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Liberty alumnus uses testimony to start ministry for pastoral efficacy in addiction crisis. During his time of intense darkness, he never thought he would one day assemble and lead the recovery ministry Blessed Hope Ministries BHM. He turned to Christ after hitting his lowest point in , evoking a passion for helping others struggling with addiction. Ponce-de-leon attended an Episcopalian church as a child, but he grappled with its role in his life. I tried to fill that hole with a lot of things. At that same age, Ponce-de-leon began drinking alcohol and shortly later started using cocaine and heroin. After high school, he earned the prestigious Peabody Scholarship at John Hopkins University, but he turned it down to attend a school in north Philadelphia, where the largest open-air heroin market on the eastern seaboard was located. I developed a very anti-Christ attitude. Ponce-de-leon was in his 16th institution for recovery, located in North Carolina, and had been there for five days when he hit rock bottom. Instead, he encouraged Ponce-de-leon to pray. As Ponce-de-leon sat in his room, he remembered the many people who had shared Christ with him over the years. On Aug. He was 29 years old and only five days sober. But, the spirit of God had entered in my heart, and my desire to not do drugs and alcohol was stronger than the desire to do it. After hearing the messages at Friendship, he quickly discovered his calling to preach. It was through this pastoral calling that he decided to enroll in Liberty University Online Programs , earning a B. While at Liberty, in , Ponce-de-leon launched Blessed Hope Ministries to provide training and resources to pastors and leaders who are dealing with addiction crises in their congregations. The training Ponce-de-leon provides is completely free to churches, and he meets with leaders in person to instruct them on effectively guiding individuals through alcohol and drug addiction crisis, finding rehabilitation centers and understanding the world of addiction through a biblical lens. Ponce-de-leon said Liberty gave him the education and support necessary to effectively lead as a pastor and start BHM, since he began his journey with limited knowledge of running a church and starting a ministry. Liberty walked me through the whole process of getting started online and just helped me navigate the different things that I had to navigate. He continues to use the material he developed in the doctoral program to reach more pastors and church leaders, even though he already graduated. In my opinion, it will have a kingdom of God impact and not simply a local church one. Ponce-de-leon has now been sober for 18 years, and he is excited to be using what he learned at Liberty to guide others to recovery in Christ. Home Liberty News Alumni Liberty alumnus uses testimony to start ministry for pastoral efficacy in addiction crisis. Search News Archives. Categories Academics. General News. Giving to Liberty. Press Release. Student Life. Additional Navigation. Matthias Ponce-de-leon was transformed by God from an addict into a pastor and ministry leader who uses his testimony and education to raise awareness of alcohol and drug addiction. Related Posts From Sao Paulo to Lynchburg and back, public policy graduate aims to impact homeland with biblical principles.

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Official websites use. Share sensitive information only on official, secure websites. Corresponding Author: James A. Inciardi, Ph. A variety of surveys and studies are examined in an effort to better understand the scope of prescription drug diversion and to determine if there are consistent patterns of diversion among various populations of prescription drug abusers. The data suggest that the major sources of diversion include drug dealers, friends and relatives, smugglers, pain patients, and the elderly, but these vary by the population being targeted. In all of the studies examined, the use of the Internet as a source for prescription drugs is insignificant. The non-medical use of pharmaceutical opioids has been an enduring problem in the United States. There has been some speculation that the trend began early in the eighteenth century with Thomas Dover, a student of British physician Thomas Sydenham 1. Following the path of his mentor, Dover developed a form of medicinal opium known as Dover's Powder , which contained one ounce each of opium, ipecac, and licorice, combined with saltpeter, tartar, and wine 2. It was introduced in England in , but quickly made its way to the American colonies and remained one of the most widely used opium preparations for almost two centuries. The attraction of Dover's Powder was in the euphoric and anesthetic properties of opium, and its introduction apparently started a trend. By the latter part of the eighteenth century, patent medicines containing opium were readily available throughout urban and rural America, and by the closing years of the nineteenth century the abuse of these drugs had