NYS Law Prescription OTC Drug Use or

NYS Law Prescription & OTC Drug Use or Abuse for Adults & Minors Michelle Accardi, B. A.

“The most effective tool we have to fight substance abuse— including cough medicine abuse —is education at the community level. ” General Arthur Dean Chairman & CEO Community Anti-Drug Coalitions of America

Federal Law of Controlled Substances

Controlled Substances Act (CSA): Enacted into law by Congress under the Comprehensive Drug Abuse Prevention and Control Act of 1970 n Policy under which the manufacture, importation, possession, use, and distribution of certain substances is regulated n Overseen by the DEA, FDA, and HHS n

Schedules of CSA: n A “controlled substance” (CS) is any drug or other substance, or immediate precursor, included in schedule I through V n Does not include distilled spirits, wine, malt beverages, tobacco, or caffeine. n Each schedule requires a specific “potential for abuse”

Schedule I n The substance has a) high potential for abuse; b) no currently accepted medical use in treatment in the US; c) lack of accepted safety use of the substance under medical supervision. n n No prescriptions may be written and substances are subject to production quotas by the DEA Sentences for first time, non-violent offenders convicted of trafficking these can turn into de facto life sentences when multiple sales are prosecuted in one proceeding. Sentences foe violent offenders are much higher.

Schedule I n n n n GHB Marijuana Heroin Ecstacy (MDMA) LSD Peyote/Mescaline Psilocybin (mushrooms) Various strong and weak opiods

Schedule II n The substance has a) high potential for abuse; b) is currently accepted for medical use in treatment; c) potential for severe psychological or physical dependence. n n Requires a prescription that cannot be refilled. Varied in potency and in nature.

Schedule II n n n n Cocaine (as a topical anesthetic) Ritalin, Concerta, Focalin, Adderall Opium Methadone Oxycodone, codeine, hydrocodone Morphine Amphetamines

Schedule III n The substance has a) potential for abuse less that those in schedules I and II; b) is currently accepted for medical use in treatment; c) potential for moderate to low physical dependence or high psychological dependence. n Requires a prescription that may not be filled or refilled after 6 months; may not be refilled more than 5 times within 6 months unless renewed by practitioner.

Schedule III n n n Anabolic steroids Buprenorphine Ketamine Hydrocodone/codeine (when compounded with ibuprofen or Tylenol) Marinol LSA

Schedule IV n The substance has a) low potential for abuse relative to those in schedule III; b) is currently accepted for medical use in treatment; c) potential for limited physical or psychological dependence relative to those in schedule III. n Requires a prescription that may not be filled or refilled after 6 months; may not be refilled more than 5 times within 6 months unless renewed by practitioner.

Schedule IV Benzodiazepines n “Z drugs” n Phenobarbital n Stimulant-like drugs n Antidiarrheal drugs n

Schedule V n The substance has a) low potential for abuse relative to those in schedule IV; b) is currently accepted for medical use in treatment; c) potential for limited physical or psychological dependence relative to those in schedule IV. n n Requires a prescription. May not be distributed or dispensed other than for a medical purpose.

Schedule V Cough suppressants n Pregabalin n Some antidiarrheals n

Scheduling Exceptions: n Dextromethorphan (DXM) n n n Exempt from scheduling under original CSA. Noted by DEA to be abused recreationally as a dissociative anesthetic similar to PCP or Ketamine. Listed as a “chemical of concern” and considered for possible evaluation for scheduling

New York State Law

Prescription Drug Monitoring Program (PDMP): As of January 2010, 34 states have operational PDMP’s that have the capacity to receive and distribute CS information to authorized users.

NYS Official Prescription Program n Located within the Department of Health n n n Kenneth Post, Acting Director, Bureau of Narcotic Enforcement 4, 498 pharmacies DEA or CS registered 83, 887 Practitioners authorized to prescribe controlled substances Monitors Schedule II, IV, V drugs 19. 5 million Rx records collected in 2008 n Data is collected once per month from pharmacies and practitioners

Article 33 (New York State Controlled Substances Act) Prohibited acts. n n 1. It shall be unlawful for any person to manufacture, sell, prescribe, distribute, dispense, administer, possess, have under his control, abandon, or transport a controlled substance except as expressly allowed by this article 2. It shall be unlawful for any person to possess or have under his control an official New York state prescription form except as expressly allowed by this article.

