps,thefollowingareasofinquiryarepertinent.
1. Awareness.Istheawarenessleveladequate?Isgreaterawarenessdesirable?Ifanswersare noandyesrespectively,howbesttoraiseawareness?(Examples:GovernmentandNGO websites;mediacampaignsincludingadsandpublicserviceannouncements,etc.)
51
2. PreventionandEducation a. CanvassHHScomponents(e.g.NIDA,SAMHSA),Dept.ofEducation,stateandlocalpre ventiongroups,andNGOstodeterminewhethercurrentpreventioneffortsareadequate, ormightbeeasilyadapted,toaddresstheproblem. b. fnot,deviseanewapproach. I 3. Treatment a. Assessourknowledgeofacuteandlongtermtreatmentthroughemergencyroomsand addictiontreatmentprograms. b. finadequate,howmightwedevelopbettertreatmentprotocols? I 4. Regulatory a. Isthesubstancescheduled? Doesitneedtobescheduledorplacedonahigher
schedule? Doesitneedandqualifyfortemporary,emergencyDEAscheduling?
b. rethereimmediateprecursors(asdefinedundertheCSA);ifso,shouldtheybe
A scheduledassuch?
c. rethereprecursororessentialchemicals thatshouldbebroughtundercontrolas
A listedchemicals?
d. Arethereanaloguesthatshouldbetreatedasthesamesubstance? 5. Legislative a. Arecurrentlawsbothfederalandstateadequatetoaddresstheproblem?Ifnot,what lawreformisneeded? b. ocurrentsentencesappropriatelyreflecttheseriousnessoftraffickingofthesubstance? D Ifnot,whatadjustmentsareadvisable? 6. Lawenforcement a. Isthereanythingspecialaboutthisdrugordrugtrendthatrequiresadifferentlawenforce mentapproach bypoliceorprosecutors;or atthefederal,state,orlocallevel? b. fso,whatnewactionsareneeded? I 7. International a. Doestheproblemhaveinternationaldimensions? b. fso,whatapproacheswouldbeeffectivethrough: I multilateraldrugcontrolentities(e.g.,UNbased,suchasINCB); regionalbodies(OASCICAD);and bilateralapproaches,ifthereisamanageablenumberofkeyforeigncountrieswith whomwehaveworkingrelationships?
52
AppendixB:
OverviewoftheNewDrugAbuseWarningNetwork (DAWN)SystemDesignandImplementation
Summary
ThenewDrugAbuseWarningNetwork(DAWN)isdesignedtoproviderealtimeaccesstosentinel eventdatathatwillbeusedbyparticipatingfacilities,clinicians,communities,andpolicymakers. Inaddition,itisdesignedtoprovideimprovednationalandmetropolitanestimatesofdrugrelated emergencydepartment(ED)visitsanddrugrelateddeathsinvestigatedbymedicalexaminersand coroners(ME/Cs).ExpansionofDAWNsgeographiccoverageandcasecriteriawillprovidemore completeandcomprehensivesurveillanceofdrugrelatedevents.DeploymentoftheSentinelEvent ReportingSystem(SERS)willprovideauthorizeduserswithrealtimequeryaccesstoDAWN recordstodetectemergingtrendsandnewdrugproblemsbeforetheybecomewidespread.
DAWN: CreationofaWarningNetwork
Followinga20yearevaluationofdesignalternativesanduserneeds,theDrugAbuseWarning Network(DAWN)hasbeenredesigned.Thenewdesign,withamultiyearimplementationsched ulethatbeganin2003,isfocusedonaccomplishingtwogoals: Goal1: Providebetternationalandmetropolitanareaestimatesofdrugrelatedemergency
department(ED)visitsanddrugrelateddeathsinvestigatedbymedicalexaminersandcoro
ners(ME/Cs).
Goal2: Becomeanactivesurveillancenetworkwiththeabilitytoidentifyaberranttrendsin knowndrugproblems,detectnewdrugproblemsbeforetheybecomewidespread,andquickly makethisinformationavailabletohospitals,clinicians,communities,andpolicymakers. WhilethefirstgoalrepresentsandenhancementofDAWNstraditionalanalyticalcapabilities,the secondisnew.Thisgoalwillbeachievedthroughcompletelynewcapabilitiesthatwillmakethe warninginDAWNsnamearealityforthefirsttime. MultiplefeaturesofthenewDAWNsupportthisgoal: 1) DAWNismovingtocompleteelectronicdatacollection.Datasubmittedelectronicallycanbe editedandcleanedoninput,andthenmadeavailableimmediatelyforrealtimequeriesand analysis. 2) ExpandedDAWNcasecriterianowcapturealltypesofdrugrelatedEDvisitsanddeaths,and reviseddataitemscapturemoremeaningfulinformationabouttheseevents.Previously,many relevantdrugrelatedeventsweremissedbyrestrictivecasecriteria(forexample,casesofdrug facilitatedrapebecamereportablewiththenewdesignin2003).
53
3) ThegeographiccoverageofDAWNisexpanding.Whentheexpansioniscomplete,DAWNwill coverthe48mostpopulousmetropolitanareasacrossallregionsoftheUnitedStateswithboth hospitalsamplesandME/Cjurisdictions.Inaddition,selectedstatewideMEsystemswillsupply dataondrugrelateddeathsforareaslackinginmetropolitancoverageandwherehospitalsam plesarenotfeasible.AlthoughdatafromME/Cswillcontinuetolagbehinddatafromhospitals intimeliness,expansionoftheDAWNmortalitycomponentintargetmetropolitanareasand stateswillaugmenttheEDdatawithanenhancedpictureofthemostsevereconsequencesof drugabuse. 4) TheSentinelEventReportingSystem(SERS)willbetherealtimemessengerfortheDAWNwarn ingnetwork.SERSisbeingdevelopedtoqueryDAWNdata,identifyemergingtrendsindrug abuse,andsupplytimelyinformationbacktohospitals,clinicians,communities,andpolicymak ers.SERS,whichwillallowuserstoaccessdatainrealtimewithoutdelaysforstatisticalweight ingormanipulation,isbeingdeployedinstages. EachoftheSERScapabilitiesforqueryingEDdatawillhaveacounterpartformortalitydata. Furtherenhancementswillbedesignedanddeployedbasedonuseracceptanceandinformation needs.Accessrightswillbelimitedasnecessarytocomplywithstatutoryprohibitionsagainst disclosureofidentifiableinformation.
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AppendixC:
DEAActionPlantoPreventtheDiversion andAbuseofOxyContin
SUMMARY
Inresponsetogrowingconcernamongfederal,stateandlocalofficialsaboutthedramaticincreasein theillicitavailabilityandabuseoftheprescriptiondrugOxyContin,theDrugEnforcement Administration(DEA)hasembarkedonacomprehensiveefforttopreventitsdiversionandabuse. ThepharmacologicaleffectsofOxyContin,abrandnameformulationoftheScheduleIInarcotic oxycodone,makeitattractivetoabusersasitoffersreliablestrengthanddosagelevelsandmay,in someinstances,becoveredbytheabuser'shealthinsurance.Abusershavediscoveredthatthecon trolledreleaseformulaofOxyContincanbeeasilycompromisedallowinginhalationorinjectionfor apowerful,morphinelikehigh. ReportsofthediversionandabuseofOxyContinarecurrentlyconcentratedinruralareasofthe easternUnitedStates;however,DEAsOfficeofDiversionControlhasidentifiedthisactivityasa 1 growingproblemthroughoutthenation. Ithasbeendescribedbysomelocallawenforcementoffi cialsasanationalepidemicinthemaking. NationalindicatorssuchasDAWN(DrugAbuseWarning Network)andSTRIDE(SystemtoRetrieveInformationfromDrugEvidence)showrecentincreasesin oxycodoneoverdosesandlawenforcementencounters.Somejurisdictionsreportasmuchasa75% increaseinpropertyandothercrimesthattheyspecificallyattributetotheabuseofOxyContin. TazewellCounty,VA,estimatesthatOxyContinaddictionisbehind80%to95%ofallcrimescom mittedthere. CriminalactivitiesresultingfromtheabuseofOxyContinarequicklydepletingtheresources,finan cialaswellashuman,oflocallawenforcement.Somestates,suchasMaine,VirginiaandKentucky, havebecomesoalarmedbythisproblemthattheyhavebeguntotakeextraordinaryactiontodeal withit. OfficialsinKentuckyareutilizingapowerfulnewtoolcalledKASPER(KentuckyAllSchedule PrescriptionElectronicReporting),adatabaseofallcontrolledsubstancesdispensedbyKentucky 2 pharmacists,intheirinvestigationsofOxyContinrelatedcrime. TheAttorneyGeneralofVirginia recentlyconvenedameetingofofficialsfromfivestatestodiscusswaystohaltillegaltraffickingin OxyContin.
THEPROBLEM
OxyContinisaScheduleIIcontrolledreleaseformofthenarcoticoxycodonemanufacturedby 3 PurduePharmaL.P.in10mg,20mg,40mg,80mg,and160mgtablets. Thecontrolledreleasemethod
1
DatafromtheOfficeofDiversionControlQuarterlyReportsindicatethatOxyContinhasrisendramaticallyinrecent monthsintermsofmentionbythefieldofficesasamostabuseddrug. ArticlepublishedintheLouisville,KY,TheCourierJournal,February8,2001
2 3
Afterthisreportwasdrafted,PurduePharmaL.P.announcedanindefinitesuspensionsofthedistributionofOxyContin inthe160mgform.
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ofdeliveryusedinOxyContinallowsforalongerdurationofdrugactionand,consequently,the manufactureoftabletscontaininglargerdosesoftheactiveingredient.Itislegitimatelyusedasa medicationtotreatmoderatetoseverepainandisbecomingthedrugofchoiceinmanypainman agementclinics.Inalittleoverfouryears,saleshavereached$1billion. Table1 showsthedramaticincreaseinthenumberofOxyContinprescriptionsfrom1998through 2000.
Oxycodonehasbeenmarketedincombinationproductswithaspirinandacetaminophen (PercodanandPercocet)formanyyears.Diversionandabuseoftheseproductscontinue. However,becausetheycontaintheseotheringredientsandonly5to10mgofoxycodone,theyare primarilyabusedorally.Whileprescriptionsforoxycodonecombinationproductshaveincreased duringtheperiodfrom1996to2000,prescriptionsforoxycodonesingleentityproducts(suchas OxyContin)haveincreasedoverfourteenfold. OxyContinhasbecomeatargetfordivertersandabusersofcontrolledsubstancesbecauseofthe largeramountsoftheactiveingredientinrelationtootherpreviousoxycodoneproductsandthe abilityofabuserstoeasilycompromisethecontrolledreleaseformulation.Simplycrushingthe tabletcannegatethetimedeffectofthedrug,enablingabuserstoswallow,inhale,orinjectthedrug, whichiswatersoluble,forapowerfulmorphinelikehigh. CommonmeansofOxyContindiversionarefraudulentprescriptions,doctorshopping,overpre scribing,andpharmacytheft.Therehavebeenmanyinstancesofpharmaciesbeingrobbedstrictly fortheirsupplyofOxyContin.Investigationshaveuncoveredorganizedringsofindividualsdivert ing,selling,andabusingOxyContin.Intelligencehasalsoshownthatforeigndiversionisanother sourceoftheOxyContinbeingsoldandusedillegallyintheUnitedStates.
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OBJECTIVE
ContinuedincreasesinthediversionandabuseofOxyContinareconsideredlikelyunlessfirmand immediateactionistaken. Itisthegoalofthisactionplantoreducetheexistingandpotentialcosts topublichealthandsafetybyhavingasignificantandimmediateimpactonthediversionandabuse ofOxyContin.
ACTIONPLAN
Inordertocombattheseriousandgrowingproblemsstemmingfromthediversionandabuseof OxyContin,DEAhasdevelopedafourpartactionplan.Theelementsoftheplanareasfollows: 1)EnforcementandIntelligence: DEAmustfocusexistingresourcesandmanagementattentionon investigationsofthediversionandabuseofOxyContin.Theseinvestigationsrequirecoordination andsupportfromenforcement,diversion,andintelligencegroups.Coordinatedoperationshavebeen initiatedinfieldofficestotargetindividualsandorganizationsinvolvedinthediversion,illegalsale, pharmacytheft,fraud,andabuseofOxyContin.DEAisusingallavailableenforcementtoolstodis rupttheseillegaloperations.Thisincludesinteragencyeffortsonthefederal,state,andlocallevels andextendstotheinternationalaswellasthedomesticarena. DEAiscontinuingtoidentifylargevolumepurchasersofOxyContinforreferraltofieldofficesfor appropriateaction. AllexportsofOxyContinarebeingcloselyscrutinizedinordertodetectpossible diversiontrends,particularlyinthosecountrieshavinglimitedcontrolsonpharmaceuticalproducts. AcompleteassessmentofthescopeandmagnitudeofOxyContinlegitimateuseandabuseisbeing undertakenutilizingtraditionalandnoveldatasources.DEAhasinitiatedcontactandcontinuesto workwiththeNationalInstituteonDrugAbuse,theSubstanceAbuseandMentalHealthServices Administration,theNationalInstituteofJustice,andotherstomodifydatasources(e.g.,the MonitoringtheFuturesurvey)toimprovethespecificityofthedatacollectedtoreflectOxyContin abuse. 2)RegulatoryandAdministrative: DEAisutilizingitsfullrangeofregulatoryandadministrative authoritytopursueactionasnecessarytopreventthediversionandabuseofOxyContin.Indoing so,itisessentialthatDEAelicitthesupportofotherregulatoryagencies.Theseactionsarenot intendedtoimpactontheavailabilityoflegitimatedrugproductsformedicaluse. DEAcontinuestoexaminetherapidincreaseintherequestedlevelsofoxycodonequotabytheman ufacturerofOxyContin. DEAcontinuestoworkcloselywiththeFoodAndDrugAdministration(FDA)instronglyurgingthe rapidreformulationofOxyContintotheextentthatitistechnicallypossible,inordertoreducethe abuseoftheproduct,particularlybyinjection.Additionally,bothagencieswillcontinuemonitoring practicesthatmaycontributetodiversionorabuse. DEAcontinuestoworkwiththeInteragencyNarcoticTreatmentReviewBoardandtheFederationof StateMedicalBoardstodevelopfurthercooperationonsuchissuesasphysicianeducationonthe treatmentofpain,therecognitionofaddiction,andimplementationoftheFederationsModel GuidelinesonPainTreatment. DEAwillpursuelegislativeinitiativestoassiststateswithfundingforprescriptiondatacollectionand analysis.
