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National Drug Intelligence Center |
Increases in legitimate distribution of prescription opioid pain relievers (the most commonly diverted and abused CPDs), amphetamine, and methylphenidate have expanded the amount of these drugs available for diversion and abuse. Legitimate distribution14 per capita of most prescription opioid pain relievers, amphetamine, and methylphenidate increased nationwide from 2003 through 2007, according to the latest data from ARCOS.15 (See Figure 3.) Additionally, the number of prescriptions written for controlled prescription opioids increased during the same time, according to publicly available prescription dispensing data. (See Table 1.)
Figure 3. Cumulative Distribution of Opioids, Methylphenidate, and Amphetamine, in Grams, per 100,000 Population, 2003-2007
Source: Drug Enforcement Administration Automation of Reports
and Consolidated Orders System.
* Fentanyl base is used to produce other fentanyl products.
** Excludes methadone distributed to narcotic treatment programs.
*** Includes dl-amphetamine base and d-amphetamine base.
Note: ARCOS provides complete data for all Schedule II and Schedule III narcotic
materials (manufacturers and distributors).
Table 1. Prescriptions
Written for Generic or Brand Name Opioid Pain Relievers,
Methylphenidate, and
Amphetamine,*
in Thousands, 2003-2007
| 2003 | 2004 | 2005 | 2006 | 2007 | |
|---|---|---|---|---|---|
| Acetaminophen/codeine | 18,503 | 16,616 | 15,679 | 14,773 | 14,092 |
| Adderall XR® | 6,443 | 7,635 | 8,653 | 8,870 | 9,190 |
| Amphetamine Salt Combination | 2,730 | 3,073 | 3,513 | 3,954 | 4,761 |
| Concerta® | 6,960 | 7,627 | 8,201 | 7,859 | 7,821 |
| Duragesic® | 3,659 | 4,114 | 1,690 | ** | ** |
| Endocet® | 4,858 | 5,361 | 3,259 | 4,601 | 3,537 |
| Fentanyl transdermal | ** | 4,524 | ** | 2,606 | 3,818 |
| Hydrocodone/acetaminophen | 87,096 | 117,200 | 93,680 | 101,639 | 109,652 |
| Hydrocodone/ibuprofen | 134 | 2,394 | 2,185 | 2,282 | 2,389 |
| Hydromorphone HCL | 1,503 | ** | ** | ** | ** |
| Methadone HCL | 1,161 | 1,161 | 1,335 | ** | 3,176 |
| Methadose | ** | 1,616 | 2,084 | 1,555 | ** |
| Methylphenidate | 2,098 | 1,930 | 1,939 | 1,879 | 1,785 |
| Morphine | 1,949 | 2,242 | 2,495 | 2,803 | 2,357 |
| Oxycodone | 1,083 | 4,375 | 1,772 | 4,715 | 8,472 |
| Oxycodone/acetaminophen | 10,185 | 23,443 | 13,360 | 18,373 | 19,014 |
| OxyContin® | 6,598 | 6,068 | 3,967 | 1,414 | 2,005 |
| Promethazine/codeine | 5,366 | 4,390 | 4,912 | 4,264 | 4,390 |
| Ritalin LA® | ** | ** | 1,391 | ** | ** |
| Roxicet® | 2,299 | 1,810 | 1,496 | 1,784 | ** |
| Suboxone® | ** | ** | ** | ** | 1,888 |
| Tussionex® | 3,204 | 2,724 | 3,306 | 2,973 | 2,861 |
Source: Drug Topics via Verispan.
*
Drugs that were listed among the Top 200 generic
and brand name drugs prescribed in these years.
**
Not in the top 200 generic and brand name drugs
in these years.
While the increase in legitimate distribution of opioid pain relievers by licensed practitioners and pharmacies has aided patients in chronic pain management, law enforcement and public health officials report that it has also increased the amount of such drugs susceptible to diversion and abuse. The increase in use of opioid pain relievers--particularly methadone--has been linked by public health officials with a parallel increase in drug overdose deaths and emergency department (ED) visits involving these drugs. Areas with the highest rates of opioid distribution are those with the highest drug overdose mortality rates.
|
Factors That Contribute to CPD Diversion and Abuse The recent increase in the extent of prescription drug abuse in this country is quite likely the result of a confluence of factors, such as significant increases in the number of prescriptions; significant increases in drug availability; aggressive marketing by the pharmaceutical industry; the proliferation of illegal Internet pharmacies that dispense these medications without proper prescriptions and surveillance; and a greater social acceptability for medicating a growing number of conditions. The fact that doctors are prescribing these drugs legitimately and with increasing frequency to treat a variety of ailments leads to the misguided and dangerous conclusion that their nonmedical use should be equally safe. This misperception of safety may contribute, for example, to the casual attitude of many college students toward abusing stimulants to improve cognitive function and academic performance. Source: Statement by National Institute on Drug Abuse Director Nora D. Volkow, M.D., before the Subcommittee on Criminal Justice, Drug Policy, and Human Resources, U.S. House of Representatives, July 26, 2006. |
Legitimate distribution of amphetamine increased from 2003 through 2007, according to ARCOS; the number of prescriptions written for brand and generic amphetamine drugs (Adderall ® and amphetamine salt combinations) also increased during that time (see Table 1). In contrast, legitimate distribution of methylphenidate increased while the number of prescriptions written for the generic drug decreased slightly overall.
14.
Legitimate distribution refers to the sale of CPDs
from the manufacturer to pharmacies, hospitals, practitioners, and teaching institutions.
15.
The Automation of Reports and Consolidated Orders
System (ARCOS) is an automated, comprehensive drug reporting system that monitors
the flow of DEA-controlled substances from their point of manufacture through commercial
distribution channels to point-of-sale or distribution at the dispensing/retail
level (hospitals, retail pharmacies, practitioners, midlevel practitioners, and
teaching institutions). Included in the list of controlled substance transactions
tracked by ARCOS are the following: All Schedule I and II materials (manufacturers
and distributors), Schedule III narcotic and gamma-hydroxybutyric acid (GHB) materials
(manufacturers and distributors), and selected Schedule III and IV psychotropic
drugs (manufacturers only).
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