become widespread 1 , 3 , 4 , 5. The abuse of opioids continued throughout the twentieth century. The first general population survey of drug abuse undertaken in the U. The New York survey found the abuse of prescription drugs to be commonplace. Subsequent surveys as well as focused research studies documented the continuing abuse of prescription drugs 7 , 8 , 9 , 10 , Concomitant with the widespread abuse of prescription drugs, since the beginning of the twenty first century increased attention has focused on diversion — the transfer of a prescription drug from a lawful to an unlawful channel of distribution or use Moreover, there is growing evidence that the diversion of significant amounts of prescription opioids and benzodiazepines occurs through residential burglaries as well as cross-border smuggling at both retail and wholesale levels 24 , 28 , Furthermore, it would appear that pill abusing middle and high school students are obtaining their drugs through medicine cabinet thefts, medication trading at school, and thefts and robberies of medications from other students. Finally, some observers consider the Internet to be a significant source for illegal purchases of prescription drugs 32 , 33 , Although a list of the mechanisms of diversion is easily compiled, little is known as to the magnitude of the primary ways that prescription drugs are making their way to the streets and who the major diverters are. In fact, the answers to these questions vary depending upon whom you ask. Officials in regulatory agencies suggest that the major diverters are pharmacists, physicians, and other health care workers, and regulatory officials come to this conclusion because these are the populations that their agencies focus on. Physicians and pharmacists suggest that the diverters are doctor shoppers and prescription forgers. This is not surprising either, given that these individuals are the clients and customers of physicians and pharmacists. Diversion investigators in police agencies consider the major diverters to be all of the above -- pharmacists, physicians, other health care workers, doctor shoppers and prescription forgers, because these are the types of diverters referred to the police by regulatory agencies, physicians, and pharmacists. However, what about all the other types of diversion, and who are the other players in the diversion paradigm? Within this context, this paper examines a variety of surveys and studies in an effort to better understand the scope of diversion and to determine if there are consistent patterns of diversion among various populations of prescription drug abusers. Currently, a comprehensive risk management program is being conducted by Denver Health and Hospital Authority, a public, not-for-profit health care system serving the Denver MSA and the Rocky Mountain region of Colorado. These data represent a scientific foundation for developing prevention and intervention efforts to address abuse and diversion. Subscribers to the RADARS System initiative include a number of pharmaceutical companies that are marketing prescription drugs having a significant potential for abuse. The poison center system consists of 48 poison centers nationwide, serving a population of more than million people. Weekly data involving cases of drug abuse and misuse are sent to the RADARS System and are compiled for quarterly reports for the pharmaceutical industry subscribers. The data provided by this system allows the RADARS program to recognize and track trends in prescription drug abuse on a weekly basis. However, no diversion data are routinely collected in this particular signal system. The opioid treatment program system includes 75 treatment programs. On a quarterly basis, patients admitted to these treatment programs are asked to complete an anonymous questionnaire, which inquires about the their drug use in the past month, lifetime drug abuse, the age when first drug use occurred, and the primary source of the abused drug diversion. This network includes professionals in the field of drug abuse, such as clinicians, epidemiologists, treatment counselors, and others who are in positions to recognize and report on drug problems. Diversion data are not routinely collected as part of the key informant system. However, supplemental data on diversion are obtained on a periodic basis. One of the more expansive RADARS System components is a diversion study with a survey sample of diversion investigators, from all 50 states, the District of Columbia, and Puerto Rico, including rural, suburban, and urban areas. Information from the four signal systems is compiled and analyzed, and forwarded to sponsoring pharmaceutical companies for the purpose of developing interventions to reduce abuse and diversion, if appropriate. The opioid drugs currently monitored by the RADARS System include buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxymorphone, oxycodone, and tramadol. The stimulant drugs currently monitored include amphetamine and methylphenidate. For each of the drugs mentioned, the following information