57
3)SeekIndustryCooperation: DEAcontinuestostresstheimportanceofvoluntarycooperation fromindustryinadheringtothespiritandsubstanceofexistinglawandregulations.Theagencyis increasingitscooperativeeffortswithalllevelsofindustryinordertostemtheabuseanddiversion ofOxyContin. ThecooperationofPurduePharmaL.P.,thesolemanufacturerofOxyContin,isintegraltothesuc cessofDEAsActionPlaninpreventingtheabuseanddiversionofOxyContin. PurduePharmahasbeenencouragedtodevelopabalancedmarketingstrategythatensuresappro priateuseofOxyContin.PurdueagreesthatOxyContinshouldbeprescribedonlytopatients whereuseofanopioidisappropriateformoderatetoseverepainlastingmorethanafewdays. Moreover,OxyContinshouldbeprescribedonlybyphysicianswhoareknowledgeableaboutthe useofopioidsinthetreatmentofpain.PurduePharmawillbeencouragedtosupportandprovide educationalprogramsalertinglegitimatepatientsaswellasthegeneralpublictothedangersinher entintheabuseofsuchdrugs. Inordertoassistinidentifyingsourcesofdiversion,DEAproposesthatPurduePharmamodifythe shape,indicia,andcolorofOxyContintabletsmanufacturedforexportfromtheUnitedStates. DEAisworkingwithmedicalorganizationsandinstitutions,governmentagencies,andinternational healthcaregroupstobetterassessthelegitimatemedicalneedsfornarcoticanalgesicsincluding OxyContin.SuchgroupsincludetheAmericanPainSociety,AmericanAcademyofPainMedicine, theJointCommissiononAccreditationofHealthcareOrganizations,theWorldHealthOrganization, andtheNationalInstitutesofHealth. 4)Awareness/Education/OutreachInitiatives: Recognizingtheimportanceoftheappropriateuse ofopioidsinthetreatmentofpain,DEAmustworktoincreasenationalawarenessofthedangers associatedwiththeabuseofOxyContin.Anaggressive,nationaloutreachefforttoeducatethe public,schools,thehealthcareindustry,andstateandlocalgovernmentsonthedangersrelatedto theabuseofOxyContinwillbeimplemented. DEAmustworkproactivelywiththeAmericanMedicalAssociation,FederationofStateMedical Boards,NationalAssociationofChainDrugStores,andNationalAssociationofBoardsofPharmacy, amongothers,toalertthehealthcareindustrytothegrowingproblemsassociatedwithOxyContin abuse.DEAisenhancingexistingpublicawarenessprograms,includingtheDemandReduction ProgramandtheDEAspublicinternetwebsites,inordertoeducatethepubliconthedangersof OxyContinabuse.
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AppendixD:
SchedulesandRegulatoryControlsApplicable totheSubjectControlledSubstances
Overview: ControlledSubstanceSchedulesandChemicalLists
TheControlledSubstancesAct,at21U.S.C.812,establishesfivelists,orschedules,ofcontrolled substances.Thecriteriaforeachschedulearebasedonthepotentialforabuseandthedegreeof acceptedmedicaluseintreatment.Schedulesalsoconsiderthedegreeandlikelihoodofphysical orpsychologicaldependence.ScheduleIcontrolledsubstanceshaveahighpotentialforabuse,no currentlyacceptedmedicaluseintreatmentintheUnitedStates,andlackofacceptedsafetyfor useundermedicalsupervision.ScheduleIIcontrolledsubstanceshavehighpotentialforabuse, currentlyacceptedmedicaluseintreatmentintheUnitedStatesorusewithsevererestrictions, andabusemayleadtoseverephysicalorpsychologicaldependence.ScheduleIIIcontrolledsub stanceshavelowerpotentialforabusethanthoseinSchedulesIandII,currentlyacceptedmedical use,andabusemayleadtomoderatetolowphysicaldependenceorhighpsychologicaldepend ence.ControlledsubstancesonSchedulesIVandVhaveacceptedmedicaluseandprogressively lowerpotentialforabuse.WhileCongressinitiallyplacedmanysubstancesonthefiveschedules whenitpassedtheCSAin1970,itvestedauthorityintheAttorneyGeneral,sincedelegatedtoDEA, toadd,remove,ortransfersubstancesamongtheschedules. Theuptodatelistingofschedulesappearsat21C.F.R.1308.11through1308.15.Listedchemi calsarechemicalsfrequentlyusedintheillicitmanufactureofcontrolledsubstances.ListI chemicals(mostlyprecursorchemicalsscientifically)areimportanttotheillicitmanufactureof acontrolledsubstance(see21U.S.C.802(34));theuptodatelistappearsat21C.F.R. 1310.02(a). ListIIchemicals(scientifically,mostlyagents,reagents,catalysts,andsolvents), whicharealsousedinunlawfuldrugproduction,appearat21C.F.R.1310.02(b).Listedchemicals aremonitoredthroughadomesticandinternationalregulatoryschemethatinvolvesregistration (forcertainhandlersofListIchemicals),recordkeeping,andreporting(notablyofunusualorsus piciousproposedtransactions).See21U.S.C.830.
MethamphetamineandMDMA
DEAregulatesmethamphetamineandamphetamineasScheduleIIcontrolledsubstances,the strictestlevelofcontrolforanydrugthathasbeenacceptedformedicaluse.Becauseofthestrict accountabilityrequirementsundertheregulatoryscheme,verylittleofthemethamphetamineor amphetamineabusedinthiscountryisdivertedfromlegitimatechannels;rather,thesedrugsare manufacturedinclandestinelaboratorieshereorabroad.Theprincipalchemicalsusedtomanu facturemethamphetamineoramphetamineclandestinelyincludingephedrine,pseu doephedrine,phenylpropanolamine,phenyl2propanone,hydriodicacid,andiodineareregu latedunderdomesticlawasListIorListIIchemicals,orasimmediateprecursorsinSchedule II,andmostareregulatedbyinternationallawunderthe1988UnitedNationsConventionAgainst
59
IllicitTrafficinNarcoticDrugsandPsychotropicSubstances(hereafterreferredtoas1988UN Convention).Listedchemicalsarenotasstrictlyregulatedascontrolledsubstances.Ephedrineand pseudoephedrinearetheprecursorsofchoiceinmostregionsintheprocesstomakemethampheta minesbecausethechemicalprocessissimple,abetteryieldisobtainedandbotharemorewidely availablethanphenylaceticacidandP2P.Thesechemicalsareusedextensivelyasdecongestantsin overthecounterpharmaceuticalpreparations. MDMAisaScheduleIcontrolledsubstance;itslegitimateuseislimitedtoapprovedmedicalandsci entificresearch.During2002,DEAscheduledtwosubstancesthathadbeenmarketedonthe InternetaslegalalternativestoMDMAbenzylpiperazine(BZP)and2,5dimethoxy4npropylthio phenethylamine(2CT7).ThesetwosubstanceswererecommendedforScheduleIcontrolandsub sequentlybothwerepermanentlycontrolled.Inearly2003,DEAtemporarilyplacedinScheduleI twootherhallucinogenic/stimulantsubstancespopularatravesandothersocialvenues:alpha methyltryptamine(AMT)and5methoxyN,Ndiisopropytryptamine(5MeoDIPTknownas Foxy). TheprecursorchemicalsusedtomanufactureMDMAsafrole,isosafrole,3,4methylene dioxyphenyl2propanone(MDP2P)commonlyknownasPMK,andpiperonalaresubjectto domesticcontrolasListIchemicalsandinternationalcontrolunderthe1988UNConvention.PMK istheprecursorfavoredbyclandestinelaboperators,whoareconcentratedinruralpartsofthe Netherlands.ProducedonlyinChinaandIndia,thereappearstobeonlylimitedlegitimatecommer cialuseforPMK,whichhasbeenseizedinlargequantitiesinEurope.Safrole,isosafrole,andpiper onalhavecommercialusesinfragrancesandflavorings. Variousessentialoils,suchassassafrasandcamphor,containlargepercentagesofsafrole.Theseoils arebeingfoundinillicitlaboratorieswheretheyareusedfortheillicitmanufactureofMDMAandits analogues.Inmanycasestheseoilsareuseddirectlyinthemanufacturingprocess,asitisnotneces sarytofirstextractordistillthesafrole.Moresimply,itrequireslessworktousesafrolethanother precursorchemicalstomanufactureMDMA.Vietnamappearstobeoneoftheforemostillegal exportersofsassafrasoilandsafrole.
OtherClubDrugs
GHBis,formostpurposesrelevanttolawenforcement,aScheduleIcontrolledsubstance,asaresult ofCongressionalandregulatoryactionin2000.Seethe"HilloryJ.FariasandSamanthaReidDate RapeDrugProhibitionActof2000(P.L.106172),signedonFebruary18,2000,andaDEAregulation followingfromthatlaw,effectiveMarch13,2000,andpublishedat65Fed.Reg.13,235.Thelimited exceptionisthatthemanufacture,distribution,anddispensingofFDAapproveddrugproductscon tainingGHBaresubjecttothelessstringentphysicalsecurityrequirementsapplicabletoScheduleIII controlledsubstances.Forexample,storageinasteelcage,ratherthanavault,issufficientfor ScheduleIIIsubstances.See21C.F.R.1301.72. Asaresultofthesamelaw,onFebruary18,2000,theprecursorgammabutyrolactonecommonly knownasGBLbecameaListIchemicalundertheControlledSubstancesAct(CSA).GBLisunique amongprecursors,however,inthatitconvertsintoGHBwheningested.Forthisreason,itisoften traffickednotasaprecursorchemicalbutasadrugofabuseinitself.Inthosecases,becauseofits similaritytoGHBinstructureandeffect,GBLmaybetreatedasacontrolledsubstanceanalogue
60
undertheCSA,subjectingtraffickerstothepenaltiesapplicabletoScheduleIcontrolledsubstances. See21U.S.C.813and802(32). KetaminewasplacedinScheduleIIIoftheCSAonJuly13,1999.Itisalegitimatepharmaceutical productforbothhumanandveterinaryuse.Flunitrazepam(Rohypnol)isaScheduleIVcontrolled substance.
ControlledSubstanceAnalogues
Asubstanceisacontrolledsubstanceanalogueif(1)itschemicalstructureissubstantiallysimilarto thatofaScheduleIorIIcontrolledsubstance,(2)ithasastimulant,depressant,orhallucinogenic effectthatissubstantiallysimilartoorgreaterthanthatofaScheduleIorIIcontrolledsubstance,or (3)itisrepresentedorintendedtohaveastimulant,depressant,orhallucinogeniceffectthatissub stantiallysimilartoorgreaterthanthatofaScheduleIorIIcontrolledsubstance.See21U.S.C. 802(32). Thus,whetherGBListreatedasaListIchemicaloracontrolledsubstanceanalogue dependsonthecircumstancesofitsdistribution.Anotherchemical,1,4butanediol,anotherana logueofGHB,alsoconvertsintoGHBwheninthebody.UnlikeGBL,however,itisnotusedtoman ufactureGHBand,therefore,isnotregulatedasalistedchemical.Ifitisintendedforhumancon sumption,then1,4butanediol,likeGBL,maybetreatedasacontrolledsubstanceanalogue. TheschedulesofcontrolledsubstancesdiscussedinthisActionPlanareasfollows:
DRUG
Methamphetamine Amphetamine MDMA(Ecstasy) GHB(exceptFDAapprovedXyrem) PCP LSD Ketamine Hydrocodone(includingVicodin) Oxycodone(includingOxyContin) Flunitrazepam(Rohypnol)
SCHEDULE
II II I I II I III IIIfordrugproducts,bulkisII II IV
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AppendixE:
Sentencing
MethamphetamineandMDMA
MethamphetaminepenaltiesareamongthemostsevereprovidedforintheControlledSubstances Act.Thelawsetsadual/alternativeformulationfordeterminingquantitybasedsentencesfor methamphetamine,inwhichactualorpuremethamphetamineisdistinguishedfromamix tureorsubstancecontainingmethamphetamine.A10:1quantityratiotriggersbothstatutoryand guidelinespenaltiesformethamphetaminemixtureversusmethamphetamineactual.Ice methamphetamine,definedbytheguidelinesasdmethamphetaminehydrochlorideofatleast80 percentpurity,issentencedlikeactualmethamphetamine.PursuanttotheMethamphetamine AntiProliferationActof2000,theU.S.SentencingCommissionincreasedguidelinessentencesfor amphetaminetoequalthoseformethamphetamine(althoughamphetaminestillhasnostatutory minimumpenalties). Additionally,theCommissionincreasedsentencesforkeymethampheta mineprecursorchemicals. TheCommissionhasalsoincreaseditsfocusonMDMAsentences.AsofMay2001,the CommissionraisedtheguidelinesforMDMAbyloweringthequantitiestriggeringthefiveand tenyearguidelinessentences.AsofNovember2002theCommissionintroducedastandard, assumedpillweightforMDMAof250mg/tablet,whichclarifiedanissuethathadproducedincon sistentsentencingdecisionsamongthecourts. Quantitiestriggeringfiveandtenyearsentencesformethamphetamine,amphetamine,MDMA, andthemajormethamphetamineprecursorchemicalsundertheSentencingGuidelinesaresum marizedinthefollowingtable.
5years(Level26) Methamphetamine, Amphetamine Ice(80%puredmeth) MDMA(Ecstasy) Pseudoephedrine,Ephedrine, PPA(Norephedrine) 5gmpure/ 50gmmixture 5gm 200gm (about800tablets) 10gm
10Years(Level32) 50gmpure/ 500gmmixture 50gm 2KG (about8,000tablets) 100gm
Also,pursuanttothe2000enactment,theSentencingCommissionincreasedthebaseoffenselevel formanufacturingamphetamineormethamphetaminetoatleast27(i.e.,7087monthsforoffend erswithnoorminimalcriminalhistories)iftheoffensecreatedasubstantialriskofharmto humanlifeortheenvironment(typicalofmostclandestinelabcases).Thesentenceisatleastlevel
63
30(i.e.,97121months)ifthelifeinquestionwasthatofaminororincompetent.TheActalsocrimi nalizedthetheftorinterstatetransportofanhydrousammoniaforthepurposeofunlawfuldrugman ufacture,assetforthat21U.S.C864,subjecttoapenaltyofupto10yearsimprisonmentandafine. EffectiveNovember1,2001,theSentencingCommissionadoptedguidelineamendmentsthatinprac ticaleffect,resultinalevel14sentenceforthisoffense(i.e.,1521months).