Article 33: Mandated Reporting n n n Addicts or habitual users of any narcotic drugs Incidents or alleged incidents of theft or possible diversion of any CS manufactured, ordered, distributed, or possessed Charges or proceedings brought in any court or before any governmental agency (state or federal) in which it is alleged that the employee has failed to comply with the law n n Result: Revocation of licensure or certificate of DEA authorization, in whole or in part, by the Commissioner In lieu of revocation, the commissioner may impose a civil penalty not in excess of $10, 000 No communication between patient and practitioner for issues pertaining to any CS will be considered confidential (includes prescribing, administering, treating, etc. )

NYS Penal Law n n Culpability Classification of Offenses n n Felonies Misdemeanors Violations Felony Misdemeanor Fines n n n Individuals Corporations Multiple fines Violation

NYS Penal Law n Class B misdemeanors: n n n False Personation Knowingly misrepresenting own name, date of birth, or address to a police officer with the intent to prevent them from ascertaining such information.

NYS Penal Law n class A misdemeanors: n n n Criminal possession of a CS in the 7 th degree. Criminally possessing a hypodermic instrument. Criminally using drug paraphernalia in the 2 nd degree. Criminal possession of methamphetamine manufacturing material in the 2 nd degree. Criminal diversion of prescription medications and prescriptions in the 4 th degree.

NYS Penal Code n class E felonies: n n n n Use of a child to commit a CS offense. Criminal injection of a narcotic drug. Criminal possession of precursors to a CS. Criminal possession of methamphetamine manufacturing material in the 1 st degree. Criminal possession of precursors of methamphetamine. Unlawful disposal of methamphetamine laboratory material. Criminal diversion of prescription medications and prescriptions in the 3 rd degree.

NYS Penal Law n class D felonies: n n n Criminal possession of a CS in the 5 th degree. Criminal sale of a CS in the 5 th degree. Criminally using drug paraphernalia in the 1 st degree. Unlawful manufacture of methamphetamine in the 3 rd degree. Criminal diversion of prescription medications and prescriptions in the 2 nd degree.

NYS Penal Law n class C felonies: n n n Criminal possession of a CS in the 4 th degree. Criminal sale of a prescription for a CS. Unlawful manufacture of methamphetamine in the 2 nd degree. Criminal diversion of prescription medications and prescriptions in the 1 st degree.

NYS Penal Law n class B felonies: n n Criminal possession of a CS in the 3 rd degree. Criminal sale of a CS in or near school grounds. Unlawful manufacture of methamphetamine in the 1 st degree.

NYS Penal Law n class A-II felonies: n n n Criminal possession of a CS in the 2 nd degree. Criminal sale of a CS in the 2 nd degree. class A-I felonies: n n Criminal possession of a CS in the 1 st degree. Criminal sale of a CS in the 1 st degree.

Summary of Penal Law n n Criminal possession of a CS ranges from a Class A misdemeanor to a Class A-I felony. This felony depends on the substance, the weight of the substance in possession, the intent to sell or use unlawfully, or previous conviction of a relevant crime. The sentences intensify as the “degree” of the crime gets closer to the 1 st degree. Criminal sale of a CS ranges from a Class E felony to Class A-I felony. This also depends on the substance, weight of the substance, and previous conviction of a relevant crime. n n Note: For criminal possession or sale in the 5 th degree the intent to sell or manufacture a CS is irrelevant, because the weight of the substance alone can justify the crime as a Class D felony. Criminal Diversion refers to knowingly transferring, delivering, or receiving a Rx medication or device, in exchange for anything of pecuniary value. This can range from a Class A misdemeanor to a Class C felony. n n. You The individual may or may not have knowledge or reasonable grounds to know that the recipient has no medical need for it; or that the seller or transferor is not authorized by law to sell or transfer such prescription medication or device. The degree of the crime intensifies as the monetary benefit of the exchange increases, or when the individual has been convicted of a relevant crime in the preceding 5 years. can find additional information in the “Resources” handout.

