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In the midst of national concern over illicit drug use and abuse,
prescription drug abuse has been identified as the United States'
fastest growing drug problem. Nearly all prescription drugs
involved in overdoses are originally prescribed by a physician
(rather than, for example, being stolen from pharmacies). Thus,
attention has been directed toward preventing the diversion of
prescription drugs after the prescriptions are dispensed.
Prescription drug monitoring programs (PDMPs) maintain statewide
electronic databases of prescriptions dispensed for controlled
substances (i.e., prescription drugs of abuse that are subject to
stricter government regulation). Information collected by PDMPs may
be used to support access to and legitimate medical use of
controlled substances; identify or prevent drug abuse and
diversion; facilitate the identification of prescription
drug-addicted individuals and enable intervention and treatment;
outline drug use and abuse trends to inform public health
initiatives; or educate individuals about prescription drug use,
abuse, and diversion as well as about PDMPs. How PDMPs are
organized and operated varies among states. Each state determines
which agency houses the PDMP; which controlled substances must be
reported; which types of dispensers are required to submit data
(e.g., pharmacies); how often data are collected; who may access
information in the PDMP database (e.g., prescribers, dispensers, or
law enforcement); the circumstances under which the information may
(or must) be accessed; and what enforcement mechanisms are in place
for noncompliance. States finance PDMPs using monies from a variety
of sources including the state general fund, prescriber and
pharmacy licensing fees, state controlled substance registration
fees, health insurers' fees, direct-support organizations, state
grants, and/or federal grants. The federal government has
established two grant programs aimed at supporting state PDMPs: The
Harold Rogers PDMP grant, administered by the Department of
Justice, and the National All Schedules Prescription Electronic
Reporting Act of 2005 (NASPER) grant, administered by the
Department of Health and Human Services. State PDMPs vary widely
with respect to whether or how information contained in the
database is shared with other states. While some states do not have
measures in place allowing interstate sharing of information,
others have specific practices for sharing. An effort is ongoing to
facilitate information sharing using prescription monitoring
information exchange (PMIX) architecture. Legislation has been
introduced in the 112th Congress that would take up these issues.
The available evidence suggests that PDMPs are effective in
reducing the time required for drug diversion investigations,
changing prescribing behavior, reducing "doctor shopping," and
reducing prescription drug abuse; however, research on the
effectiveness of PDMPs is limited. Assessments of effectiveness may
also take into consideration potential unintended consequences of
PDMPs, such as limiting access to medications for legitimate use or
pushing drug diversion activities over the border into a
neighboring state. Experts suggest that PDMP effectiveness might be
improved by increasing the timeliness, completeness, consistency,
and accessibility of the data. Current policy issues that might
come before Congress include the role of state PDMPs in the federal
prescription drug abuse strategy and the role of the federal
government in interstate datasharing and interoperability. While
establishment and enhancement of PDMPs enjoy broad support,
stakeholders express concerns about health care versus law
enforcement uses of PDMP data (particularly with regard to
protection of personally identifiable health information) and
maintaining access to medication for patients with legitimate
medical needs.
Savvy criminals constantly develop new techniques to target U.S.
persons, businesses, and interests. Individual criminals as well as
broad criminal networks exploit geographic borders, criminal turf,
cyberspace, and law enforcement jurisdiction to dodge law
enforcement countermeasures. Further, the interplay of these
realities can potentially encumber policing measures. In light of
these interwoven realities, policy makers may question how to best
design policies to help law enforcement combat ever-evolving
criminal threats.
Savvy criminals constantly develop new techniques to target U.S.
persons, businesses, and interests. Individual criminals as well as
broad criminal networks exploit geographic borders, criminal turf,
cyberspace, and law enforcement jurisdiction to dodge law
enforcement countermeasures. Further, the interplay of these
realities can potentially encumber policing measures. In light of
these interwoven realities, policy makers may question how to best
design policies to help law enforcement combat ever-evolving
criminal threats. Criminals routinely take advantage of geographic
borders. They thrive on their ability to illicitly cross borders,
subvert border security regimens, and provide illegal products or
services. Many crimes-particularly those of a cyber nature-have
become increasingly transnational. While criminals may operate
across geographic borders and jurisdictional boundaries, law
enforcement may not be able to do so with the same ease. Moreover,
obstacles such as disparities between the legal regimens of nations
(what is considered a crime in one country may not be in another)
and differences in willingness to extradite suspected criminals can
hamper prosecutions. The law enforcement community has, however,
expanded its working relationships with both domestic and
international agencies. Globalization and technological innovation
have fostered the expansion of both legitimate and criminal
operations across physical borders as well as throughout
cyberspace. Advanced, rapid communication systems have made it
easier for criminals to carry out their operations remotely from
their victims and members of their illicit networks. In the largely
borderless cyber domain, criminals can rely on relative anonymity
and a rather seamless environment to conduct illicit business.
