POP Center Problems Robbery of Pharmacies Page 2

Understanding Your Local Problem

The information provided in the previous section is only a generalized description of pharmacy
robbery. You must combine the basic facts with a more specific understanding of your local problem. Analyzing the local problem carefully will help you design a more effective response strategy.

Stakeholders

The following groups have an interest in the pharmacy robbery problem and ought to be considered for the contribution they might make to gathering information about the problem and responding to it: 

• Law enforcement agencies are an excellent source of data on the problem of pharmacy robbery, and at the national level, the DEA’s Office of Diversion Control serves as a central source for national policy guidance, support, and the collection and sharing of intelligence regarding pharmaceutical diversion issues including pharmacy robberies.
• Healthcare and substance use disorder treatment providers can offer information on prescription drug trends and provide insight into current trends in opioid use disorders and treatment.
• Pharmacists in particular may have a wealth of insight—often not reported to police—regarding criminal activity, methods of operation, and prescription drug trends.
• Parents and educators may have experience with youth with substance use disorders who have not yet come to police attention. Educators could also assist in distributing confidential questionnaires to measure the extent of the problem.

In addition to the above, other key stakeholders are drug-free community coalitions, pharmaceutical companies, and a variety of state and Federal Government agencies, such as pharmaceutical and medical licensing boards and public health agencies. 

Asking the Right Questions

The following are some critical questions you should ask in analyzing your particular problem of
pharmacy robbery, even if the answers are not always readily available. Your answers to these and
other questions will help you choose the most appropriate set of responses later on.

Incidents

• What is the nature of past pharmacy robbery incidents? Did they occur in the same part of town, the same retail chain, or involve similar modus operandi? What are the common patterns or differences by time of day, day of week, number of individuals involved, etc.?
• What environmental design features and business practices distinguish pharmacies that fall victim to robbery? Are they open late at night when few customers are likely to patronize them? Are they staffed with multiple pharmacists and cashiers during all business hours? Is the parking lot well lit? Are the windows free of obstructions?
• What is the nature of the pharmaceutical shipment, intake, distribution, and disposal process, and how does it create vulnerabilities for robbery?
• How many police calls for service and cases involve some aspect of prescription drug diversion or misuse in addition to pharmacy robberies (as higher numbers may lead to more robberies)?
• What is the precise nature of these cases and calls for service? (Determining this might require some careful analysis of police reports, as the precise involvement of prescription drugs or information that the robbery was of a pharmacy may be revealed only in the report narrative of a wide range of call and case types.)
• What is the cost to the community—in both monetary and nonmonetary terms—to respond to the pharmacy robberies specifically and the problem of prescription fraud and misuse more generally?

Victims

• Whom does pharmacy robbery directly victimize? Pharmacists, other employees, and customers (who are put in harm’s way and may suffer trauma following a robbery incident)? Pharmacies (that lose revenues through loss of business)?
• What types of injuries and physical costs have been incurred by these victims?
• Whom does pharmacy robbery indirectly affect (the community at large, through fear of victimization; those who are legitimately prescribed painkillers, who may find them difficult to obtain when pharmacies restrict supplies to prevent robberies)?

Offenders

• What are their characteristics (e.g., age, gender, or profession)?
• Where do they live, go to school, or work? How do those locations correspond to pharmacy robbery locations (e.g., are pharmacies in some geographic areas more likely targets than others)?
• What is the pattern of offending? Are robberies intermittent/seasonal or regular? Is there a regular time span between acts (e.g., based on how long it takes to exhaust a supply of drugs)?
• What are the characteristics of those arrested for possession of the types of pharmaceuticals most often taken in robberies?
• What are their motives? Do they have an opioid use disorder? Are they selling the drugs on the black market? Both? (You can interview them to collect this information.† Undercover investigations, buys, and surveillance can reveal more about their practices.)
• Do they act alone or as part of a group? If the latter, do robberies appear to be organized crimes?
• Is there evidence of inside knowledge through pharmacy employees who may be knowingly or unknowingly facilitating robberies?
• What are their preferred tactics? Think about this in relation to their planning and entry, the robbery itself, and the escape.

† See Problem-Solving Tools Guide No. 3, Using Offender Interviews to Inform Police Problem Solving, for further information.