Summary of Penal Law n n Criminal sale of Prescription by a practitioner, that goes against professional practice, is considered a Class C felony. Sale or attempted sale of CS in violation of this article using a child less than 16 to conceal the CS on or about the body or directs, forces, or otherwise requires the child to sell or attempt to sell or offer assistance in the sale to a third party, is considered a Class E felony. Knowingly and unlawfully possessing a CS and intentionally injecting, by means of syringe or needle, all or a portion of the drug into another’s body, with or without consent, is considered a Class E felony. Possession of a certain precursors of controlled substances, including methamphetamines, at the same time and with or without equipment, under the intent to manufacture unlawfully, ranges from a Class A misdemeanor to a Class B felony.

Rockefeller Drug Law Reform 2 n n Signed on October 7, 2009 by Governor Patterson Gives judges more discretion about sentencing and diverting n n first-time drug offenders Addicted persons Non-violent offenders Individuals eligible for probation 2 Bill adopted by NYS Legislature as part of 2009 -2010 State Budget.

Dextromethorphan (DXM): Bills n 1. Limits the access of any products containing DXM to a person under the age of 18. Proposed in 2009 to the Higher Education Committee. Contact the National Alliance for Model State Drug Laws (703) 836 -6100

Example 1 A pharmacy technician is caught and prosecuted for stealing opiates in several instances, and has intent to sell. This person may be charged with: n Criminal possession of a CS in the 3 rd degree (class B felony).

Example 2 Suppose an individual obtains a prescription from his physician for 40 tablets of Percocet 2. 5 mg/325 mg then presents it to his pharmacist but has changed the 40 to 140 or changed the 2. 5 mg to 12. 5 mg. That person could be charged with: Forgery in the 2 nd degree for altering the Rx. Criminal possession of a CS if they obtained the Rx. n n n If not, attempted criminal possession of a CS.

Example 3 An 18 year old college student exchanges a prescription for Ritalin for a half gallon of vodka. n n This person may be charged with: Criminal diversion of a prescription in the 4 th degree (class A misdemeanor) If the value of the benefit exchanged is in excess of $1000 the crime becomes diversion in the 3 rd degree (class E felony).

It’s illegal. Getting prescription drugs without a prescription, called "diversion" is illegal and may put you at risk for arrest and prosecution. Regardless of how you acquire a prescription medication, using these types of drugs without a valid prescription — one written for you — is unsafe and illegal.

Brief Report: Adolescent Rx and OTC Use in Broome County As measured by the Prevention Needs Assessment (PNA) 2004, 2006, & 2008

PNA measures: Other Narcotics n Sedatives n Amphetamines n Tranquilizers n Steroids n Methamphetamines n

Other Narcotics: n “On how many occasions (if any) have you taken narcotics other than heroin (such as methadone, opium, morphine, codeine, Demerol, Vicodin, Oxy. Contin, and Percocet) without a doctor telling you to take them? ”

Percent of Students Using Other Narcotics

Other Narcotics (2008) n Lifetime n n 8 th Grade: 2. 7% KYDS, 4. 5% MTF 10 th grade: 10. 2% KYDS, 10. 7% MTF 12 th grade: 15. 7% KYDS, 13. 4% MTF Past 30 Day n n n 8 th Grade: 1. 3% KYDS, 1. 1% MTF 10 th grade: 5% KYDS, 3. 9% MTF 12 th grade: 7. 9% KYDS, 3. 8% MTF

Sedatives: n “Sedatives, including Barbiturates, are prescribed by doctors to help people relax or get to sleep. They are sometimes called downs or downers, and include Phenobarbital, Tuinal, Nembutal, and Seconal… n On how many occasions (if any) have you taken Tranquilizers, without a doctor telling you to take them? ”