OtherClubDrugs
EffectiveNovember1,2004,sentencesforGHBtraffickingwillbesignificantlyenhanced.Atthattime, theguidelinewillprovideforsentencesofapproximatelyfiveyearsfortraffickinginthreegallonsof GHB(oritsanalogues)andtenyearsforthirtygallons.ThesechangesresultfromaCongressional directiveinlegislationenactedinApril2003.BeforeNovember2004,thefiveandtenyearguideline sentencesaretriggeredbyapproximately13.2and132gallons,respectively. TheseamendmentsfollowotherrecentrevisionstostrengthentheguidelineswithrespecttoGHB. EffectiveNovember1,2001,theSentencingCommissioneliminatedthecapatoffenselevel20for ScheduleIandIIdepressants,includingGHB.Thepreviousguidelineresultedinasentencingrange of3341monthsforfirsttimeoffenderstraffickingin40,000ormoreunits(20liters,orapproximate ly5.3gallons). Evenwiththisamendment,untilNovember2004,itstilltakes100,000unitsofGHB (over13gallons)totriggeralevel26(i.e.,6378months)sentence. ThesentencingguidelineswillalsobestrengthenedforseriousoffensesinvolvingtheGHBprecursor GBL. AsofNovember2004,sentencesofaboutfiveyearswillbetriggeredby227liters(insteadof 1,000kilograms)ofGBL.SentencesforGBLwillstillbecappedatlevel30(97121monthsforafirst offense)at2,271litersormore.WeunderstandthattheCommissionwillsoonconsideradditional revisionstolowerthethresholdsforGBL. Theguidelineswillalsoincludeasentencingenhancementformassmarketingcontrolledsubstances throughtheInternet.Thisincreasewillbeespeciallyusefulintheclubdrugcontext,asthesedrugs, andtheiranalogues,areoftenadvertisedandsoldviatheInternet. TheDrugInducedRapePreventionandPunishmentActof1996"(P.L.104305)establishedspecial penaltiesofuptofiveyearsimprisonmentandafineforoffensesinvolving30milligramsormoreof flunitrazepam(aScheduleIVcontrolledsubstance)andupto20yearsimprisonmentandafinefor offensesinvolving1gramormore.Inresponsetosexualassaultscommittedwiththisdrug,thebill alsoenacted21U.S.C.841(b)(7),whichmakesdistributionofacontrolledsubstancetoaperson withoutthatpersonsknowledge,andwiththeintenttofacilitateacrimeofviolence,includingsexual assault,subjecttoupto20yearsimprisonmentandafine. Ketamine,aScheduleIIIdepressant,issubjecttoamaximum5yearsentenceforafirstoffense,butis notsubjecttoamandatoryminimumpenalty.TheSentencingGuidelinesestablishamaximum offenselevelof20(i.e.,3341months). EffectiveNovember2002,theU.S.SentencingCommissionamendedthefederalsentencingguideline applicabletoviolationsof21U.S.C.856,thesocalledcrackhousestatute,whichmaybeused againstpromotersandoperatorsofravetypeeventsdesignedorintendedtofacilitatedrugtrafficking.
64
Thenewguidelinesraisetheprevious,inadequatebaseoffenselevelfromLevel16(i.e.,2127 monthsincriminalhistorycategoryI)toLevel26(i.e.,6378monthsincategoryI). InApril2003,Congressapprovedamendmentstobroadenthescopeof21U.S.C.856(thecrack housestatute)tomaketheprovisionmoreclearlyapplicabletoravesandsimilarevents,where appropriate.Thelegislationalsointroducesstiffcivilpenaltiestoremovetheprofitmotivefrom sponsorshipofdrugorientedravetypeevents.
OtherSyntheticDrugsandDivertedPharmaceuticals
Oxycodone,aScheduleIInarcotic,issubjecttoamaximum20yearsentenceforafirstoffense,but isnotsubjecttoamandatoryminimumpenalty.EffectiveNovember5,2003,theSentencing Guidelinesforoxycodonearebasedontheactualweightoftheoxycodoneinthetablet,notthetotal weightofthetablet;thisdiffersfromthetreatmentofmostothercontrolledsubstances,including pharmaceuticals.Attheequivalencysetintherevisedguidelines(1gramofoxycodone=6,700 gramsofmarijuana),alevel26(roughly5year)sentenceisreachedatabout3,0005mgpills,1,500 10mgpills,75020mgpills,and37540mgpills.Level32(roughly10year)sentencesapplyfortraf fickingin10timesthosequantities,respectively.Beforethisrecentchange,theSentencing Guidelinesestablishedbaseoffenselevel26fortraffickingin200gramsofoxycodoneandbase offenselevel32fortraffickingin2,000grams(2kilograms).Theweightofthepills,notjustthe activeingredient,determinedthesentence.Useofthetotalpillweightledtoincongruousresults becausetheconcentrationofoxycodoneincontrolledreleaseformulationssuchasOxyContinis muchgreaterthanthatinstandard,noncontrolledreleaseformulations(suchasPercocet, Percodan,andRoxicet),whichalsocontainotheractiveingredientslikeaspirinandacetaminophen. ConcernsaboutdisproportionatesentencingledtheSentencingCommissiontoexamineandact uponthisissue.DOJprovidedinput. PCPshareswithmethamphetaminetheunusualdual/alternativepenaltystructure,whichdistin guishespurePCPfrommixturesorsubstancescontainingit.Traffickingin10gramsofPCPactual or100gramsofPCPmixturetriggersa5yearmandatoryminimumsentence.A10yearmandatory sentenceappliestotraffickingin100gramsofPCPactualor1kilogramofPCPmixture. StatutoryandguidelinespenaltiesforLSDarenotcongruent.Thestatutesetsfiveandtenyear sentencesat1and10grams,respectively,butincludesthecarriermedium,usuallyblotterpaper, whendeterminingtheweight.See21U.S.C.841(b)(1)(A)and(B)and960(b)(1)and(2)andNeal v. UnitedStates,516U.S.284,296(1996). TheSentencingGuidelinesexcludethecarriermedium andtreateachdoseas0.4mg.BecausethecarriermediumisheavierthantheactualLSD,andthus constitutesmostoftheweight,theinterplayofthesetwoprovisionstendssimplytoresultinimposi 93 tionofthe5or10yearstatutoryminimumsentence.
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AppendixF:
ExamplesofNotableStateLawswithRespectto PrecursorChemicalControl
Oklahoma
On6April2004,Oklahomaenactedthenationsmoststringentstatemethamphetamineprecursor controllaw.Now,onlylicensedpharmacistsorpharmacytechniciansmaysellproductscontaining nonprescriptionpseudoephedrine.Productsmustbekeptbehindthepharmacycounter,orelse whereifinalockedcabinet.Thesellermustobtainthepurchasersidentificationwithdateof birth;purchasersmustbeatleast18yearsold,andtheymustsignawrittenlog.Onlyninegrams maybesoldtoapersonin30days.Thepharmacistisresponsibleforkeepingtrackofonlyhisown storessalesuntilthestatedevelopsarealtimestatewideelectroniclogbookExceptionsarepro videdforcompoundsinliquid,liquidcapsule,orgelcapsuleform,andtheOklahomaStateBureau ofNarcoticsandDangerousDrugsControlmay,byrule,exemptotherproductsthatitsDirector findsarenotusedintheillegaldrugmanufacture.SeeOkla.Stat.Title63,2212and2332,as amendedbyH.B.No.2176.
Missouri
On28August2003,Missourienactedalawimposingadditionalrestrictionsonthesaleofoverthe counterdrugscontainingtheprincipalmethamphetamineprecursors.Forproductscontaining ephedrine,pseudoephedrine,orphenylpropanolamineasthesoleactiveingredient,storesmaysell onlytwopackagescontainingatotalofsixgramsofprecursor.Unlesstheretailerhasanelectronic antitheftsystem,theseproductsmustbedisplayedeitherbehindthecheckoutcounterorwithin 10feetofunobstructedviewfromanattendedcheckoutcounter.Forcombinationproductscon tainingthoseprecursorsandotheractivemedicalingredients,theymaysellthreepackagescon tainingnomorethanninegramstotal.KnowingviolationsaresubjecttoclassAmisdemeanor penalties;thestoreowneroroperatormayinvokeindefensethatanemployeetrainingprogram wasinplace.SeeMo.Ann.Stat195.417(2003).
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Notes
Ravesareallnightdanceparties,usuallyadvertisedasalcoholfreetoallowfortheadmissionofunderagechildrenand youngadults.Techno,industrial,trance,andothermusicgenresarethefocusoftheraveexperience.Circuitpartiesare multidaygatheringsofgayandbisexualmenthatoccureachyearataroundthesametime,inthesametownorcityand centeredononeormorelarge,latenightdanceeventsthatoftenhaveatheme.Raveeventsattractfromhundredstothou sandsofparticipants,whilecircuitpartiesmayattractasmanyas20,000mentoalocalcommunity.Widespreadandopen drugconsumptionappearstobethenormatsomeoftheseevents. GHB(gammahydroxybutyricacid),underthetradenameXyrem,wasapprovedinJuly2002bytheFoodandDrug Administration(FDA)forthetreatmentofcataplexy,asuddenlossofmuscletoneassociatedwithnarcolepsy.Theavailabili tyofsmallquantitiesoflegallymanufacturedGHBhasnotchangedthefactthatthevastmajorityofabusedGHBisofillicit origin.
3 2 1
Formoreinformation,seetheDEAFactSheet:http://www.usdoj.gov/dea/pubs/pressrel/methfact01.html
TheDrugAbuseWarningNetwork(DAWN)Report,preparedundertheauspicesoftheDepartmentofHealthandHuman Services,compilesinformationfromasurveyofdataonpatientsseekinghospitalemergencydepartmenttreatmentrelated totheiruseofillegaldrugsornonmedicaluseoflegaldrugs.Since1988,DAWNdatahasbeencollectedfromarepresenta tivesampleofeligiblehospitalsnonFederal,shortstaygeneralhospitalswitha24houremergencydepartmentlocated throughouttheUnitedStates,butexcludingAlaskaandHawaii.Thedataisusedtoestimatethetotalnumberofemergency roomdrugepisodesandmentionsofspecificdrugsinallsuchhospitals.TheDAWNsystemalsocollectsdataondrugrelat eddeathsfromanonrandomsampleofmedicalexaminers.DAWNemergencyroommentionsforalldrugshaveremained relativelystablefrom1999throughthefirsthalfof2002. SAMHSAOfficeofAppliedStudies,DAWN2001data.Twooutofthreeemergencyroomepisodesinvolvingketamine involvedalcoholoranothercontrolledsubstanceaswell. TheMonitoringtheFutureStudyisconductedbytheUniversityofMichiganInstituteforSocialResearchandfundedbythe NationalInstituteonDrugAbuse(NIDA).ThestatisticsreportedhereshouldbeconsideredinthecontextoftheoverallU.S. druguseprofile.The2001HouseholdSurveyestimatesthattheoverallrateofcurrentillicitdruguse(definedinthesurvey asusewithinthepast30days)increasedslightlyin2001,buttheratehadbeenstabilizinginpreviousyears.Therateofcur rentillicitdruguseamongyouthage1217(approximately10.8percentin2001)ishigherthantherateofuseamongthe overallpopulationage12andolder(approximately7.1percent).
7 6 5
SAMHSAOfficeofAppliedStudies,DAWN2002data.
TheNationalInstituteofJustice'sArresteeDrugAbuseMonitoring(ADAM)programtrackstrendsintheprevalenceand typesofdruguseamongarresteesinurbanareas.Theprogramprovideslocalareaestimatesoftherateofdruguseamong adultandjuvenilearresteesbasedonvoluntaryandanonymousinterviewsandurinespecimencollectionundertakenwithin 48hoursofarrest.Theprogramcurrentlyoperatesin39siteswithdatacollectiontakingplaceforaperiodoftimeeachcal endarquarter.TheADAMprogram,however,doesnotreportnationalestimates.Preliminaryfindingsfor2001arebasedon reportsfrom27sitesinvolvingadultmalearrestees.Thereasonfortheregionalvarianceinthedataisunknown. CommunityEpidemiologyWorkingGroup,EpidemiologicTrendsinDrugAbuse: AdvanceReport,June2003,p.10.Hawaii HIDTA2003ThreatAssessment,pp.2324.AccordingtotheTreatmentEpisodeDataSet(TEDS),admissionsformetham phetamineabuseincreasedoverallfrom498in1993to1,548in2000.Nearly36percentofalladultarresteestestedpositive formethamphetamineuse.Themethamphetamineassociateddeathtollrosefrom27deathsin1998to54in2001.
10
9
SAMHSAOfficeofAppliedStudies,TheDAWNReport: ClubDrugs, 2002Update,July2004,p.13.
11
TheCommunityEpidemiologyWorkGroup(CEWG)oftheNationalInstituteofDrugAbusecollectsandanalyzesdrugdata fromanumberofquantitativeandqualitativesources,including,amongothers,ADAM,DAWN,andDEAseizure,price,puri ty,prescription/distribution,andarrestdata.TheCEWGreportsthatinthe21areasthatcompriseitssurveillancenetwork, MDMAisreadilyavailableatravesandotherdancepartiesandnightclubs,andMDMAuseisspreadingbeyondtheselocales intomorecasualsocialsettings.DeathslinkedtoMDMAoccur,butareunpredictable,andarenotnecessarilyrelatedtothe dose(DAWNstatisticsreveal27deathspossiblylinkedbetween1994and1998).TheJune2002CEWGreportalsonotesthat mentionsofMDMAandotherclubdrugsinmortalitydata,whileclimbing,remainrelativelylow.
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12
SAMHSAOfficeofAppliedStudies,TheDAWNReport: ClubDrugs, 2002Update,July2004,p.13. 2002MonitoringtheFuturestudy. SAMHSAOfficeofAppliedStudies,TheDAWNReport: ClubDrugs, 2002Update,July2004,p.13. 2002HouseholdSurvey.
13
14
15
16
SAMHSAOfficeofAppliedStudies,TheDAWNReport: Oxycodone, Hydrocodone, andPolydrugUse, 2002,July2004,p.13. TheDAWNReportcautionsthatestimatesforoxycodonementionsshouldnotbeattributedtoanyparticularbrandofanal gesiccontainingoxycodone.
SAMHSAOfficeofAppliedStudies,DAWN2002data.AlsoseeCommunityEpidemiologyWorkingGroup,Epidemiologic TrendsinDrugAbuse: AdvanceReport,June2003,p.42,whichstatesthatPCPindicatorsincreasedinLosAngeles, Philadelphia,Phoenix,Washington,DC,andTexas,andremainedsteadyinChicago.