is requested: the total number of diversion cases logged in, the number of cases in which the targeted drugs were mentioned, and the dosage form tablet, liquid, patch, powder, wafer, suppository, or other. For the next 10 most diverted drugs in their jurisdictions, over and above the targeted drugs, reporters are asked to provide the number of cases in which they occur, as well as the dosage form. This procedure provides a comprehensive distribution of the types and numbers of diversion cases in a given jurisdiction. Where are the drugs coming from? Who are the suppliers? How are the drugs reaching the street? Who are the diverters? Although information on the sources of diversion is not available for collection as part of the RADARS System drug diversion system, a brief survey was conducted with the diversion investigators in the police and regulatory agencies participating in this nationwide surveillance program Only small proportions of the surveyed participants viewed other sources of diversion as particularly significant. No doubt these considerations were based on the kinds of cases the diversion investigators were coming into contact with. As noted above, the RADARS System opioid treatment program system includes 75 treatment programs, and measures of substance abuse and sources of prescription drugs are routinely collected. Participation in this study by methadone maintenance patients is voluntary, and the project protocols for the protection of clients against research risks were reviewed and approved by the National Development and Research Institutes, Inc. Institutional Review Board. As illustrated in Table 1 , during the 4 th quarter of , This raises the question of where the dealers, friends, and relatives are obtaining the drugs. Includes respondents who reported using a prescription opioid in the past 30 days. Includes participants who reported using a prescription opioid as their primary drug in the past 30 days. Participation in all phases of the study was voluntary, and the project protocols for the protection of clients against research risks were reviewed and approved by the Washington University Institutional Review Board IRB. Completed survey instruments were identified solely by a unique case number and were sent directly to Washington University School of Medicine. As illustrated in Table 3 , the primary prescription opioids of abuse within this population included extended-release oxycodone In several ways, the sources of diversion among the individuals accessed through the key informant network were not unlike those of the methadone maintenance patients. National Survey of Drug Use and Health offers a national perspective on the sources of prescription drug diversion as well as annual data on drug use in the United States. This general population survey provides yearly national and state level estimates of alcohol, tobacco, illicit drug, and non-medical prescription drug use. In addition, data are collected on the methods of obtaining prescription opioids for non-medical use. As illustrated in Table 5 , lifetime non-medical use of prescription opioids appeared to be considerable The majority of these lifetime users, furthermore, were in the 26 or older age group As illustrated in Figure 2 , two-thirds of these abusers reported friends or relatives either for free or purchased as their major source of supply, followed by prescriptions from a physician. In contrast to other populations noted above, few obtained their prescription opioids from drug dealers. Includes other drugs that are not asked about explicitly in the opioid module but fall into this category. School surveys have been carried out annually in Delaware since to provide estimates of student alcohol, tobacco, and other drug abuse incidence and prevalence for state assessment and planning purposes. The survey was conducted as an anonymous classroom endeavor in the Spring, using a self-administered form that could be completed in no more than one class period. To help ensure anonymity, the survey was directed by University of Delaware personnel. Survey participants were essentially a census of all 11 th grade public school students who agreed to participate, were not in a classroom randomly selected to be in the Center for Disease Control and Prevention's CDC Youth Tobacco Survey, and whose parents did not object to their child's participation. Figure 3 illustrates the reported sources of prescription drugs for those 11 th graders who reported any use of prescription drugs to get high in the past year. Parents, either knowingly or unknowingly, were also a meaningful source for students' prescription drugs. Miami, Florida, has long since been a major tourist destination, and for more than three decades it has been a national center for cocaine importation, distribution, and use 36 , 37 , Moreover, Miami has been designated by the Drug Enforcement Administration as a destination where large amounts of prescription drugs are regularly being channeled into the illegal marketplace As such, this locale is an excellent place to study