Percent of Students Using Sedatives

Sedatives (2008) n Lifetime n n 8 th Grade: 4. 6% KYDS, 9. 2% MTF 10 th grade: 10% KYDS, 14. 8% MTF 12 th grade: 9. 5% KYDS, 15. 2% MTF Past 30 Day n n n 8 th Grade: 2. 3% KYDS, 3% MTF 10 th grade: 4. 1% KYDS, 4. 6% MTF 12 th grade: 4. 4% KYDS, 4. 6% MTF

Amphetamines: n “Amphetamines have been prescribed by doctors to help people loose weight or give people more energy. They are sometimes called uppers, ups, speed, bennies, dexies, pep pills, and diet pills. Amphetamines do NOT include over-the-counter diet pills (like Dexatrim) or stay awake pills (like No-Doze), or any mail-order drugs… n On how many occasions (if any) have you taken Tranquilizers, without a doctor telling you to take them? ”

Percent of Students Using Amphetamines

Amphetamines (2008) n Lifetime n n 8 th Grade: 2. 4% KYDS, 7. 3% MTF 10 th grade: 8. 2% KYDS, 11. 2% MTF 12 th grade: 9. 5% KYDS, 12. 4% MTF Past 30 Day n n n 8 th Grade: 1. 4% KYDS, 2. 1% MTF 10 th grade: 3. 7% KYDS, 3. 5% MTF 12 th grade: 4. 9% KYDS, 3. 7% MTF

Tranquilizers: n “Tranquilizers are sometimes prescribed by doctors to calm people down, quiet their nerves, or relax their muscles. Librium, Valium, Xanax, are all tranquilizers… n On how many occasions (if any) have you taken Tranquilizers, without a doctor telling you to take them? ”

Percent of Students Using Tranquilizers

Tranquilizers (2008) n Lifetime n n 8 th Grade: 2. 1% KYDS, 4. 3% MTF 10 th grade: 4. 9% KYDS, 7. 2% MTF 12 th grade: 5. 6% KYDS, 10. 3% MTF Past 30 Day n n n 8 th Grade: 1. 1% KYDS, 1. 3% MTF 10 th grade: 1. 9% KYDS, 2. 4% MTF 12 th grade: 2. 1% KYDS, 2. 7% MTF

Steroids: n “Steroids, or anabolic steroids, are sometimes prescribed by doctors to promote healing from certain types on injuries. Some athletes, and others, have used them to try to increase muscle development… n On how many occasions (if any) have you taken steroids, without a doctor telling you to take them? ”

Percent of Students Using Steroids

Steroids (2008) n Lifetime n n 8 th Grade: 0. 8% KYDS, 1. 6% MTF 10 th grade: 2. 5% KYDS, 1. 8% MTF 12 th grade: 1. 9% KYDS, 2. 7% MTF Past 30 Day n n n 8 th Grade: 0. 5% KYDS, 0. 5% MTF 10 th grade: 1. 6% KYDS, 0. 6% MTF 12 th grade: 0. 6% KYDS, 1. 1% MTF

Methamphetamine: n “On how many occasions (if any)… have you used methamphetamine (meth, speed, crank, crystal meth) by any method? ”

Percent of Students Using Methamphetamines

Methamphetamine (2008) n Lifetime n n 8 th Grade: 0. 8% KYDS, 1. 8% MTF 10 th grade: 1. 8% KYDS, 2. 8% MTF 12 th grade: 1. 6% KYDS, 3. 0% MTF Past 30 Day n n n 8 th Grade: 0. 5% KYDS, 0. 6% MTF 10 th grade: 0. 5% KYDS, 0. 4% MTF 12 th grade: 0. 5% KYDS, 0. 6% MTF

Adult Use n Estimates from New Horizons indicate that 80% of admissions into a detoxification program in the last year were involving abuse of prescription medications, both individually prescribed and bought on the street.

Acknowledgements… • Terry Cole, LMSW, CASAC • Katie Cusano, MA, CASAC • Melinda Kmetz, BA • Stephen Lisman, Ph. D • Paul Burnett, JCPD • Patrick Foley, Pharm D. • Kim Newell, City Drug Court • Steven Ferri, Office of the DA For more information, visit us online: www. kydscoalition. org