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17
2000HouseholdSurvey.
MonitoringtheFuturesurveysofLSDusebeganin1991forgrades8and10andin1975forgrade12.The2001survey resultsweremixed,withpastmonthuseincreasingamong12thgradersfrom1.6percentto2.3percent,whilepastyearuse declinedamong10thgradersfrom5.1percentto4.1percent.Asof2001,anestimated10.9percentof12thgradestudents reporteduseofLSDatsomepointintheirlives.

20
19
SAMHSAOfficeofAppliedStudies,TheDAWNReport: ClubDrugs, 2002Update,July2004,p.13. Unlessotherwisenoted,thesourceofthedatainthissectionisDEAHeadquarters.
21
EPICNationalClandestineLaboratorySeizureSystem,2003data.Thankstoimprovedreporting,EPIClabfigureshave becomemorecomprehensiveandreliable.TheBureauofJusticeAssistanceandtheCommunityOrientedPolicingServices (COPS)programhaveagreedtorequirestateandlocalgovernmentstoreportlabseizurestoEPICasaconditionoffederallab cleanupgrants.

23
22
EPICNationalClandestineLaboratorySeizureSystem,2003data. EPICNationalClandestineLaboratorySeizureSystem,2003data.
24
Baseduponthenumberoflabsseized,averyroughestimateisthatthereare10timesasmanylabsinoperationasareever seized.Baseupontheamountofmethamphetamineproducedbytheselabs,officialsestimatethatupto2,844,000poundsof toxicbyproductsofmethamphetamineproductionhavebeendumpedinCalifornia.