both the abuse and diversion of prescription drug medications. To this end, the authors of this paper have been involved in a number of projects which focus on these topics — particularly with drug-involved, women street sex workers and members of Miami's vast club culture. In the first Miami study, designed as an HIV outreach and intervention program for drug-involved, street-based women sex workers, a total of women were interviewed extensively about their drug use Participation in all phases of the study was voluntary, and the project protocols for the protection of clients against research risks were reviewed and approved by the University of Delaware's IRB. The drug use histories of the sex workers were quite extensive. The participants were typically poly-drug users, and reports of past month activity indicated that alcohol and crack-cocaine were the substances most widely used In terms of prescription drug abuse, As illustrated in Figure 4 , these women sex workers reported obtaining prescription opioids through a variety of mechanisms: None of the women reported accessing prescription opioids through prescription thefts, prescription forgery, doctor shopping, or the Internet. In addition to its reputation as one of the cocaine capitals of the Americas, Miami is also a major player in the U. In fact, with the restoration of Miami's art deco districts and the large and continuously expanding South Beach area, Miami has become a national and international destination for partying, sexual tourism, and club drug use. And to a great extent, South Beach has also become an East Coast center for the club culture — setting trends that are emulated and replicated elsewhere in the United States, Western Europe, and Latin America 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , And a recent trend in this regard has been a significant incursion of prescription drugs into the club culture 23 , 50 , with the concomitant health consequences associated with their abuse Because of the young age of the vast majority of club drug users and their tendency to mix numerous drugs during their typical drug binges, club drug users tend to be a highly vulnerable population 23 , 52 , 53 , 54 , 55 , 56 , 57 , Within this context, a recent NIH funded study is examining the patterns of drug use and health consequences of prescription drug abuse within this population. For all of the interviews, informed consent procedures were approved by the University of Delaware's Institutional Review Board IRB , and were rigorously followed. All of these individuals reported using prescription drugs for recreational purposes during the past 90 days, and as illustrated in Figure 5 , the drug most commonly used was alprazolam, followed by oxycodone and hydrocodone. All of these club drug users had multiple sources for obtaining prescription drugs, but as indicated in Table 6 , almost three-fourths used local drug dealers, more than half shared or traded prescription drugs with friends, and almost a fourth obtained drugs from family members In addition to the quantitative studies described above, a qualitative research program was developed by the authors to further investigate sources of prescription drugs. Two qualitative studies are described here — the first focused on the Miami club culture, and the second was a rapid assessment study conducted in Wilmington, Delaware. Four focus groups of prescription drug abusers in the Miami club culture were conducted, and included 27 ethnically-diverse men and women ages 18 to Three in-depth interviews with particularly heavy users of both opioids and benzodiazepines were also conducted. In addition, 8 prescription drug dealers connected to the club scene were interviewed. All interviews and focus groups were tape recorded and transcribed. Coding categories were established to capture response patterns in the topics covered by the interview and focus group guides. A common theme in the focus groups was Medicare and Medicaid fraud as a mechanism for obtaining prescription drugs. One of the focus group participants stated:. But they have a habit for crack or heroin, so they sell their prescription at a little bit less than street market value, knowing that they'll get rid of them fast and in bulk. A dealer will take an old man to a doctor who's a little bit crooked. He's got a broken arm or a bad hip; he complains of pain. Doctor knows what's going on; he gets kickbacks from patients coming in through Medicaid. The old man gets prescribed OxyContin. Its all because a lot of old people don't have any money on the 20 th of the month when their social security checks are gone; they don't want the pills, they want the money. And if you do, they'll sign you up right there. And he had a prescription for Percocet. They bought those off of him for 2 bucks a piece. The 8 dealers interviewed provided especially interesting information about diverse modes of drug diversion. This guy comes from Mexico by boat. He's got the pills, I have the money and we switch camera bags. It's the same bag. No one can tell the