trends where we are today. And it's done by the Drug Enforcement Administration in collaboration with the American Dental Associations Council on Dental Practice and their partners at the American Academy of Addiction Psychiatry and its providers, Clinical Support System Project. Thank you all for being with us today on www.ada.org. Our viewers are able to watch these presentations at their leisure and take a short quiz and then receive one CE credit. And I'll tell you more about how to get that CE credit following this presentation. If you're interested in learning more from DEA, we have two different talks coming up in the near future. One is scheduled for Tuesday, August 23rd. And in that session, we're gonna be discussing the closed system of distribution and record keeping. And then on Thursday, September 22nd, the topic is going to be prescribing controlled substances. So if you're interested in attending either of these or both of them, please visit DEADiversion at usdoj.gov, select meetings and events, and then select the talk that's of interest to you. So the next talks are gonna be offered on Zoom so that we're able to host a lot of people for the live event. But both of these talks are also gonna be posted on ADA's website at ada.org. So before we begin, I just wanna let you know that this Webex is going to be running a little less than an hour. Next slide, please. So my name is Linda Stokum and I have been working with the Drug Enforcement Administration for a little over 18 years now. I joined on in 2004 and I was stationed in the Orlando, Florida office. I worked there for 11 years and then I was promoted to a group supervisor in Orlando and I worked there for three years in that position. So then I was fortunate enough to serve as a diplomat for DEA's European division, where I was stationed in Brussels, Belgium for three years. And for the last year, I have been stationed in DEA headquarters in Arlington, Virginia. And I've been assigned to be a staff coordinator with the liaison section in diversion control. So in this role in liaison, I'm working with DEA registrants and other partners to prevent controlled substance diversion. Next slide, please. This presentation is intended for dentists, administrative staff, physicians, social workers, students and educators and interprofessional teams. Next slide, please. Our legal department asks that I read three disclaimers to you. The first one, the content of this document do not have the force and effect of law and are not meant to bind the public or DEA in any way. This document is intended only to provide clarity to the public regarding existing requirements under the law or agency policies. This presentation is for educational purposes. Materials, images or sounds authored or created by parties other than DEA may be subject to copyright and are used here in accordance with the Fair Use Provision of Title 17, United States Code Section 107. DEA's use of these materials does not authorize persons outside of DEA to further distribute or use copyrighted materials. Next slide, please. And this is the last of our disclaimer slides. I have no financial relationships to disclose. Next slide, please. So today we're gonna talk about who works for the DEA and we're gonna highlight the DEA Diversion Control Program. So diversion is a group that regulates DEA registrants. We're also going to talk to you about where we are in the opioid crisis today. And we'll discuss which drugs are being seized and analyzed by DEA and across the country by our state and local partners. And you'll also be able to cite some drug combinations that abusers prefer. And we'll talk a little bit about DEA's new One Pill Can Kill campaign. And finally, I'm gonna share with you where you can locate DEA regulations and other resources. So a lot of problems associated with drug abuse are sadly the result of legitimately made controlled substances and listed chemicals that are being diverted from their lawful purpose into the illicit drug trafficking market. So DEA diversion is charged with preventing, detecting and investigating the diversion of controlled substances and listed chemicals from legitimate sources while at the same time ensuring that an adequate and uninterrupted supply are available for legitimate medical, commercial and scientific needs. Next slide, please. So DEA is made up of numerous job series. And I know most of you are probably all familiar with the special agent position. They are gun carrying and they conduct search warrants and they seize assets and make arrests for those connected with illicit drug trafficking. But there are three other core series if you're interested in working with DEA, but you're not so interested in carrying a gun that are options for you. One is the Diversion Investigator position. It's also called the DI and that's what I am. DIs enforce the Controlled Substance Act or the CSA and the Chemical Diversion and Trafficking Act or the CDTA. And we do this by overseeing the closed system of distribution that was established by the United States Congress. So that means that all legitimate handlers of controlled substances be they manufacturers, distributors, practitioners, pharmacies, researchers and others, they have to be registered with DEA unless they're exempt by DEA. And they have to maintain strict accounting for all their controlled substance transactions. So good record keeping is really important