26
25
EPICNationalClandestineLaboratorySeizureSystem,DrugEndangeredChildren,2003data.
27
TheNetherlandsandBelgiumareconservativelyestimatedasbeingthesourceofroughly70percentoftheMDMAcon sumedworldwide.
EPICNationalClandestineLaboratorySeizureSystem,2002data.ThenumberoflabsseizedintheUnitedStatesduring 19952002isasfollows:
28
Year #Labs
29
1995 3
1996 5
1997 4
1998 4
1999 13
2000 8
2001 11
2002 10
2003 10
2004 thru Oct.6 13
OnecauseforconcernistheentryofMexican,Dominican,Asian,andColombiantraffickinggroupsintotheMDMAdistri butionnetwork. Figure18reflectsinteragencydatacompliedbyEPIC,showingthatapproximately1.5millionMDMApillswereseizedin theU.S.arrivalzonein2003.Thisfigurewasdownfromapproximately3.6milliontabletsin2002,whichwasinturnlessthan theapproximately6.8milliontabletsseizedin2001,thehighestnumberever;thefigurefor2000wasabout5.8million tablets.Domestic(nonarrival)seizurefigureshaveshownasimilartrend:approximately3.5milliontabletsin2003,8.3mil lionin2002,11millionin2001,and8.3millionin2000.

