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Diverted Pharmaceuticals

Diverted Pharmaceuticals . Broad Issues for Consideration by the SPF- SIG Strategic Planning and Related Committees Developed by: SPF SIG Data Analysis Committee. Prescription drug diversion is defined as “the deflection of prescription drugs from medical sources into the illegal market.”.

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Diverted Pharmaceuticals

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  1. Diverted Pharmaceuticals Broad Issues for Consideration by the SPF- SIG Strategic Planning and Related Committees Developed by: SPF SIG Data Analysis Committee

  2. Prescription drug diversion is defined as “the deflection of prescription drugs from medical sources into the illegal market.”

  3. Eastern Kentucky • Eastern Kentucky is the prescription painkiller capital of the United States, receiving more prescription painkillers than anywhere else in the nation.(Lexington Herald-Leader, 2003)

  4. Eastern Kentucky • Admissions of prescription drug addicts to residential treatment centers in Eastern Kentucky tripled from 1998 to 2001. • Some Appalachian pain specialists have suggested that Eastern Kentucky, with its older population, many injured coal miners and high rates of lung cancer, might need more amounts of narcotics to treat legitimate pain sufferers. (Lexington Herald-Leader, 2003).

  5. 2004 Kentucky Incentives for Prevention (KIP) Survey • On how many occasions (if any) have you taken narcotics or drugs that require a doctor’s prescription, without a doctor telling you to take them in your lifetime? • 1-2 occasions: • 3% of 6th graders • 6% of 8th graders • 8% of 10th graders • 7% of 12th graders

  6. 2004 Kentucky Incentives for Prevention (KIP) Survey • On how many occasions (if any) have you taken narcotics or drugs that require a doctor’s prescription, without a doctor telling you to take them in the past 12 months? • 1-2 occasions: • 2% of 6th graders • 4% of 8th graders • 7% of 10th graders • 6% of 12th graders

  7. 2004 Kentucky Incentives for Prevention (KIP) Survey • On how many occasions (if any) have you taken narcotics or drugs that require a doctor’s prescription, without a doctor telling you to take them in the past 30 days? • 1-2 occasions: • 1% of 6th graders • 3% of 8th graders • 5% of 10th graders • 5% of 12th graders

  8. Nationwide Facts • More than 6 million people aged 12 or older were current illicit users of prescription drugs in 2002. • In 2001, prescription drug abuse and misuse were estimated to impose approximately $100 billion annually in health care costs. • The number of individuals abusing pain medications for the first time grew from 628,000 in 1990 to nearly 3 million in 2000. Source: Trends Alert, Prescription Drug Diversion, 2004

  9. Facts (cont.) • American youth abuse prescription drugs more frequently than heroin, cocaine, and every other illicit drug except marijuana. • The 2003 Monitoring the Future survey of 50,000 high school students nationwide reported that substance abuse by teenagers has dropped overall with the exception of two prescription pain medications- OxyContin and Vicodin.

  10. Kentucky Legislation • In 1998, Kentucky passed legislation that requires use of prescription paper with security features for all controlled substances. • While this safeguard has proven effective in decreasing written forgeries, it has led to an increase in attempted fraudulent prescriptions phoned in to pharmacies.

  11. Legislation (cont.) • Effective June 2005, Governor Ernie Fletcher instituted Senate Bill 63, which calls for the Kentucky Board of Pharmacy to regulate Internet pharmacies that ship drugs into Kentucky, and requires that customers ordering drugs online have valid prescriptions. The Kentucky Office of Drug Control Policy is currently assisting with a plan to implement the legislation.(Commonwealth of Kentucky press release, March 29, 2005.)

