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National Drug Intelligence Center |
Approximately 6.9 million individuals aged 12 or older were current (past month) nonmedical users of prescription-type psychotherapeutic drugs (opioid pain relievers,1 tranquilizers, sedatives, or stimulants) during 2007, according to the Substance Abuse and Mental Health Services Administration (SAMHSA) 2007 National Survey on Drug Use and Health (NSDUH). Current nonmedical use of these drugs, collectively referred to as "controlled prescription drugs (CPDs)" (see text box in Overview section) for the purposes of this report, remained relatively stable from 2003 (6.5 million) to 2007 (6.9 million); however, the number of deaths and treatment admissions involving CPDs, particularly prescription opioids, increased significantly. According to the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics, unintentional overdose deaths involving prescription opioids increased 114 percent from 2001 (3,994) to 2005 (8,541), the most recent nationwide data available. (See Figure 1.) Further, the number of treatment admissions for prescription opioids as the primary drug of abuse increased 74 percent from 46,115 in 2002 to 80,131 in 2006, the most recent data available, according to the SAMHSA Treatment Episode Data Set (TEDS).
Figure 1. Prescription Opioid Analgesic Deaths Nationwide, 2001-2005
Source: Centers for Disease Control and Prevention.
Pain relievers are the most widely diverted and abused prescription psychotherapeutics, according to NSDUH. (See Figure 2.) The Drug Enforcement Administration (DEA) believes that most of these pain relievers are controlled prescription opioids.2 Abusers use opioid pain relievers largely for their euphoric effect. Tranquilizers and sedatives are abused, although to a lesser extent; abusers often use the drugs in combination with opioid pain relievers because they potentiate the effects of the opioid. Opioid pain relievers, tranquilizers, and sedatives are abused primarily by young adults aged 18 to 25; adolescents (12 to 17 years of age) also compose a significant user group for these drugs. Prescription stimulants are abused to a much lesser extent, primarily by young adults who reportedly use the drugs in an attempt to enhance their academic, professional, or athletic performance. Diverted CPDs are generally distributed by individuals, among friends and family, and through rogue Internet pharmacies; they typically are not distributed in the same manner as illicit drugs such as heroin, cocaine, marijuana, and methamphetamine--through drug trafficking organizations (DTOs) and criminal groups. However, some illicit drug distributors, particularly street gangs and outlaw motorcycle gangs (OMGs), have added diverted CPDs to their drug supplies. CPDs are also acquired by abusers through such diversion techniques as doctor-shopping, prescription fraud, and theft.
Figure 2. Past Month Nonmedical Use of Psychotherapeutics by Individuals 12 or Older, by Percentage, Nationwide, 2003-2007
Source: National Survey on Drug Use and Health.
The societal impact of CPD diversion and abuse is considerable. Violent and property crime associated with CPD diversion and abuse has increased in all regions of the United States over the past 5 years, according to the National Drug Intelligence Center (NDIC) National Drug Threat Survey (NDTS). However, the association between crime and CPD diversion is reported much less frequently than the association between crime and illicit drugs. Increases in crime rates often result in higher budgetary expenditures for additional law enforcement resources. Moreover, the estimated cost of CPD diversion and abuse to public and private medical insurers is $72.5 billion a year,3 much of which is passed to consumers through higher health insurance premiums. Additionally, the abuse of prescription opioids is burdening the budgets of substance abuse treatment providers, particularly as prescription opioid abuse might be fueling heroin abuse rates in some areas of the United States. Treatment providers anecdotally report that some prescription opioid abusers are switching to heroin as they build tolerance to prescription opioids and seek a more euphoric high. Further anecdotal reporting by treatment providers indicates that some prescription opioid abusers are switching to heroin in a few areas where heroin is less costly or more available than prescription opioids. Such reporting could be an indicator that an increasing number of prescription opioid abusers might switch to heroin. However, DEA has not evidenced a trend in any investigative or intelligence systems showing the substitution of heroin for CPDs.
Prescription Drug Monitoring Programs (PDMPs) have been established legislatively in many states to curb CPD diversion and abuse. PDMPs have decreased CPD diversion and abuse by reducing the amount of doctor-shopping by drug-seeking individuals, according to the most recent U.S. Government Accountability Office (GAO) report regarding PDMPs. However, law enforcement and public health officials indicate an increased need for information sharing between physicians, pharmacists, and law enforcement officers, particularly between such individuals in neighboring states. To this end, the Bureau of Justice Assistance (BJA) has provided technical assistance and funding for a project through which public and private technology solutions providers, the Integrated Justice Information Systems (IJIS) Institute,4 and PDMP representatives are working to establish a nationwide information-sharing platform that will facilitate the interstate exchange of PDMP data.