on regulated drugs and chemicals. Basically the drugs have to be accounted for from the time of their creation until the time of their disposal. And DIs do inspections, regular inspections on our registrar community. And then if sanctions are necessary, we determine if there are administrative sanctions, civil sanctions or criminal sanctions and we pursue that. So another job series are Intelligence Research Specialists and they truly are the backbone of DEA. They support counter drug investigations, they analyze information, they conduct organizational charts and they put together pattern analysis. And they're also increasingly involved more in cyber, criminal cyber investigations. So, and then finally we have our Forensic Chemists. This is a growing field for us with all the new illicit chemicals being found on the global market. They become a really important part of our team. They provide scientific, technical and administrative support to all of this to Intelligence Research Specialists, Diversion Investigators and agents. Next slide, please. So all businesses that intend to handle controlled substances, they need to register with the DEA and the schedules that they wanna handle. So drugs and other substances that are considered controlled substances under the CSA, they're divided into five schedules. So drugs listed in schedule one, they currently have no accepted medical use in the United States. So that means they cannot be prescribed, administered, dispensed for medical use. So in contrast, drugs that are listed in schedules two through five, they do have some accepted medical use and they can be prescribed, administered, dispensed for medical purposes. If you're interested in knowing which controlled substances fall on which schedules, you can visit the Code of Federal Regulations at 1308.11 through 15. Next slide, please. So Congress passed the Chemical Diversion and Trafficking Act, otherwise known as CDTA in 1988. And that provided a system for regulatory controls and criminal sanctions that was gonna address domestic and international diversion of important chemicals. So CDTA created two categories. The list one and list two chemicals. So suppliers of these chemicals are subject to regulation and control measures. Many of those chemicals do have legitimate use. They can be used to make cleaning products or to make perfumes, but unfortunately, they are also used to make illegal drugs. So they have to be closely monitored. Next slide, please. So basically by regulating industry, DEA is able to ensure that diversion is limited and that the public continues to have access to safe supply chain. Next slide, please. Okay, the opioid crisis today. Now, a lot of this information, you might not think applies directly to you as a dentist, but I would argue differently. I think it's really important as members of Congress really important as members of the healthcare community that you need to stay aware of current opioid threats for your own safety and dealing directly with the public. And also it's always good to know since we are having the issue with members of the public ordering off social media and the internet. If someone comes in and tells you that, hey, I popped a couple Xanax to relax before my procedure, you might wanna inquire, hey, where did you get the Xanax from? Just to cover yourself. But additionally, as respected professionals, you have the right, it's really important that you have the right information to share with your patients and other members of the community that you live in and work in. People look up to you. Next slide, please. So the overdose crisis in our country so far is a story of three interconnected waves. And this is just a really quick review of how we landed where we are now in the current drug epidemic. In the late 1990s, pharmaceutical companies assured the medical community that patients would not become addicted to opioid pain relievers. And so healthcare providers began heavily prescribing addictive medications such as Oxycontin. And a lot of individuals with aches and pains took home some extremely addictive medications and unfortunately they developed a taste for them rather quickly. So then not long after that, authorities noted widespread misuse of the prescription opioids. We began to crack down on pill mills and then the public had a much harder time obtaining prescription opioids. So the drug use in population was already suffering from addiction. So when one source tried up, they turned to another option and that option was heroin. Around 2010, 2011, that's when the second wave of drug abuse began. And heroin was really easy to obtain in the streets and it was much cheaper than purchasing opioid prescriptions. Then in 2013, our third wave began and unfortunately it is still with us today. Fentanyl entered the picture. Dealers, drug dealers were getting more bang for their buck. They were offering users a really good high at a much cheaper price, cheaper than heroin in fact. So it was easy access, abundant availability has been blurring in users. And it's really important to note here that the fentanyl I'm speaking about today that's most often being abused is illicitly manufactured fentanyl. It's not fentanyl from our closed system of distribution. It is not fentanyl that is produced by DEA licensed manufacturers or distributors. So, and then there are some circles that are stating that they think psychostimulants may