difference. A second dealer reportedly restricted his diversion to oxycodone, averaging 1, pills per month. Several other dealers reported obtaining prescription drugs from people who hijacked delivery trucks. And finally, inner-city crack houses were identified as useful sources for obtaining prescription drugs. For example:. I know at the crack house that they get them from street people, like the homeless, that have prescriptions. Because usually the people in the street have a variety of ailments, so when they get prescribed anti-depressants, muscle relaxants, pain killers, and they don't really want to use them, they want to be smoking crack or whatever. The World Health Organization defines rapid assessment as a series of strategies for ascertaining, understanding, and characterizing the nature and extent of health and social problems in a particular locale, and for suggesting ways in which those situations can be improved Rapid assessment investigations speed up the usual process of behavioral science and epidemiologic research, reducing the time needed to less than a year or even perhaps just a few months of investigation, surveys, and interviews, and then linking assessments with action. An important characteristic of rapid assessment is that it aims to prioritize realistic outcomes over scientific ones. Rapid assessment embraces several different research methods, including such techniques as surveys, key informant interviewing, direct observation, focus groups, or even intercept interviewing. In addition, quantitative methods in epidemiology and behavioral science are sometimes utilized, particularly risk factor approaches and prevalence estimation. A rapid assessment was carried out in Wilmington, Delaware, during December Wilmington, the largest city in Delaware and having a population of almost 73, in , was chosen for this investigation for two reasons. First, several authors of this paper were familiar with the area and already had a number of key informant contacts in the prescription drug abusing community. Second, throughout media reports repeatedly noted the problems of prescription opioid abuse and diversion throughout the state, and particularly in Wilmington 60 , 61 , As part of this rapid assessment, six focus groups were conducted with 32 patients in two residential programs Each of the focus groups was recorded, and lasted approximately 90 minutes. The focus group areas of inquiry included perceptions of the prescription drug problem in Delaware, the more popular prescription medications and their prices on the street, how the participants started using prescription drugs for non-medical purposes, and how the drugs were obtained. Dealers were recruited from the same treatment facility sources. However, because pill brokers were not active substance users, and hence, not in treatment, they were referred for interviewing by dealers known to one of team members who has substantial experience conducting street-based recruitment in drug-using communities. Many pill brokers specialize in only one or two drugs, while others buy and sell any type of prescription medication. A consistent theme among the focus group participants was that many members of the elderly population in Wilmington were in the business of duping their physicians — because they could complain of pain whether they were in pain or not and get prescriptions they wanted. Some of these elderly individuals were reportedly abusing their drugs, but the overwhelming majority was diverting medications for economic reasons. Some sold their prescriptions on their own initiative, while others would work in conjunction with a dealer or pill broker. Another prominent theme among the focus group participants, dealers, and pill brokers was that many patients who were suffering from serious pain would use part of their medications and sell the rest because of a need for cash. Several patients would reportedly ask for additional prescriptions from their pain management specialists, which they would fill and sell to an abuser, a drug dealer, or a pill broker. Also common in this group was selling supplies of unused medications. In addition to these two major sources of diversion, pill brokers, dealers, and sellers of often congregate in open air drug markets — typically strip mall and pharmacy parking lots, and outside methadone clinics -- to buy, sell and trade prescription drugs. Sometimes prescription drugs are traded for crack, heroin, or just cash. Pill brokers also purchase used fentanyl patches from nurses who have stolen them from pain patients or from disposal containers in hospitals. Some individuals frequenting the drug markets barter their oxycodone for other opioids or benzodiazepines, typically alprazolam. Earlier in this paper it was stated that identifying the primary sources of prescription drug diversion depended on whom you asked, and the studies and surveys summarized above support this contention to a great extent. At the same time, however, some similarities are apparent across a number of populations. One of the difficulties