Locations/Times

• Where do pharmacy robberies occur in your community and region? To detect patterns, you should conduct location analyses, which can help you determine which targets are most vulnerable. For example, robberies in specific areas may indicate where individuals committing pharmacy robberies live or work.
• In which specific locations do robberies most commonly occur? Are certain pharmacies less likely to experience them? Are certain types of pharmacies (e.g., independent stores versus chain stores) more susceptible to robbery based on location or business practices?
• Are robberies associated with the timing of incoming shipments of prescription drugs that will be distributed by the pharmacy?
• What are the physical characteristics of the pharmacies that have been robbed? Are they pharmacies within stores or stand-alone? Are they well-lit? What is the staffing and security?
• What specific types of prescription drugs are diverted in your community or region? (This can vary greatly from region to region and may shed light on demand reduction strategies.)
• When does pharmacy robbery occur? What times of day? What days of the week? Are pharmacy closing times (when few—if any—customers are present) the most vulnerable times for robbery?

Current Responses

• Does your agency have policies and procedures specific to taking pharmacy robbery incident reports that collect the types of information highlighted above? If so, do you capture and analyze the data generated in those reports?
• Does your agency share intelligence on pharmacy robberies occurring across jurisdictional boundaries regarding modus operandi or trends in the types of drugs sought through robberies? This may be done via participation in local, state, or federal prescription drug diversion task forces.
• Does your agency currently work with pharmacists, healthcare professionals, the schools, or community organizations on prescription drug misuse prevention and education?
• What are the state and local laws relating to prescription drug diversion and enforcement?

Capturing and Analyzing Data

The details behind past incidents of pharmacy robberies are likely captured in crime incident reports and investigative records. But understanding the larger context of pharmacy robberies requires obtaining data on supply and demand of prescription drugs on both the legal and illegal markets. Several national data-collection efforts provide state- and regional-level information on trends and patterns in substance use disorders, including misuse of prescription drugs. For example, the DEA’s Theft Database collects data on pharmacy thefts.

However, participation in this database is voluntary; the resulting incomplete reporting limits the database’s utility. Understanding these patterns can help alert police to the emergence of new trends in commonly abused prescription drugs. They can also inform pharmacies on the types of drugs that are most sought after, guiding decisions on restricting the sales and availability of such drugs (and widely publicizing those restrictions) in order to prevent robberies.

National Data Sources with State, Regional, and/or Local Data

Sponsored by the National Institute on Drug Abuse, the Community Epidemiology Working Group (CEWG) was a consortium of more than 20 researchers from major metropolitan areas who met annually to report on local drug abuse patterns and trends. It was replaced in August 2014 with the National Drug Early Warning System (NDEWS), which builds upon and expands the former program by broadening the network, including national perspectives and innovative identification and monitoring approaches, and reporting on new trends and issues that arise nationwide. Local police agencies can consult the group’s website at www.drugabuse.gov/related-topics/trends-statistics/national-drug-early-warning-system-ndews.

The Arrestee Drug Abuse Monitoring (ADAM) program collected data through drug tests and self-reported drug use of adult male arrestees in 10 U.S. counties from 2007 through 2011 and in 5 counties in 2012 and 2013; the program was discontinued in 2013. ADAM data were particularly useful to local police in identifying shifts in local trends in illicit drug use, including the nonmedical use of prescription drugs. Annual reports of ADAM data can be found on the Office of National Drug Control Policy’s website. In addition, some other metropolitan areas (e.g., San Diego County through the San Diego Association of Governments) are collecting their own ADAM-type data.

The Treatment Episode Data Set, supported by the Substance Abuse and Mental Health Services Administration (SAMHSA), reports admissions to specialty treatment facilities by state and primary abused substance, enabling local police to identify statewide trends over time. The data set’s website has a search engine enabling users to select data by year and state.

The Drug Abuse Warning Network (DAWN) reported data on drug-related emergency department (ED) visits and drug-related deaths reported by medical examiners (ME). The ED visit data was nationally representative and for a small number of selected metropolitan areas; the ME data was available for some states and selected metropolitan areas. The DAWN system was discontinued in 2011; currently SAMHSA is working with the National Center for Health Statistics to implement a new system for collecting drug-related data in EDs. Drug-involved death data, including those involving prescription medications are available from the Centers for Disease Control and Prevention mortality files. 

The Monitoring the Future (MTF) study and the National Survey on Drug Use and Health (NSDUH) are both excellent sources for examining trends in substance use and related issues among youth and the general U.S. household population , respectively. The MTF collects data on drug use and related attitudes and behaviors among 8th, 10th, and 12th grade students; the survey is nationally representative and can provide estimates by region, but the sample cannot support state-level estimates. The NSDUH collects data on drug use, treatment need and receipt, initiation, and attitudes and beliefs on Americans 12 and older living in households and other group quarters. The data are nationally representative; estimates also are provided by state for many of the variables.