be representing a new fourth wave. There's been a big uptick in methamphetamine use in the United States, so much so that President Biden recently in March of this year signed a Meth Response Act where he designated methamphetamine as a drug threat warranting national response. So that's good because it's gonna mean more funding and manpower that are dedicated to fighting meth abuse. Next slide, please. If you look at the CDC statistics, you're gonna note that we have jumped significantly higher from 2016 with 63,632 deaths to 2021 with 107,622 deaths. And I wanna point out that the data from 2021 is from the CDC, but it's provisional data. It's likely to increase. That is not the final figure. So you can see from looking at the slide that there was a slight dip in 2018, but unfortunately it turned right around in 2019 and the numbers keep going up. The drug using populations are increasingly becoming more diverse as illicit drugs are so widely available across the country. So today's drug dealers are electronically accessible. You can order whatever you want online, on social media. So consequently the ease of trying new drugs is pulling more people in. Not that long ago, you had to put clothes on, get dressed. That's a big deal now, right? We all like to stay at home in our pajamas, but you have to get dressed. You have to go to a specific neighborhood, make your transaction on some random street, some random individual. Now you can sit at home in your pajamas and you can have your choice of drugs delivered right to your front door. So I think the ease with which you can acquire drugs has a lot to do with the increase in drug abuse that we're seeing. People using now may never have ventured to try new drugs when they had to seek them out by going into certain neighborhoods, but buying online has definitely increased our drug user. Next slide, please. So you can see from the graph that overdose deaths for all ages show synthetic opioids other than methadone. We're talking about primarily fentanyl. It's that light blue line. They started to spike at about 2015 and they continue to go up. So then psychostimulants, the gray line, we're mostly talking about methamphetamine here. It's also showing a steady increase from 2015. Next slide, please. So provisional data from the CDC for 2021, there was a 15% increase in the total drug overdose deaths from 2020 to 2021. And we've kind of went over that data, but additionally, you can see that overdose deaths from all opioids increased from 70,029 in 2020 to 80,816 in 2021. Next slide, please. Oh, and then looking at this slide, you'll note that synthetic opioids like fentanyl, the number of deaths increased from 2020 to 57,834 to 71,238 in 2021. So that's 13,404 more deaths in one year. And then methamphetamine, the psychostimulant deaths, they are also on the uptick from 24,576 to 32,856. And then cocaine deaths also increased from 19,927 to 24,538. The only decrease on the chart is a natural semisynthetics, and those are your prescription drugs. And they dip from 13,722 to 13,503. So it's still higher than anyone would like, but it is definitely trending in the right direction. Next slide, please. So according to the CDC, the overall national opioid dispensing rate has been declining from 2012 to 2020. In 2020, the dispensing rate had fallen to the lowest it's been in 15 years. So I do wanna preface that although pill abuse in the healthcare industry has vastly declined, it hasn't been obliterated. As you can see on the slide here, the CDC records 38 deaths occur every day from prescription opioids. So we think that there are a lot of reasons for the decline, including the fact that DEA decreased manufacturing quotas for the most abused opioids. A lot of healthcare organizations offered more training geared towards medical professionals regarding prescribing opioids. And then a lot of state legislation occurred across the country that began regulating pain clinics. And finally, the advent and use of the Prescription Drug Monitoring Program. Next slide, please. So the Prescription Drug Monitoring Program, otherwise known as PDMP, it has been a fabulous tool for everybody. The PDMP, as you are aware, it's an electronic database and it tracks controlled substances in the state. So it provides healthcare authorities timely information about prescribing and patient behavior. It's a really effective state level intervention, just so that you know, DEA has nothing to do with the PDMPs. They are run, they're operated by each state independently. It's great that opioid prescriptions have decreased. I think the PDMP has been an awesome tool. It's helping healthcare professionals make much more informed decisions. Next slide, please. Okay, so while prescription drug abuse is down, unfortunately the taste for mind altering drugs is not. Next slide, please. So these are some common drug combinations or cocktails that DEA sees a lot of abuse through users from. So we just wanna make you mindful, you know, in reviewing some of your patients' PDMPs to look for these, okay? The Holy Trinity has been around since 2010, I guess. It became very popular. It's a combination of an opioid, a benzo, such as Xanax and carisoprodol, also known as, it's called Soma, it's a muscle relaxant. And then we have the Stimulant Trinity, which is an opioid, a benzo, and a stimulant. And the GABA Trinity, okay? This one is opioid, benzo, and gabapentin. You may