Further, in the rapidly evolving digital age, law enforcement may
not have the technological capabilities to keep up with the pace of
criminals. Some criminal groups establish their own operational
"borders" by defining and defending the "turf" or territories they
control. Similarly, U.S. law enforcement often remains constrained
by its own notions of "turf"-partly defined in terms of competing
agency-level priorities and jurisdictions. While some crimes are
worked under the jurisdiction of a proprietary agency, others are
not investigated under such clear lines. These investigative
overlaps and a lack of data and information sharing can hinder law
enforcement anti-crime efforts. U.S. law enforcement has,
particularly since the terrorist attacks of September 11, 2001,
increasingly relied on intelligence-led policing, enhanced
interagency cooperation, and technological implementation to
confront 21st century crime. For instance, enforcement agencies
have used formal and informal interagency agreements as well as
fusion centers and task forces to assimilate information and
coordinate operations. Nonetheless, there have been notable
impediments in implementing effective information sharing systems
and relying on up-to-date technology. Congress may question how it
can leverage its legislative and oversight roles to bolster U.S.
law enforcement's abilities to confront modern-day crime. For
instance, Congress may consider whether federal law enforcement has
the existing authorities, technology, and resources-both monetary
and manpower-to counter 21st century criminals (particularly
cybercriminals, e.g., S. 2105, S. 3414). Congress may also examine
whether federal law enforcement is utilizing existing mechanisms to
effectively coordinate investigations and share information.
Twenty-first century criminals increasingly rely on the Internet
and advanced technologies to further their criminal operations.
These criminals can easily leverage the Internet to carry out
traditional crimes such as distributing illicit drugs and sex
trafficking. In addition, they exploit the digital world to
facilitate crimes that are often technology driven, including
identity theft, payment card fraud, and intellectual property
theft. Cybercrimes have economic, public health, and national
security implications, among others. For over three decades,
Congress has been concerned about cybercrime and its related
threats. Today, these concerns often arise among a larger
discussion surrounding the federal government's role in ensuring
U.S. cyber security. Conceptualizing cybercrime involves a number
of key elements and questions that include where do the criminal
acts exist in the real and digital worlds (and what technologies
are involved in carrying out the crimes), why are malicious
activities initiated, and who is involved in carrying out the
malicious acts? The U.S. government does not appear to have an
official definition of cybercrime that distinguishes it from crimes
committed in what is considered the real world. Similarly, there is
not a definition of cybercrime that distinguishes it from other
forms of cyber threats, and the term is often used interchangeably
with other Internet- or technology-linked malicious acts. Federal
law enforcement agencies often define cybercrime based on their
jurisdiction and the crimes they are charged with investigating.
And, just as there is no overarching definition for cybercrime,
there is no single agency that has been designated as the lead
investigative agency for combating cybercrime. The United States
does not have a national strategy exclusively focused on combating
cybercrime. Rather, there are other, broader strategies that have
cybercrime components. Policymakers may question whether there
should be a distinct strategy for combating cybercrime or whether
efforts to control these crimes are best addressed through more
wide-ranging strategies such as those targeting cyber security or
transnational organized crime. Congress may also question whether
these broader strategies provide specific cybercrime-related
objectives and clear means to achieve these goals. Comprehensive
data on cybercrime incidents and their impact are not available,
and without exact numbers on the current scope and prevalence of
cybercrime, it is difficult to evaluate the magnitude of the
threats posed by cyber criminals. There are a number of issues that
have prevented the accurate measurement and tracking of cybercrime.
For one, the lack of a clear sense of what constitutes cybercrime
presents a barrier to tracking inclusive cybercrime data.
Additionally, much of the available data on cybercrime is
self-reported, and individuals or organizations may not realize a
cybercrime has taken place or may elect-for a host of reasons-not
to report it. Policymakers may debate whether to direct a thorough
evaluation of the threats posed by cyber criminals.
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