State Data Sources

Most states have implemented prescription drug monitoring programs (referred to as PMP or PDMP). These programs are databases that provide information to health care providers on what prescriptions individuals are receiving. Law enforcement may be able to obtain the identified data to spot a trend; check with your state PDMP administrator. In most states, law enforcement must have a subpoena to obtain specific data. PMPs document all retail sales of certain prescription drugs. Depending upon the law in your state, police can analyze this data to identify unusual sales volumes by retailer, healthcare provider, and drug type. You may contact your state data collection entities to gain access to the data, which can illustrate the types of prescription drugs that are dispensed, the degree to which certain medical prescribers appear to be overprescribing, and other statewide patterns of potential misuse and diversion. This information is useful, as the demand for these drugs may soon be followed by increases in robberies to acquire it. Understanding the illicit demand for specific drugs can help police and pharmacists anticipate and prevent robberies to get those drugs.

Local Data Collection

The sources mentioned previously are limited to data at the state or metropolitan area level, but they may not tell the local story. Police agencies tackling the problem of pharmacy robbery can create their own data collection tools in order to capture the true local context and underlying causes of the problem. The Reno (Nevada) Police Department, for example, conducted surveys of area pharmacists and doctors and also reviewed and revised the way the department coded reported incidents of prescription drug related crimes to enable the agency to isolate those cases from other drug-related crimes.16 Another source of local data may be the Coroner or Medical Examiner’s Office, which tracks overdoses.

A key question you should ask is to what degree can your agency effectively track the types of prescription drugs that are associated with robberies, burglaries, and other criminal acts? Is this information only available through a manual search and count? If so, it will be critical in the long term to create new sources of data rather than adjusting current reporting in order to be effective.  Ultimately, agencies will need to stop building one-off data collection methods and instead strive to develop an accurate and comprehensive database that can be shared across agencies and jurisdictions.

Measuring Your Effectiveness

The analyses referenced above will aid you in identifying appropriate responses to your pharmacy robbery problem (a description of possible responses appears later in this guide). Once a response (or series of responses) is implemented, it will be critical to measure its effectiveness. Measurement allows you to determine to what degree your efforts have succeeded and suggests how you might modify your responses if they are not producing the intended results.

You should take measures of your problem before you implement responses to determine how serious the problem is and, after you implement them, to determine whether they have been effective. All measures should be taken in both the target area and the surrounding area. For more detailed guidance on measuring effectiveness, see Problem-Solving Tools Guide No. 1, Assessing Responses to Problems: An Introductory Guide for Police Problem-Solvers and Problem-Solving Tools Guide No. 10, Analyzing Crime Displacement and Diffusion.

The following are potentially useful measures of the effectiveness of responses to pharmacy robbery. Process measures show the extent to which responses were properly implemented. Outcome measures show the extent to which the responses reduced the level or severity of the problem.

Process Measures

• Changes in arrest patterns for drug possession and sales in your and neighboring jurisdictions
• Changes in types of prescription drug diversion (e.g., if you prevent pharmacy robberies, would burglaries increase)
• Changes in locations of pharmacy robberies
• Changes in types of drugs obtained through robberies and other forms of prescription drug diversion
• Changes in the number of prescriptions filled for certain target drugs such as oxycodone
• Increased adoption by pharmacies of robbery-prevention good practices

Outcome Measures

• Reduced number of reported pharmacy robbery cases
• Reduced number and severity of injuries related to pharmacy robberies
• Reduced value/dollar loss related to pharmacy robberies
• Reduced number of arrests of possession of the types of pharmaceuticals typically taken in pharmacy robberies

It is important to remember that some of these measures may be misleading depending on the types of responses your department applies to the problem. For example, if your agency partners with pharmacies to institute better target-hardening measures to reduce robberies, and those robberies decline but other forms of diversion such as prescription-drug fraud increase, the harms associated with robbery may be reduced, but the larger problem of prescription-drug diversion remains. This underscores the importance of tackling the problem of pharmacy robbery within the larger context of prescription drug diversion and misuse. But regardless, reducing pharmacy robberies is a notable end goal in and of itself, as these crimes pose substantial danger to employees, customers, and responding officers.