know, gabapentin is an anti-epileptic drug that's used to treat seizures. And it has been gaining in popularity by users as an alternative to opioids. So it's currently not federally regulated, but a number of states have enacted legislation so that their PDMPs are monitoring the use of gabapentin. I think seven states right now, including Alabama, Kentucky, Michigan, North Carolina, Tennessee, Virginia, and West Virginia, they've all reclassified gabapentin into a Schedule V on the state level. So recently, a consumer safety organization called Public Citizen, they filed a petition with the FDA and DEA to call for gabapentin to be reclassified as a Schedule V federally. So that is going through process, and we'll have to wait and see what happens there. Okay, and then you see our Zolpidem Trinity. It's an opioid benzo with Zolpidem, which is a Schedule IV that's used to treat insomnia. And finally, the Speedball, it's been around for a super long time. Commonly uses cocaine and heroin, but a lot of modern Speedballs use pharmaceutical opioids. So it's good in reviewing, like I said, your PDMP to see which patients are getting now that you're armed with these popular drug combinations. Next slide, please. DEA utilizes a lot of tools to monitor prescription drugs across the US. And one of those tools is a database that we refer to as ARCOS, otherwise known as Automated Reports and Consolidated Ordering System. So it's a data collection system in which manufacturers and distributors, they report their controlled substance transactions to the DEA. Next slide, please. So these are the ratings from January, 2021 to March, 2022. The top prescription drug sales to retail registrants. Number one drug is hydrocodone, and it's supposed to often abuse for its opioid effects. It's supposed to often abuse orally and in combination with alcohol. So hydrocodone isn't typically found in clandestine labs. It's most commonly diverted pharmaceutically through doctor shopping, thefts, bogus call-in scripts. Hydrocodone is a schedule two federally. Number two on the chart is oxycodone, also schedule two, semi-synthetic narcotic analgesic. And this is abused in all kinds of ways, most commonly orally and intravenously, but users also crush the pills and they inhale the drug or they dissolve the pills in water and inject it. Other abusers like to heat the tablet on a piece of oil and then they inhale the vapors. A lot of the abusers have reported that this method of delivery is more rapid than more rapid response or effect than taking the drug orally or by injecting it. And then vaping is also very big right now. So that's another method of delivery. Number three is amphetamine. Amphetamines are stimulants most often used to treat attention deficit disorder or ADHD. It was commonly used by school-age kids, but we're seeing increasingly that young adult populations are being drawn to ADHD. So they're either taken orally or injected. It is a Schedule II and DEA has noted that over the last few years, amphetamine has been increasing slightly each year. Number four, methylphenidate. It's also a Schedule II, it's a stimulant. Ritlan is the most common brand. It's not too common in illicit labs. It's usually pharmaceutical products that are obtained by doctor shopping theft or from friends. And then last is buprenorphine. It's a Schedule III, it's intended for treatment of pain and opioid addiction. So buprenorphine can produce euphoria and it's sometimes abused in combination with a benzodiazepine. Next slide, please. So these next few slides I'm gonna show you, there are three slides actually. They're gonna show three to five non-ARCOS reportable drugs. It's just giving you some insight into what DEA is seeing, what's being ordered. Klonazepam, it's a Schedule IV controlled substance and it's as common brand name as Klonopin. And it comes as tablets or as a liquid that you can swallow. It is in the benzodiazepine drug class, so that makes it a depressant. And as you're aware, it is used to control seizure or fits of epilepsy. But on the slide, you can see a marked increase from early 2020 to early 2022 in Klonazepam sales. So we were initially thinking the increases were due to the pandemic, but we don't seem to see the levels declining just yet. So we are watching that. Next slide, please. Okay, diazepam, also a Schedule IV, most common brand name is Valium. It's also in the benzodiazepine drug class. It's frequently used to relieve anxiety. You look at diazepam sales in early January, March, 2020, you can see their orders have increased quite a bit in recent data in January, March, 2022. Next slide, please. So Alprazolam is also Schedule IV and Xanax is the most common brand. So just for your information, Alprazolam and Klonazepam are two of the most frequently encountered benzodiazepines in the available in the illicit market. They're quite popular. So Alprazolam is frequently prescribed for anxiety disorders. And you can notice that in early January, March, 2020, the almost steady incline to high levels we're seeing now in January, March, 2022. Next slide, please. So stimulant use is on the rise and we know that illicit, the non-pharmaceutical stimulants like cocaine and methamphetamine, they're on the uptick. But additionally, stimulant sales to retail registrants have significantly increased, which is due to the increase of stimulant prescriptions being issued. So this chart is for all pharmaceutical