31 30
Customs2001seizuredata. CommunityEpidemiologyWorkingGroup,EPIC,andDEA. CommunityEpidemiologyWorkingGroup,EPIC,andDEA.
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33
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MDMATraffickingintheUnitedStates,EpidemiologicTrendsinDrugAbuseAdvanceReport,December2001,Community EpidemiologyWorkGroup.DEAusesvarioussourcestoassessthetraffickingofMDMAintheUnitedStates.Theseincluded theUnitedStatesCustomsServicereports;theNationalForensicLaboratoryInformationSystem(NFLIS);andtheDEA SourceDeterminationProgram.DEAdrugtestinglaboratoriesarelocatedinsevenCEWGareas:Miami,NewYorkCity, Washington,D.C.,Chicago,Dallas,SanFrancisco,andSanDiego.Inaddition,aspecialtestingandresearchlabislocatedin Chantilly,Virginia. RockyMountainHIDTA2002ThreatAssessment,p.37.2labswereseizedinColoradoSprings,and1labwasseizedinFt. Collins.

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RockyMountainHIDTA2002ThreatAssessment,p.37.ThistakedownwaspartofOperationGreenClover.
AninternationalketaminesmugglingorganizationwasexportingthousandsofvialsatatimefromMexicoonafrequent basis. VarioussourceswithintheDepartmentsofHealthandHumanServices(HHS)andJusticeprovidedataandanalysesuseful fordetectingemergingdrugtrendsthatcommunitiescantargetaspartoftheiroverallpreventionefforts.Initiativesinclude StateIncentiveGrantsforCommunityBasedActiondistributedto27governorsofficesandthemayorsofficeintheDistrict ofColumbiainsupportofplanningforcoordinatedsubstanceabusepreventionefforts. TheNationalInstituteonDrugAbuse(NIDA)conductsacomprehensive,multidisciplinarypreventionresearchprogram examiningtheinteractionofmultiplefactorsthatcontributetoandprotectagainstdrugabuse.In1997,basedonmorethan 20yearsofpreventionresearch,NIDAidentifiedfundamentalprinciplesofdrugabusepreventioninthepublication PreventingDrugUseAmongChildrenandAdolescents. Thepublicationalsodiscussescommunitydrugabuseriskassess ment,preventionprogramimplementationandevaluation,andscientificfindingsabouttheefficacyofseveralidentifiedpro grams.Thispublicationiscurrentlybeingrevisedtoaccountfornewfindings.NIDAsInfoFactssystemandResearch ReportSeriesallowaccesstopublicationscontainingpertinentinformationwithrespecttopreventioneffortstargeting methamphetamine,theclubdrugs,andOxyContinandotherprescriptiondrugs.InformationisavailableontheInternet sitewww.clubdrugs.org. NIDAisnowdevelopingaResearchReportpublicationthatwillfocusonMDMAandpossiblyother syntheticdrugs.BasiceducationaleffortsincludetheteachingaidseriesMindOverMatter,acomponentoftheNIDA GoestoSchoolprogramthatdistributesinformationtoschoolsandencouragesstudentstolearnabouttheeffectsofdrugs ontheirbodiesandbrains.Researchbasedmaterials,suchasapopularpostermagazineseries,includeasegmenton methamphetamine,andNIDAisdevelopingmaterialsonMDMA.NIDAhascompletedacurriculumforhighschoolstudents aswellascurriculaforsecondandthirdgradestudents;curriculaforkindergarten,firstgrade,andfourthandfifthgradestu dentsarestillunderdevelopment.Furthermore,ateachingpacket,"TheNeurobiologyofEcstasy,"nowavailableonNIDA's Internetsite,wasdevelopedforusebyteachersandresearchersprimarilyworkingwithhighschoolstudents.NIDAalso recentlysetasideadditionalfundingforthePreventionResearchInitiative,whichincludes:(1)developmentofnew approachesforprevention,buildingonscientificfindings;and(2)enhancementofdisseminationofeffectiveprevention practicesthroughmultisitestudiesincommunitysettings.
40 39 38
37
TheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA)CenterforSubstanceAbusePrevention(CSAP) hascreatedaNationalRegistryofEffectivePreventionPrograms(NREPP)tocatalogprogramsfoundtobeeffective.Through thiseffort,CSAPhasdevelopedandimplementedacomprehensivesystemtoidentifyanddisseminatescientificallyproven modelpreventionprogramstolocalcommunities.ThiseffortdirectlysupportstheHHSStateIncentiveGrantprogram. Additionally,preventionresearchisfundedthroughtheSubstanceAbusePreventionandTreatmentBlockGrantProgramand theProgramsofRegionalandNationalSignificancefocusonmoreeffectivelydeliveringpreventionservices.
Inadditiontourinebasedtestsconductedinspeciallyinspectedandcertifiedlaboratories,newfederalregulationsare nearingcompletionthatwouldincludealternativetechnologiesallowingthetestingofspecimenssuchashair,oralfluid, sweat,andallowingpointofcollection(onsite/immediatescreening)tests.FurtherinformationcanbefoundontheInternet atwww.drugfreeworkplace.gov. TheNLCPalsocollaborateswithmilitary,criminaljustice,transportation,educationalinsti tution,clinical,andsportsrelatedtestingeffortsnationallyandinternationally.

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41
Thecampaigninvolves$5millioninpurchasedmessagestargetingyouthandadultsandanadditional$3.9millioninpro bonomediamatchmessagestargetingparents.Inaddition,ONDCPredesigneditsnewspaperandnewsorientedmagazine outreacheffortstobettertargetparentsandmetwithentertainmentindustrywritersandexecutivesinLosAngelesandin NewYorktodiscussthedangersofsyntheticdrugs.
Since1998,DEAsDrugandChemicalEvaluationSectionoftheOfficeofDiversionControl,inconjunctionwithDemand ReductionandTrainingCoordinatorsfromthe22DEAfielddivisions,hasprovidedscientificconferencesonclubdrugsin over70communitiesacrosstheU.S.thataddressedanddisseminatedinformationtolawenforcement,drugtreatmentpro
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fessionals,medicalemergencytechnicians,physicians,andhospitalstaffonissuesofhealthandsafetyregardingthesedrugs. Itisestimatedthatover10,000stateandlocalpoliceofficershaveattendedoneoftheseconferencesthusfar. DEAisjoiningwithantidrugcoalitions,themedicalcommunity,statelegislators,communityleaders,andordinaryciti zensin"townhall"meetingsthatfeaturediscussionsbetweenlocalresidentsandapaneloflocalandnationalexperts. MeetingssofarhavetakenplaceinSanDiego,KansasCity,Miami,andNewYork,andmoreareplanned.Thecampaigncan bereplicatedandcustomizedincommunitiesacrossthenation.Additionally,IntegratedDrugEnforcementAssistance (IDEA)isanintegratedenforcementandcommunitybaseddemandreductionprogramsponsoredbyDEAinsixcommuni ties.TheprogramfeaturesDEAenforcementactivitiesfollowedbytheimplementationofacommunitydevelopedstrategyto preventfutureillegaldruguse.AdditionalpertinentDEApublicationsincludeGetItStraight!APreventionBookforYoung Americans. Allpublicationsareavailableonline.
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Theearlyidentification"ofnewillicitlyusedsyntheticdrugs,andthemeasurementandunderstandingofthetrueimpact, requirethedevelopment,validation,anddisseminationofnewdrugdetectiontoolsandtests.Theprocessincludesawide rangeofparticipantsandresourcesfromgovernment,academia,instrumentmanufacturers,clinicalandforensicpatholo gists,toxicologists,andtheirsupportlaboratories.Thesegroupsnetworkactivelyandrecognizetheneedfornewtests,butit remainsachallengetodevelopcommerciallyavailabletestproductstospecificallydetectandmeasurethepresenceofsome syntheticdrugs.
Muchabusetrendinformationiscollectedbypublichealthandlawenforcementagencies.DEAisoftenabletoundertake emergencyregulatoryactionbasedonpreliminaryinformationaboutabuseandtraffickingofnoncontrolledsubstances. Forexample,asnotedinAppendixDofthisActionPlan,from2002tothepresent,DEAhasundertakentemporary,emer gencyschedulingoffiveclubdrugs,allofwhichhadbeenmarketedaslegalalternativestoMDMA.Asp[artofitsfunctionto monitornewandemergingdrugproblems,theDrug&ChemicalEvaluationSectionofDEAsOfficeofDiversionControlcur rentlyhasasystemwhichhasidentifiedspecificdrugproblemswellinadvanceofnationalcrisesaswell.Likewise,institu tionalizedforaexisttoreviewavailabledata.AnInteragencyCommitteeonDrugControl(ICDC)meetsmonthlytodiscuss emergingdrugproblemsandconsiderappropriate,multifacetedresponses.TheICDCinvolvestheOfficeofNationalDrug ControlPolicy,theNationalInstituteonDrugAbuse,theFoodandDrugAdministration,andtheDrugEnforcement Administration.TheCommunityEpidemiologyWorkingGroupmeetstwiceayeartoreviewcurrentandemergingsubstance abusedata.
47
46
Theseeffortsmayinclude,amongotherthings,datafromHHSMethamphetamineandEcstasyinfrastructuregrantrecipi entsandDOJWeedandSeedsites,aswellasdatafromNIDA/CEWG,DAWN,andDEA.Thecompilationandanalysescanbe usedinternallyforpolicyandprogramdevelopmentandcouldbemadeavailableinsomeformforcommunityusefroman existingInternetaccessedfederalSAMHSAserverusingthePreventionDecisionSupportSystemqueryandneedsassess mentresources.
SAMHSAsSubstanceAbuseTreatmentFacilityLocator,TreatmentImprovementExchange,andNationalClearinghousefor AlcoholandDrugInformationcanbeaccessedviatheinternetatwww.findtreatment.samhsa.gov,www.treatment.org,and www.health.orgrespectively. DuringtheannualUNCommissiononNarcoticsandDrugs(CND)InternationalNarcoticsControlBoard(INCB)meeting inVienna,inMarch,2001,theUnitedStatesandtheEuropeanUnion(EU)passedajointresolutiononsyntheticprecursors: Recommendingcreationofanearlywarningsystemtoidentifyandadviseindustryonnewchemicalsusedinillicitsyn theticdrugmanufacture. Urgingcountriestocomprehensivelytestseizedsyntheticdrugsandestablishanetworkofcollaboratinglaboratoriesto tracknewillicitdrugmanufacturingtrends. SpecificallytargetingtheprecursorPMK,akeychemicalinMDMAproductionwithlimitedlegitimatecommercialuse.
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21U.S.C.971.
TheproceduresusedbyDEAtoadministertheletterofnoobjectionsystemhavebeenchallenged,withpartiallyadverse results,intheU.S.DistrictCourtfortheDistrictofColumbia.PDKLabsInc.v.Ashcroft,CivilActionNos.002894and00 2899(HHK). PDKLabsInc.isamanufacturerofdrugproductscontainingprecursorchemicals,butisnotregisteredto importsuchchemicals.PDKchallengedDEAsdenialofitsrighttorequestanadministrativehearingafterDEAfailedtogrant aletterofnoobjectiontothefirmimportingchemicalsforsaletoPDK.

