In my past 2 articles, I addressed the last 20 years of pharmaceutical diversion in this country. We now need to address the problems of 2011 and beyond, and see where our collective efforts can be best used to impact the problem.
Prescription Monitoring Programs (PMPs)
In the past, the single biggest advancement in reducing and investigating prescription drug abuse has likely been the PMP. In my mind, it has been the biggest success story in some states and a dismal failure in others.
The successful PMPs, those doing the most to combat the problem, have some things in common. They address all scheduled drugs, not just CII. Anyone investigating diversion knows that the bulk of the cases will fall into the CIII to CIV realm, where hydrocodone and the benzodiazepines live. Addressing CIIs only looks at 1 part of the problem and probably does not include the most abused pharmaceuticals in our country.
Successful PMPs also provide unburdened access by prescribers, dispensers, and law enforcement to important information. By unburdened, I mean law enforcement is not required to jump through the hoops of obtaining a subpoena or search warrant in order to look at a prescription drug profile of a suspect. Some parameters to obtain this information need to be met by all 3 groups mentioned previously, so that a fishing expedition or improper request is not being made under the guise of a legitimate case. Criminal and/or administrative sanctions should be forthcoming if the system is abused by any of these 3 groups.
On the horizon in some states in 2011 is an initiative to allow PMPs in adjoining states to easily or automatically share information when a query is made. This will only improve these already good systems. It will also help deter the folks who still want a national PMP, something that I think would lead to disaster if ever implemented.
Let’s hope the state of Florida gets serious and puts together a very good PMP that can be accessible by authorized prescribers, dispensers, and law enforcement to help curb the massive amount of diversion coming out of that state. Georgia is in the infant stages of trying to get a PMP to the legislature, as they have found that the problem in Florida has crept its way north past its borders. I am hoping for the best for both states.
Abuse-Resistant Controlled Substances
The abuse of OxyContin seemingly started in the state of Maine several years ago and traveled down the east coast of the United States, including a large stopover in southeastern Kentucky, a place familiar with drug diversion.
Arguably one of the best pain relievers ever made, OxyContin grew in popularity with the drug-seeking population when it was discovered that by crushing the pill you could release as much as 80 mg of oxycodone at one time. Of course, this allowed the snorting, chewing, injecting, and even smoking of OxyContin, which led to its popularity and sent the street price soaring.
In August 2010, the new formulation of OxyContin was released to retail pharmacies as a pill that is much more difficult to break down for the kind of illicit use mentioned above. As of this writing, the popularity of OxyContin has slumped, along with its street price. Some blogs have reported success with breaking down the new formulation, but I am not familiar with any reports that indicate that it is easily broken down or that the end product is compatible with original abuse methods.
The year 2011 should tell us a lot about whether Purdue Pharma’s new formulation of OxyContin has made a successful impact on the world of drug diversion and abuse.
Next month, I will talk about the human side of reducing the problem of pharmaceutical diversion in 2011 by exploring the legitimate pain patient and how with the assistance of others he or she can be a major positive player in lessening diversion.