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Mexican DTOs control the distribution of powder cocaine, Mexican powder and ice methamphetamine, Mexican marijuana, and Mexican black tar and brown powder heroin in the Appalachia HIDTA region; they supply most midlevel and retail-level distributors in the region. Mexican DTOs use stash locations in the region to store illicit drugs, particularly powder cocaine and Mexican marijuana, prior to distribution.

A number of traffickers, including Caucasian and African American DTOs, criminal groups, and local independent dealers, distribute illicit drugs at the midlevel and retail level in the region; their methods of operation change little from year to year. Caucasian DTOs and criminal groups are the principal midlevel and retail-level drug distributors in many rural areas of the region; they typically distribute locally produced marijuana, Mexican marijuana, powder methamphetamine, ice methamphetamine, powder cocaine, heroin, and CPDs. African American DTOs and criminal groups are the principal midlevel and retail-level distributors in many urban areas of the Appalachia HIDTA region; they typically distribute powder and crack cocaine, marijuana, Mexican and SA heroin, methamphetamine, MDMA, and CPDs. Retail-level drug distribution generally takes place at open-air drug markets, private homes and businesses, and housing projects throughout the region as well as in prearranged meeting areas such as parking lots; however, most retail distribution in Kentucky takes place in private homes and businesses.

Traffickers and abusers illicitly obtain CPDs through traditional diversion methods (primarily doctor-shopping, theft, and forged prescriptions as well as through unscrupulous physicians and pharmacists who work alone or in association). CPDs are also diverted through Internet sales by rogue Internet pharmacies.19 However, the number of sites offering such drugs has decreased, most likely because of increased law enforcement pressure through improved cooperation among federal and state law enforcement agencies, Internet service providers (ISPs), package delivery services, and financial services companies typically used by rogue Internet pharmacy operators. Federal legislation designed to reduce the number of rogue Internet pharmacies that sell CPDs was enacted in 2008. (See text box.) Drug traffickers are increasingly attempting to circumvent law enforcement efforts to prevent CPD diversion in the region by obtaining these drugs in Florida, particularly Broward County, Fort Lauderdale, and Miami, as well as in Pennsylvania and Tennessee.

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 was enacted in October 2008. This federal law amends the Controlled Substances Act and prohibits the delivery, distribution, and dispensing of CPDs over the Internet without a prescription written by a doctor who has conducted at least one in-person examination of the patient. Provisions of the law increase the criminal penalties for illegal Internet prescribing of Schedules III, IV, and V controlled substances. The law will most likely deter some Internet pharmacy operators from engaging in "script mill" practices, which provide alleged medical consultations (for a fee) and prescriptions that are sent to local pharmacies or directly to customers, who can take them to a pharmacy to be filled.

Drug traffickers facilitate drug sales in the Appalachia HIDTA region using electronic communications, usually cellular telephones and the Internet. Drug traffickers use cellular telephones with preloaded minutes and no contracts, such as TracFone, because they believe that such telephones are more difficult for law enforcement officials to intercept. In addition, African American street gang members use the Internet to communicate, facilitate gang activities, spread gang culture, and coordinate drug sales.

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Drug-Related Crime

Drug-related violent and property crimes often occur within the HIDTA region as distributors, particularly street gang members, protect their distribution operations and abusers seek funds to sustain their addictions. Drug distributors commit violent crimes, including assault and homicide, to maintain control of local drug markets. For instance, officials with the Knox County Sheriff's Office in Tennessee report that territorial violence continues to increase among street gangs in their jurisdiction and that the majority of homicides in the county occur in areas with high levels of street gang activity and drug distribution. Metropolitan Drug Enforcement Network officials in Charleston report continued high levels of violence among street gangs operating in their area, primarily those that distribute crack cocaine. Drug-related violence in southeastern Kentucky typically occurs between dealers and customers. Cocaine, methamphetamine, and prescription drug abusers and distributors often commit crimes such as retail fraud, burglary, robbery, and theft to obtain drugs, or money to purchase drugs. Moreover, according to NDTS 2009 data, 40 of the 92 law enforcement agency respondents in the Appalachia HIDTA region identify CPDs as the drugs that most contribute to violent crime in their jurisdictions, and 53 out of 92 report CPDs as the drugs that most contribute to property crime.


19. Rogue Internet pharmacies are unlicensed, fraudulent, and disreputable businesses that sell prescription drugs illegally.

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