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TitleVI,SubtitleAofPub.L.100690(partoftheAntiDrugAbuseActof1988"),passedNovember18,1988. TitleXXIII(Sec.2301)ofPub.L.101647(CrimeControlActof1990),November21,1990. Pub.L.103220,effectiveApril16,1994.
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Pub.L.104237,signedOctober3,1996.DEAhasfinalizedimplementingregulations,withatransactionthresholdof0.4 kilograms(about1pound).Inordertoensurethatthefederalgovernmentitselfdoesnotbecomeasourcefordiverted chemicalmaterials,theDEA,pursuantto21U.S.C.890andproceduresinrecentlypublishedproposedregulations,moni torssalesofcrudeiodinefromthechemicalstockpilesmaintainedbytheDepartmentofDefense.Withrespecttoeach knownpotentialbidder,DEAcertifieswhetherthereisreasonablecausetobelievethatasalewouldresultintheillegalmanu factureofacontrolledsubstance.Tomakethisdetermination,DEAexaminestheprospectivebiddersandenduserspast experienceinmaintainingeffectivecontrolsagainstdiversionandotherrelevantfactors.Thesystemworkssatisfactorily, althoughitisdifficultforDEAtogeneratethenecessarycertificationcorrespondencewithinthe15daybidwindowwhena newfirmappearsasabidder.Overall,diversionfromthisstockpileisunlikelybecauseoftheclosegovernmentscrutiny,the verylargevolumesinvolved(5,000poundsisthesmallestquantitypurchasedundertheprogramsofar),thetransportation logistics,andtheextensiveprocessingrequiredtomakethecrudeformofextractediodinecommerciallyuseable. UnitedStatesv.Lopez,514U.S.549,581(1995)(Kennedy,J.,concurring),citedandquotedinGrutterv.Bollinger,539U.S. 306,342(2003).
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55
Therehavebeenreportsofmorefrequenttheftofanhydrousammonia,afarmfertilizerusedtomanufacturemethamphet amine.Theftofanhydrousammoniaisafederalcrime,see21U.S.C.864.Somestates,suchasNorthDakota,havetaken actionstoimprovesecurityatammoniadistributioncentersandtoencouragefarmerstobuylocksfortheiranhydrous ammoniatanks.Somestateshavecriminalizedorenhancedpenaltiesforthetheftofanhydrousammonia.Furtherefforts, suchasfederalassistancetodevelopabestpracticesmanual,maybewarranted. See21C.F.R1310.12and1310.13,aspublishedat68Fed.Reg.23195(May1,2003).
58
Inadditiontotheabovefigures,20,000kilogramsofmahuang,whichcontainsephedra,werevoluntarilywithdrawnbyan importerinMay2003,duetonewFDAactionwhicheffectivelybannedthemarketingofmahuanginproductsmarketedas dietarysupplements. ApublicprivateSuspiciousOrdersTaskForcewasestablishedasaresultofSec.504oftheComprehensive MethamphetamineControlActof1996.Thegroupconsistedoffederalandstateregulatorsandlawenforcementofficialsand theregulatedbusinesscommunity;itmetfivetimesand,inareporttotheAttorneyGeneraldatedFebruary1999,agreedto severalvoluntarymeasuresthat,ifwidelyimplemented,willassistbothindustryandlawenforcement.TheSuspicious OrdersTaskForceidentifiedindicatorsofsuspicioustransactions,recommendedthatmanufacturersofretailoverthecount erdrugproductscontainingmethamphetamineprecursorslimitpackagesizesanduseonly"blister"packaging,andrecom mendedthatallretailsalesofelementaliodineandredphosphorousbereportedtoDEA.Manysegmentsofindustryhave implementedtheserecommendations. PfizerPharmaceuticalinvested$12millionoverfiveyearsintothedevelopmentofanewtechnologywhichwouldmakeit impossibleformethamphetaminetraffickerstouseSudafedandrelatedproductsforillicitpurposes.Whileinitialattempts provedunsuccessful,researchcontinues.
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59
ThefinalregulationswerepublishedintheCanadaGazettePartII,Vol.136,No.21onOctober9,2002.A1996law,the ControlledDrugsandSubstancesAct,wasunabletostemthechemicalflowuntiltheseimplementingregulationswere promulgated. Theoperationsundertakensofarhavebeen,inorder,Purpleforthecocaineoxidizingagentpotassiumpermanganate, Topazfortheheroinchemicalaceticanhydride,andPrismfortheprecursorstoamphetaminetypestimulants. TheU.S.positionisthatsuchpharmaceuticalpreparationsshouldbecontrolledpursuanttoArticle12(14)ofthe1988UN Convention.
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UndertheMethamphetamineAntiProliferationActof2000(MAPA),DEAwasdirectedtoprepareareporttoCongresson theblisterpackexemption. DEAforwardedareporttoCongressinNovemberof2001recommendingtheremovalofthis exemptionandtheimpositionofastrict9gramthreshold,thelimitallowedbyCongressfornonblisterpackproduct,and thecurrentthresholdfornonblisterpackpseudoephedrineproducts.SeeSec.3642oftheMethamphetamineAnti ProliferationActof2000,setforthat21U.S.C.802(note),formoredetails.InOctober2003,Sen.Feinsteinintroducedabill (S.1784)proposingtheremovalofthisexemption.

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See21U.S.C.971.
AlthoughDEAregulatesimportsoflistedchemicalsthroughaprenotification/verificationsystemandlettersofnoobjec tiontogovernmentsinkeychemicalsourcecountries,iteffectivelylosesoversightonceashipmententerstheUnitedStates. Iftheimporterssaletothedeclaredcustomerisnotconsummated,thechemicalsmaybesoldonthespotmarketwithout DEAoversight,whichineffectcircumventsthelegalcontrolsonchemicalimports.
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Seeforexample21U.S.C.952(importcontrols),823(registrationrequirements),and826(productionquotas).Fortechni calreasons,itisimpracticalunderthecurrentlawstodesignatebulkephedrineandpseudoephedrineasimmediateprecur sorsofmethamphetamine.See21U.S.C.802(23),butseealso811(g). BecausepharmaciesarespecificallyexemptfromregistrationtohandleListIchemicals,byvirtueoftheirregistrationto handlecontrolledsubstances(theywouldalsobeexemptasretailoutletsunderaseparateprovisionoftheDEAregulations), theydonotreceivepreregistrationsitevisitsbyDEAandarenotsystematicallymadeawareofthechemicaldiversionprob lem. Casesinvolvinglargescalediversionfrompharmacieshavebeenreportednationwideand,inmanycases,inregions notassociatedwithmethamphetamineproduction.