  12. Commonly Abused Drugs • According to the Kentucky Division of Substance Abuse, the most widely abused prescription drug categories during FY2000 (in order of prevalence) were: • alprazolam (Xanax) • oxycodone (OxyContin) • diazepam (Valium) • hydromorphone hydrochloride (Dilaudid) • methadone hydrochloride (methadone) • codeine phosphate/sulfate (codeine) • amphetamine sulfate (amphetamine)

  13. Benzodiazepines (aka Benzos) • Xanax is a benzodiazepine-type depressant used as an anti-anxiety tranquilizer. Benzodiazepines affect the central nervous system, have hypnotic and sedative qualities, and are often abused in conjunction with alcohol, heroine, or cocaine. According to the Kentucky Division of Substance Abuse, Xanax was the most widely abused prescription drug during FY2000. • Another form of benzodiazepine popular in Kentucky is Valium, also a depressant. • Nationally, approximately 50% of individuals entering treatment for narcotic or cocaine addiction also report using benzodiazepines.

  14. Opioids • Oxycodone, an opiate agonist, is known commercially as OxyContin, Percocet, Percodan, and Tylox. Opioids act like morphine, and are the most effective painkillers available. • Oxycodone-related deaths in Kentucky have increased significantly since 1998. • OxyContin is one of the most abused oxycodone products in Kentucky.

  15. OxyContin • Abusers administer oxycodone in various ways; the most dangerous is by intravenous injection, which involves combining crushed OxyContin tablets with water and injecting the mixture. • Other abusers rub off the controlled-release coating on the tablets, crush them, and snort the powder, or use OxyContin as a suppository. • Abusers often have white streaks on their blue jeans indicating that they have been rubbing the coating off OxyContin tablets.

  16. OxyContin (cont.) • Kentucky is one of the leading states for OxyContin-related robberies and burglaries. • Between January 2000 and June 2001, 69 of the state’s 1,000 pharmacies reported OxyContin-related burglaries or robberies. Source: National Drug Intelligence Center, Kentucky Drug Threat Assessment, 2002

  17. Methadone • Methadone hydrochloride, known commercially as Dolophine, is a synthetic opioid used primarily for the management of heroin and narcotic addiction at treatment centers. • Although it is closely regulated, illegal use of Dolophine tablets is common. It is often used in combination with benzos to enhance its narcotic effect. • Individuals may unintentionally overdose on methadone because they do not realize that the residual chemicals remain in the body long after the drug’s intended effects have subsided.

  18. Methods of Diversion • While youth typically acquire drugs by stealing from relatives or buying from classmates who sell their legitimate prescriptions, the diversion of prescription drugs among adults typically occurs through: • Doctor shopping • Illegal internet pharmacies • Drug theft • Prescription forgery • Illicit prescriptions by physicians Source: Trends Alert, Prescription Drug Diversion, 2004

  19. Diversion (cont.) • Doctor shopping is defined as “a practice in which a patient visits multiple physicians to acquire numerous prescriptions.” • Diverted pharmaceuticals are transported into Kentucky by couriers, in private vehicles, or via package delivery services. • Prescription drugs often sell on the street for as much as 10 times what they are worth retail.

  20. Treatment • As of January 2003, every person in Eastern Kentucky’s 21 bed Mountain Comprehensive Care Center was a prescription drug addict. They are younger and sicker (rarely older than 30) than most past patients.

  21. KASPER • As of January 1, 1999, all prescriptions in Kentucky are tracked by a statewide electronic monitoring system database known as the Kentucky All-Schedule Prescription Electronic Reporting System (KASPER). • The system allows physicians to query the database by sending a request prior to the patient’s arrival or while the patient is in the office. Within a few hours, the doctor receives a fax report concerning the individual’s controlled substance prescriptions and the doctors the patient has visited. • Approximately 100 requests are processed daily, most from practitioners attempting to verify the authenticity of patients’ complaints and requests.

  22. ARCOS • DEA officials use the Automated Reports and Consolidated Orders System (ARCOS) to track specific drugs from manufacturer to retail distributor. This system enables the agency to track these substances as they are manufactured and ultimately prescribed to the user. The DEA analyzes ARCOS data and provides it to state agencies at no cost. States can use the information to determine retail distributors who receive unusual quantities of certain drugs. Source: Trends Alert, Prescription Drug Diversion, 2004

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