The principal sources of information used in this assessment include the following. (Note: Agencies that responded to the NDTS5 have not been included in the source list at the end of this assessment.)
The greatest impediment to the collection of accurate abuse-related data is the lack of standardized terminology used in surveys and drug-related death reporting. Moreover, NDTS respondents provide anecdotal information based on individual perceptions of the situation. Additional impediments include lack of data regarding the following:
The collection of diversion- and abuse-related data for this assessment was fostered by the large number of NDTS responses in 2008 (3,049). Additionally, private industry, treatment experts, academicians, and researchers provided valuable data and information for this assessment.
The data contained in this report reflect the most recent data available at the time of publication and typically cover a 5-year period. For example, when 2008 data are available, the period examined commences in 2004. When 2005 data are the most recent available, the period examined commences in 2001.
Different data sources use different terminology for various prescription drugs. This report uses the terminology referenced in each source in order to accurately portray the data. For example, some sources use the term "pain relievers" (which includes both opioids and nonopioids), others may specifically use the term "opioid pain relievers," and still others may refer to such drugs as "opiates" or "narcotic pain relievers."
CPD data often vary according to the source of the data. Some studies and surveys mention specific CPDs, while others use a more general approach to collection and refer only to Schedule II, III, or IV prescription drugs. For example, the National Center on Addiction and Substance Abuse (CASA) at Columbia University uses a general approach in its Internet studies and targets CPDs, "primarily those appearing in Schedules II and III." NSDUH is slightly more specific when conducting surveys and uses "pain relievers, stimulants, depressants, and tranquilizers" as categories under an umbrella term of "psychotherapeutics." The National Seizure System (NSS) captures all prescription drug seizures and lists specific drugs when possible while maintaining one "prescription drugs - other" category to record seizures that involve possibly unknown prescription drugs. DEA Automation of Reports and Consolidated Orders System (ARCOS) data include Schedule II and III narcotic controlled drugs, while the Drug, Theft, and Loss database includes Schedule II through V CPDs. In this assessment, all attempts have been made to be as inclusive as possible in reporting data sets while maintaining some consistency in the drug types being compared. Thus, some portions of the assessment refer generically to Schedule II, III, or IV drugs, while others discuss specific drugs that are the most frequently reported diverted and abused CPDs.
1.
Different data sources use different terminology
for prescription drug categories. This report uses the terminology referenced in
each source so as to accurately portray the data. For example, some sources use
the term "pain relievers" when these drugs typically fall under the category of
"opioids."
2.
Drug Enforcement Administration (DEA) Deputy Assistant
Administrator Joseph T. Rannazzisi, Statement to the Committee on House Government
Reform, Subcommittee on Criminal Justice, Drug Policy, and Human Resources, July
26, 2006, and Mr. Rannazzisi, Statement to members of the Judiciary Committee, May
16, 2007. Information was presented at the Good Medicine Bad Behavior exhibit at
DEA Headquarters and can be found at http://www.goodmedicinebadbehavior.org/explore/pain_management.html.
3.
This is an estimate provided by the Coalition Against
Insurance Fraud (CAIF), a nongovernment source.
4.
The Integrated Justice Information Systems (IJIS)
Institute is a nonprofit organization responsible for bringing private industry
and government together to assist in the development of new standards and practices
across the justice, public safety, and homeland security communities.
5.
The National Drug Intelligence Center (NDIC) administers
its annual National Drug Threat Survey (NDTS) to a probability-based sample of thousands
of state and local law enforcement agencies designed to represent all national,
regional, and state agencies. Since 2003, the survey response rate has been close
to 90 percent or higher. Agencies are asked to identify the drug that poses the
greatest threat, the drug that most contributes to violent and property crime, the
level of gang involvement in drug distribution, and the number of gangs and gang
members in their jurisdictions. Agencies are also asked if gang-related drug distribution
has increased or decreased in their jurisdictions.
6.
The NDIC Field Program Specialist (FPS) program was
created to increase the flow of strategic and current domestic drug intelligence
from local and state law enforcement agencies to NDIC and other counterdrug agencies.
The FPS program is staffed by retired law enforcement officers, each of whom has
approximately 25 years' experience. FPSs often work closely with law enforcement
agencies within their assigned regions, enabling them to rapidly query state and
local officials. In addition, these reports were used to validate information collected
through the NDTS.
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