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Thecontinuedproliferationofthousandsofsmallclandestinemethamphetaminelabsthroughoutmuchofthecountryis fueledbyretailleveltheftandsmurfing(thepurchaseofsmallamountsofproductatseverallocationstoavoidattention). Tocurbthesepractices,itwillbenecessarytofurthercontrolaccesstothemostpopularprecursorinthemostwidelyused formpseudoephedrineinoverthecountermedicationswithoutprecludingaccessbylawabidingconsumers.Some stateshaveimposedstrictercontrolsthanapplyunderfederallaw.Forexample,theysetpurchasinglimitsonallpseu doephedrineandephedrineproducts,regardlessoftheformofpackaging.SeveralcountiesandmunicipalitiesinMissouri requiretheplacementoftheseproductsbehindthestorecounter,muchlikecigarettes.
Shortlyafterhisconfirmation,formerDEAAdministratorAsaHutchinsonmademethamphetamineoneoffivepriority areas.InSpring2002,helaunchedatourwiththethemeMethinAmerica,NotinOurTown,anationwidecampaignto raiseawarenessofthegrowingmethamphetamineproblem.

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TheNMCIhascreatedasecure,internalwebsitewherelawenforcementofficialsshareideasandinformation.
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ThetaskforceincludesrepresentativesfromDEA,FBI,ICE,DCIS,EPA,USAttorneysOffices,theCaliforniaDepartmentof Justice,theKentuckyStatePolice,theOregonStatePolice,theRockyMountainHIDTA,theArizonaAttorneyGeneralsOffice, theCaliforniaDepartmentofToxicSubstanceControl,thePhoenixPoliceDepartment,theMesa,ArizonaPoliceDepartment, andtheArizonaDepartmentofPublicSafety. ThefundsareprovidedtoDEAthroughtheCommunityOrientedPolicingServices(COPS)program. TwoDEAcomponentsprovidetrainingonInternetbasedinvestigations.
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PersonstracingtheirnationalandethnicrootstotheMiddleEasthavebeendisproportionatelyrepresentedamongthe ranksofroguechemicalcompanyexecutives,brokers,andsmugglersofillicitpseudoephedrinefromCanadatotheUnited States.

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Mediansentencesin2000and2001were30months.
Specifically,twolargescaletraffickerswereextraditedfromIsraelonchargesinMiamiinJuly2002forconspiracytoimport MDMAintotheU.S.(thefirstextraditionofanyIsraelicitizentotheU.S.foradrugcrime); threeIsraelis,whowerepartofa sophisticateddrugtraffickingorganizationbasedinIsrael,werearrestedafteraninternationalcontrolleddeliveryof1.4mil lionEcstasypillshiddeninthreediamondpolishingtables;andIsraelicitizenOdedTuito,adesignatedkingpinunderthe ForeignNarcoticsKingpinDesignationAct,wasindictedandextraditedfromSpaintofacechargesintheEasternDistrictof NewYork(Brooklyn)stemmingfromhisleadershipoftheworldslargestMDMAsmugglingring.

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21U.S.C.856.
Labsthatproducelessthantwoouncesofmethamphetamineperbatchareconsideredsmalllabs.SeeUSSG2D1.1(c)(6), whichrespondstoSec.3612ofMAPA.Careeroffenderenhancementsmayalsobeavailableinthesecases.SeeUSSG4B1.1. In2000,only31federalmethamphetaminedefendantsreceivedthisadjustmentunderSentencingGuidelineUSSG 2D1.1(b)(5). Whilenotall3,358methamphetamineoffenderswereprosecutedforoffensesrelatedtomanufacturingas opposedtoimportationordistributionthenumberoflabsseizedindicatesthatmanywerechargedwithmanufacturing methamphetamine.

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Thesefakeandknockoffproductsaddtotheexistinguncertaintyanddangerofthedrugmarket,andinparticularthe clubdrugscene.
Someoftheapproachessuggestedinthisoutlineforfasterandmorecomprehensivedatagatheringanddissemination couldrequireadditionalresources.Asappropriate,optionsforadditionalfundingshouldbeconsidered. ThisdatacanbecomplementedbyreviewofMicrogram,apublicationcompiledbytheDEAOfficeofForensicSciences thattracksunusualdrugseizuresandmeansofconcealment.

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SmallcitiesandtownsandruralareasmustsomehowbeincludedthiswillhelpavoidmissingthenextOxyContinor methamphetamineproblem.Itisacknowledgedthatitwillbeachallengetoselectrepresentativeorbellwethertowns.
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ThenewequivalenciesforMDMAandrelatedsubstanceswerefirstsetbyemergencyamendmentstoUSSG2D1.1 (Amendment609,effectiveMay1,2001)andwererepromulgatedandmadepermanentbyAmendment621.SeeU.S. SentencingGuidelinesManual,supp.toapp.C.(2001). USSG2D1.1,Amendment640(2001).
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Forconsistencyandsimplicity,referencesthroughoutthisActionPlanaretoSentencingGuidelinesrangesforcriminal historycategoryI.Generally,offendersinthiscategoryhaveneverbeenincarceratedorhavebeenimprisonedononlyone occasionforlessthan60days.Chapter4oftheU.S.SentencingGuidelinessetsforthapointsystemoffactorsforassessinga defendantscriminalhistory.Thehigherthecriminalhistorycategory,thelongerthesentence.

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TheCommissionsproposedchanges,whichwillgointoeffectunlessCongressrevisesthem,werepublishedat69Fed.Reg. 28994(May19,2004). ThisActionPlanincludesonlylimitedrecommendationsforchangestothefederalsentencingguidelines.Ratherthanset tingforthextensiveproposalsatthistime,DOJcomponentswillworktoassurethat,ifnecessary,legislativeandguidelines changesoccursothatsentencesforparticularoffensesmoreappropriatelyreflecttheharmsuffered. U.S.SentencingGuidelinesManual,supp.toapp.C.(2001),Amendment640. Section608ofPub.L.10821(passedasS.151),signedApril30,2003(thePROTECTAct).
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ItshouldbenotedthataffirmativecivillitigationseekingcivilpenaltiesandinjunctionsundertheControlledSubstances Actagainstpersonsandfirmsthatviolatethechemicalcontrolsystemhasincreasedinrecentyears.Asmall,informalcadre offederalaffirmativecivilenforcementlitigatorshasdevelopedsomefocusingonchemicalimportersandoverthecounter drugmanufacturersinjudicialdistrictsfarfromareasofmethamphetamineproduction
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NATIONAL SYNTHETICDRUGS ACTIONPLAN

TheFederalGovernmentResponsetothe Production,Trafficking,andAbuseofSynthetic DrugsandDivertedPharmaceuticalProducts

TheFederalGovernmentResponsetothe Production,Trafficking,andAbuseofSynthetic DrugsandDivertedPharmaceuticalProducts

EXECUTIVE OFFICE OF THE PRESIDENT

JohnP.Walters Director OfficeofNationalDrugControlPolicy

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

Figure4: DAWNSyntheticDrugMentions, 19942002

NATIONAL SYNTHETIC DRUGS ACTION PLAN

Figure5: ADAMTestingResultsforMethamphetamine, 20002002

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

gencydepartmentvisitsinvolvingMDMA, andtheCommunityEpidemiologyWorkGroup(CEWG) reportfromJune2002notedthattheannualnumberofdeathsassociatedwithMDMAmaybe 11 increasingaswell,althoughthemortalitynumbersremainlow.

8thGrade 10thGrade 12thGrade

3.5 3.0 2.1

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

180 49 151 49 492 413 592 75 55 23 9

Source:NationalClandestineLaboratoryDatabase Total:10,144/47StatesReporting Dates: 01/01/03to12/31/03

Methamphetaminecooksburytheleftover chemicalwasteinthesoilordumpitintosepticsys temsorstreamsinruralareas,orintotheplumbing whenstayingathotelsorrentalhomes.Thetoxic wastedumpedintothesoilorstreamscanthenmake

NATIONAL SYNTHETIC DRUGS ACTION PLAN

Figure16:Makeshiftlaboratoryequipmentandchemicalsusedin asmallmethlab.Someofthemorecommonchemicalsfoundat methlabsincludesodiumhydroxide,methanol,acetone,isopropyl alcohol,ether(startingfluid),andcharcoallightingfluid. Source: DrugIdentificationBible

NATIONAL SYNTHETIC DRUGS ACTION PLAN

Figure17: ChildrenAffectedinMethamphetamineLaboratoryRelatedIncidents, 20002003

NATIONAL SYNTHETIC DRUGS ACTION PLAN

0 2000 2001 2002 2003 2004June

Figure18: TotalU.S. &ArrivalZoneMDMASeizures, 20002004

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

drugitemsidentifiedas,ketamineduring2002(comparedto1,802itemsin2001and581itemsin 2000). In2002,thisconstitutedroughly12percentofallclubdrugexhibitsenteredintheNFLIS database.

NATIONAL SYNTHETIC DRUGS ACTION PLAN

Figure20:Asmallglassvialcontainingabout3 ccsofliquidPCP.Smokingacigarettethathas beendippedinliquidPCPisthemostcommon wayofingestingthedrug. Source: DrugIdentificationBible

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

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Source: USDepartmentofJustice, InformationBulletin: ChildrenatRisk(7/2002)

NATIONAL SYNTHETIC DRUGS ACTION PLAN

dardsformembernationstocontroldomesticandinternationalchemicalcommerceandprevent thediversionof23specifiedchemicals.PartiestotheConventionpledgetocooperatewithone anothertowardthisobjective.Otherinternationalvehiclesthathavepromotedchemicalcontrol include:

NATIONAL SYNTHETIC DRUGS ACTION PLAN

NATIONAL SYNTHETIC DRUGS ACTION PLAN

2003 2004 (March)

Figure22: RawandtabletPseudoephedrineandEphedrineImports, CalendarYear2003March200459