stimulants sold from January, 2018 to March, 2022. You'll see we had a steady acceleration in sales from the beginning of January, 2018 until January, March, 2020, where we saw like a steep decline. And that was just for about a month or two in the early days of the pandemic. But then beginning in April, 2020, sales really began to skyrocket and that is something we are keeping a close eye on. Next slide, please. So the national annual rate of stimulant dispensing is rapidly increasing. Stimulant medications are commonly prescribed for the treatment of attention deficit disorder, but they also have a really high potential for diversion and misuse. So this chart just breaks down the data from the previous chart a little bit. You'll notice for 2021, nearly 3.5 billion dosage units of stimulants were sold to retail registrants. So approximately 2.1 billion of those were amphetamine products. Just in the first quarter of 2022, you'll see sales of more than 895 million dosage units. So that's likely to mean that the total sales for 2022 are on track to exceed those of 2021. So DEA is studying this trend and we are working very closely with DEA registrants to try to understand the need for this increase. Next slide, please. Another tool we use here at DEA to measure what drugs are being abused is the National Forensic Laboratory Information System. It's also known as NIFLIS. So NIFLIS, it's a DEA program, it's supported by Diversion Control and it's been around since the late 1990s. So DEA's NIFLIS collects all kinds of drug identification results that come in from local laboratories, state laboratories, other federal laboratories across the United States where drug seizures, they come into those labs, the labs analyze them and then they send the information on to NIFLIS so that DEA is able to report a really good cross-sectional. I believe right now we have 286 individual labs that participate in this. So it's a good snapshot of what's being seized across the country. Next slide, please. So NIFLIS reviews about 1.5 million exhibits every year and most of them are opiate stimulants and benzodiazepines. That continually show up on the list. But among all those drug cases, methamphetamine was the most common drug reported in 2020. And you can see on this chart, fentanyl is number four. And then you may not be aware, you probably are familiar with all the drugs on the chart but maybe not number nine, which is eutalone. That is a stimulant in the synthetic cathinone family. So it belongs to a group of drugs that we call new psychoactive substances or NPS. It's basically a designer drug. Eutelone is not approved for medical use in the United States. So it is a schedule one and it is kind of a party drug, much like MDMA that's abused in pill form. Number 12 is ANPP. And that is a direct precursor to fentanyl and some fentanyl analogs. Next slide, please. And you can see that from January 1st, 2021 to June 30th, 2021, methamphetamine was the most frequently identified drug followed by cannabis, cocaine, fentanyl and heroin. The NIFLIS data indicates that fentanyl reports have increased significantly in all regions across the United States. Tramadol reports have increased significantly in all regions except the West part of the U.S. And amphetamine reports have been extremely high in the Northeast. Next slide, please. This slide is from NIFLIS where they're just graphing a steady decline in fentanyl abuse from 2013. No one likes this trend. Next slide, please. Okay, this next section of the presentation, we're kind of gonna go over some of DEA's initiatives and resources. Next slide, please. Our new administrator, Anne Milgram, came on board. She joined us, I believe, at the end of June last year. And the One Pill Can Kill campaign is one of her big initiatives. So this video is gonna highlight a message that DEA has been putting out. On the job less than three months, DEA administrator Anne Milgram is shocked that already this year, they've seized nine and a half million fake pills, mainly containing deadly fentanyl, sometimes methamphetamine. That's more than we've seized in the last two years combined. And the percentage of those pills that are deadly, potentially deadly, has never been higher. Four out of 10 counterfeit pills that contain fentanyl are deadly, four out of 10. Yes, they have two milligrams of fentanyl or more. That's minuscule, the size of the tip of a pencil. It's like Russian roulette then. It's Russian roulette, but it's even more dangerous in one sense. In Russian roulette, people know that they're passing around a loaded gun. Here, you are talking about many people who think that they are actually buying oxycodone, or they're buying Percocet, or they're buying Vicodin, a painkiller. They think they're buying a prescription drug bought in an illegal market, and they're not. They're buying fentanyl or methamphetamine. And the fentanyl pills can kill people. The only pill that is safe to take is the one that is prescribed by... Next slide, please. On the job, less than three... Regrettably, counterfeit pills, they've been seized in every state now. And that's largely the result of criminal drug networks that are mass producing fake pills, and they're falsely marketing them. A lot of times, social media outlets, and the marketing them is legitimate. So they're intentionally deceiving the American public. You can see from this slide that DEA science labs have found