with comparing these populations, however, is the fact that different survey instruments were used for each, and hence, categories of diversion sources tend to vary. Nevertheless, a number of commonalities exist. One of the most frequently mentioned sources of prescription medications are drug dealers. For example, as illustrated in Figure 6 , the majority of the methadone maintenance patients, as well as patients accessed through the RADARS System key informant network and members of the Miami club culture obtained their drugs from street dealers. This is not an unexpected finding given these individuals involvement with, or proximity to, street drug cultures. One might find it surprising, however, that so many of the Delaware 11 th graders have access to street dealers, but other studies of these students have demonstrated that 11 th graders who abuse prescription drugs are also abusers of other substances, including street drugs The qualitative studies in Miami, Florida, and Wilmington, Delaware, suggest that a number of pain patients and some members of the elderly population work with dealers and pill brokers, and no doubt this phenomenon is occurring elsewhere. However, this likely explains only a small part of the supplies that dealers are selling. In addition, it is probable that a portion of the prescription medications that are diverted through robberies, burglaries, and thefts make their way to street dealers, but little is known about this aspect of the illicit market. There is also the matter of traffickers smuggling prescription drugs into the United States, but the only information on this practice is limited. Again, where are the friends, relatives, and traders obtaining their supplies? In all likelihood, some of these drugs are coming from family medicine cabinets, but little is known about the magnitude of the problem in this regard. However, it is likely widespread, given the tendency of many patients to hold on to medications after they no longer need them. For example, on August 1, , the St. Lucie County, Florida, Sheriff's Department initiated its Operation Safe Medicine Cabinet program, which gave community residents the opportunity to properly dispose of unwanted or unused prescription medications In exchange, gift cards to local stores were provided. In all, people responded, turning in more than , pills, with some of the prescriptions dating as many as 30 years. Doctor shopping would appear to occupy a minor position in the diversion activities of the populations studied. Physicians' prescriptions, on the other hand, were a significant source of drugs for those identified through the RADARS System key informant network. Internet sales have been identified as a major source of diversion by some observers. In fact, on May 16, , Joseph A. Califano, Jr. Califano suggested that the easy availability of addictive drugs has, for many children, made the Internet a greater threat than street drug dealers. Califano's comments were based on several studies by CASA 34 , but it would appear that a reality check is in order see Figure 7. Without question, drugs can be purchased on the Internet. However, survey data suggest that this is not where abusers, including Internet-wise youths, typically go to find prescription drugs. In fact, the Internet appears to be one of the least likely places that drug seekers go to find prescription medications to get high. The Internet is indeed a source for prescription drugs, but the overwhelming volume of purchases is likely at the wholesale level, since few end users report accessing the Internet for drugs. Califano argued But if not the Internet, then where? For those abusers who report getting prescription medications from friends, relatives, and dealers, where are these latter individuals obtaining them? In the final analysis, no one really knows for sure. As a library, NLM provides access to scientific literature. J Addict Dis. Published in final edited form as: J Addict Dis. Find articles by James A Inciardi. Hilary L Surratt , Ph. Find articles by Hilary L Surratt. Theodore J Cicero , Ph. Find articles by Theodore J Cicero. Steven P Kurtz , Ph. Find articles by Steven P Kurtz. Steven S Martin , M. Find articles by Steven S Martin. Mark W Parrino , M. Find articles by Mark W Parrino. PMC Copyright notice. The publisher's version of this article is available at J Addict Dis. This article has been corrected. See the correction in volume 32 on page Open in a new tab. Heroin Extended-release oxycodone Age Group Total 12 to 17 18 to 25 26 or Older Pain Reliever Propoxyphene or Codeine Products 1 , 2 20, 1, 4, 14, Oxycodone Products 1 , 3 13, 3, 8, Hydrocodone Products 1 , 4 21, 1, 6, 13, Tramadol Products 1 , 5 1, 92 Data not available Fioricet and Fiorinal 38 Methadone 1, Morphine 2, 1, Talwin 13 38 Demerol 2, 91 1, Dilaudid 1, 15 Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. Propoxyphene or Codeine Products 1 , 2. Oxycodone Products 1 , 3. Hydrocodone Products 1 , 4. Tramadol Products 1 , 5.

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