that four out of 10 pills seized on the streets contain a potentially deadly dose of fentanyl. So the short take on fentanyl, and I wanna emphasize that, once again, we're not talking about fentanyl that comes from licensed DEA manufacturers or distributors. This is illicit fentanyl made in unlicensed, unregulated laboratories. So China is a primary source of fentanyl and fentanyl ingredients, or precursor chemicals, as we call them, that are used to make fentanyl. So not that long ago, you might remember Chinese manufacturers were flooding US mail houses with fentanyl products. And that was around 2014. And then you might remember that in 2019, President Donald Trump met with President Xi of China and urged him to control fentanyl in China, which they did. So then with the new stricter Chinese controls, Chinese manufacturers began to sell fentanyl ingredients to make the fentanyl to cartels that are located in Mexico. And the cartels are manufacturing these illegal drugs in what we call super labs. So these are like state-of-the-art labs. They kick out vast quantities of drugs, and it's illegal. So there's no oversight group like OSHA monitoring them. So you can't really be assured that they're sanitizing their equipment in between batches. So what goes in the vat as a filler is whatever the cartels can get their hands on. You can see how a user might be exposed to a lot of different chemicals. And then I told you earlier on, DEA does regulate listed chemicals that are used to make illicit drugs, much like we regulate controlled substances. But a big struggle for us is that once authorities regulate one chemical, the bad guys develop another chemical to manufacture illegal drugs. So today's drug manufacturers, they are employing a lot of highly intelligent chemists. So they're continually tweaking molecular structure of chemicals to avoid attention from law enforcement. Next slide, please. DEA has been made aware of drug trafficking organizations that have been using emojis to buy and sell counterfeit pills and other illicit drugs on social media and through e-commerce. So emojis are kind of a new drug slang and the symbols you're looking at might appear ordinary and harmless, but they each have some hidden meaning. And it is good, I think, for parents to know what to look out for. So a lot of young people are using these codes because they're trying to avoid law enforcement and parental detection. So instead of saying, if you're looking at the chart, I wanna buy cocaine, they might use the key emoji or for heroin. They might use the heart or the dragon emoji. Crystal ball represents meth and a cookie signifies a large batch. So I wanna preface that an emoji by itself is not bad, but if you see these emojis with regularity and in a certain string, it could represent something more sinister. So, and I will tell you that the easiest way to access this chart is to just punch in DEA emojis in your search engine. You can also locate it on our website, but it's pretty easy to just punch in DEA emojis. Next slide, please. So these are actual seized counterfeit pills. DEA is warning that pills purchased outside of a licensed pharmacy are illegal, dangerous, and potentially deadly. So all of our offices are on point with this message and we're putting out frequent interviews warning the public that they need to be aware. So to the trained eye, these might not pass the smell test, but to the average lay person, they look pretty legitimate. So DEA is focusing a lot of our resources on taking down drug traffickers, selling these fake pills, and we're alerting the general public that the only safe medications are the ones prescribed by trusted medical professionals and that are just dispensed by licensed pharmacists. So any help from you all in getting that message out, we appreciate. This is a photo of a seizure our administrator highlighted late last year. DEA conducted this case in conjunction with our state and local enforcement partners, and we were able to seize 1.8 million fentanyl-based fake pills, and we arrested 810 drug traffickers across the US. So drug cartels frequently distribute fentanyl by kilogram, and it's estimated by DEA that one kilogram of fentanyl has the potential to kill about a half a million people. So this seizure could have killed potentially 700,000 Americans. Next slide, please. So every day, we at DEA get newspaper articles from across the country that pertain to illegal drug abuse, seizures, arrests, and increasingly, we're finding that the headlines are emphasizing the increase in fake prescription drugs being sold on the black market. Many contain lethal doses of fentanyl, and sadly, they highlight a lot of real people who are very much impacted by this fentanyl crisis. Next slide, please. So this is a flyer DEA is circulating to educate the general public on counterfeit pills. Posting it is optional. If you want a copy, please visit DEA.gov and just type in the search bar counterfeit pill fact sheet. Next slide, please. So you might be asking why counterfeit pills? Well, because it's a really low-tech operation. As you can see from the slides, there's huge profit in producing and selling fentanyl. So ingredients are cheap, and it's easy to make and ship, and it's highly addictive. So you're able to hook your customer base. One milligram of fentanyl can get you high, but two or three milligrams can kill you. Another reason a lot of bad guys like to manufacture fentanyl is because it's super easy to manufacture. It is not like heroin, where it's a huge hassle to cultivate. You gotta plant your fields. You gotta worry about the weather. You have to process the raw opium, and then you've gotta go through a chemical process, and you have to deal with workers to pick your yield. So with fentanyl, you just need a small lab, a couple of people, and some raw materials that are most plentiful from China. You can make a good, dependable yield. Unfortunately, it's always fentanyl season. Next slide, please. So these next few slides, I'm gonna highlight some non-scheduled drugs of interest that DEA is monitoring. This first one is xylosine. It's a non-opioid drug. It's commonly used in veterinary medicine as a sedative and analgesic and muscle relaxant for animals, but we have been noting it has also been used as an adulterant in fentanyl, heroin, and cocaine exhibits. Some users report that they think it enhances the effect of the drug, so it's currently not approved by the Food and Drug Administration for human consumption. Next slide, please. So according to NIFLAS, they received 860 reports of xylosine from items submitted to participating labs in 2020. So you can see 84% contained at least one other identified drug, and most concerning is that fentanyl was present in 96% of the items that contained xylosine and at least one other drug. Next slide, please. Selvia divora. This is a plant native to Mexico. It looks really similar to a mint. They usually grow about three feet high and they have huge green leaves. Selvia, it can be chewed, it can be smoked, and it's now being vaped, produces a lot of psychic effects and distortions. It is currently not approved for medical use in the United States. Next slide, please. So kratom, that's being marketed as safe because it's plant-based. It's from a tropical evergreen tree found in Southeast Asia. Most people there most commonly use it to treat chronic pain, and it's commonly used by chewing leaves and pill form. It's smoked or it's made into a tea and it's now being vaped. So its effects is similar to opioids and stimulants, and there are deaths associated in combination with other drugs. So it's a mind altering, excuse me, psychotropic, and it's currently not controlled. It's pretty easy to get on the internet. And this is just, it's another drug where drug deaths are involved, but always in combination with other substances. So the FDA is currently warning consumers not to use kratom and they are also actively warning companies that they cannot sell it as a product used to treat pain. FDA has been doing some scientific evaluation on kratom. They recently did a study with 30 different kratom products and they found that all of them contained heavy metals such as lead and nickel at unsafe concentrations. Next slide, please. So as you're probably aware, scammers are impersonating law enforcement, government officials at a lot of government agencies. And DEA is no exception that we have scammers that are trying to extort money and other personal information from the community at large. And they often will tell the victim that their identity was stolen and a car was rented in their name at the scene of a crime at the border. And they threatened to arrest or prosecute the victim if they don't pay a fine. DEA will never approach anyone demanding money and you can't get out of trouble by paying DEA without going forward through the legal process. So if you have patients or family or friends that receive such a call, please contact DEA because we like to collect information. They're not in any trouble, but it just helps us identify where the scammer might be coming from and might help us shut them down so they don't try to scam anyone else. Another big problem that we're having is with EPCS or electronic prescribing. One DEA office uncovered a situation where an EPS account was fraudulently set up without the doctor's knowledge. His identity had been stolen, so the bad guys were able to set up an electronic prescribing token so that they could write prescriptions without the doctor ever being involved. So one way to avoid this, we work with the physician community is to keep checking the PDMP and make sure that the things you're writing for are the things that appear on the PDMP. So what do you do if you think that, if you have scam questions, you can go to reportfraud.ftc.gov. This information is shared with over 3,000 law enforcement officers, so cases can be made against the offender. There's also ic3.gov, and this site lists bunches of consumer alerts. It's really good to stay up on what scams are trending. And if you think your DEA number has been compromised in any way, please contact your local DEA diversion group. Next slide, please. Okay, so DEADiversion.usdoj.gov is a great source of information. If you're not familiar with DEA Diversion Control website, I'm gonna share some useful bits of intel that you can find. Next slide, please. So this is the top of our homepage, and you can see already all kinds of good information. That red banner on the top of the homepage is always gonna indicate the most up-to-date information regarding current issues such as COVID, social unrest, information on new regulations. We also have posted telephone numbers and email addresses if you have registration questions. And then you can see the green area, there are links to the most frequently sought-after information. So if you need a copy of your DEA certificate or drug disposal or need to know about renewing online, that's where you'd go. And under the resources button, you will find a full copy of the Code of Federal Regulations should you wanna review it. Next slide, please. This is the bottom half of our DEADiversion.usdoj.gov website. And you can see in that first what's new, who we've taken action against and why. And that's good to visit once in a while because you will see by reviewing those that we only go after the worst of the worst. These are not people who made a one-off mistake. So we also list a bunch of ready reference quick links. So if you have questions regarding thefts and losses or electronic prescriptions, ARCOs, if you wanna submit a tip. And then you can also read about our Take Back Program at the bottom. DEA sponsors two take back events a year and you can find a location, direct your patients to a pill collector by clicking on DEA National Take Back. You click on locate a collection site near you, you put in your zip code and nearby locations will be displayed. But I do wanna make it a point that you do not have to wait for DEA Take Back event to get rid of unwanted drugs. If you know someone that's trying to get rid of drugs, there is a link on the bottom of our homepage where you can search for nearby year round pharmaceutical disposal locations. So you can safely dispose of your unwanted drugs from over 15,000 registered locations across the country. It's the same thing. You enter your zip code and it'll direct you to the closest disposal locations. Okay, DEA sponsors some websites including GetSmartAboutDrugs.com. So this website is really geared towards parents. Parents can find help and download information, get some DEA publication. They can find resources on dealing with mental health, social media influences, bullying and drug use, fentanyl and other drugs and all about drug paraphernalia. Next slide, please. And then we have the website JustThinkTwice.com. And this website is geared toward teens. So there's a lot of true stories, consequences about drug use, there's facts, statistics. There's information, a lot of information about counterfeit pills, marijuana, vaping, stimulants, steroids, the latest school trends. And there's also a video that talks, it interviews people who are going through recovery and the difficult process that is. And the last website is OperationPrevention.com. This one is geared for school and work curriculum. So DEA joined forces here with the Discovery Education to provide no cost online tools that address communities about drug abuse. So it's a great free resource for schools and it discusses the science of addiction and you can go on virtual field trips. It's worth a look at. Next slide, please. Okay, these are a couple of QR codes and it's gonna take you to a section called Frequently Asked Questions and Answers. So it's to our most commonly asked questions and we provide the answers, that's worth looking at. And we also have a QR code for our DEA diversion website. So if you wanna stop those. Next. Okay, and this is the Government Performance Results Act link so you can share your feedback. Your feedback on this program is really important to ADA and providers of clinical support systems. So if you visit this link and you take, it just takes a couple of minutes to fill this out and it means so much, it's good information for us. Thank you. Okay, and here's some information on the PCSS Mentoring Program. So, next slide, please. And we also wanted to share information on the PCSS Discussion Forum. Next slide, please. Okay, PCSS, it's a collaborative effort led by the American Academy of Addiction Psychiatry or AAAP. And it's in partnership with all these organizations that are listed on this slide. Next slide, please. You can find PCSS online at the listed locations on the bottom of this slide. Next slide, please. The ADA is a CERP recognized provider. Next slide, please. Okay, most importantly, you will be receiving an evaluation from the ADA in regards to your CE online credit. Okay, you have to complete this evaluation in order to claim your CERP CE for this webinar. So once you complete the evaluation and get it to ADA, your CE verification letter will be sent to you within seven to 10 business days. Okay, so once you complete that evaluation, you get it to ADA, it's gonna take about seven to 10 business days to receive your credit. So if you have any questions about the CE, you can contact CE underscore online at ADA.org or you can email dentalpractice at ADA.org. So please keep in mind, this evaluation is different than the earlier evaluation that you filled out for GPRA, the Government Performance Result Act. So it's important to fill that, get that credit. Thank you. Next slide. You can track your credits and learn about upcoming events in one spot at ADA.org forward slash myADA. It's a useful resource. So it's thanks to the strength of the 163,000 ADA members that helps us successfully advocate for you and bring you essential resources like today's webinar. Don't miss a single development, join or renew with ADA today. Thank you so much for your attention. Please note the three important websites on this page that you can refer to for more information. Thank you.

drug enforcement

addiction

DEA

controlled substances

opioid crisis

fentanyl

counterfeit pills

drug combinations

DEA website