Cutting Rx Opioid Supply Is Not Stopping Diversion

Cutting Rx Opioid Supply Is Not Stopping Diversion — Pain News Network – by Roger Crhiss – Oct 2018

Drug diversion is an increasingly important factor in the opioid overdose crisis.

A new report from Protenus found that 18.7 million pills, valued at around $164 million, were lost due to drug diversion in the United States during the first half of 2018. This represents a vast increase over 2017, when 20.9 million pills were diverted during the entire year.

I’ve posted before about my suspicions that it’s large scale diversion in the supply chain that’s feeding the availability of prescription opioids on the black market, not pain patient prescriptions. These huge numbers of diverted pills make clear that these diverted prescription opioids are not from grandma’s medicine cabinet, but these events don’t “make the news”. 

As we’ve described previously, drug diversion in the supply chain is a vast, complex and old phenomenon. And it is rapidly worsening.  

According to the textbook, “Prescription Drug Diversion and Pain,” drug thefts from hospitals “have increased significantly within the past decade as street prices have climbed sharply for diverted prescription opioids and benzodiazepines.”

In other words, the steep cuts in opioid production that began in 2017 aren’t working. And Attorney General Jeff Sessions was wrong when he said, “The more a drug is diverted, the more its production should be limited.”

A tightening supply has actually resulted in more diversion.

Drug diversion can be broadly divided into three categories:

1. clinical diversion (drug diversion by healthcare workers),
2. personal diversion ( sale or transfer by a patient who received a legitimate prescription to a third party)
3. industrial diversion. (everything else, from diversion by employees at manufacturing facilities to theft in distribution centers or pharmacies)

Personal diversion has gotten substantial attention in recent years. Prescription drug monitoring databases, pain agreements, and urine drug testing are all intended to help prevent such diversion.

Clinical drug diversion is a long-standing problem in healthcare that has garnered more interest recently. The bipartisan opioid bill recently passed by Congress includes a provision that allows hospice workers to destroy opioid medication that has expired or is no longer needed by a patient. The National Institutes of Health has also awarded a grant to further expand efforts to detect opioid and other drug theft in hospital systems.

Industrial diversion is less well known, but appears to be a longstanding problem. In the book “Dopesick,” journalist Beth Macy writes that as early as 2001 the DEA was investigating lax security standards at Purdue Pharma manufacturing plants after the arrest of two Purdue employees accused of trying to steal thousands of pills.

Between 2009 and 2012, over 63,000 thefts of opioids and other controlled substances were reported to the DEA. Pharmacies (66%) and hospitals (19%) accounted for the vast majority of those drug thefts.

And in 2007, an audit of CMS Medicare Part D payments identified 228,000 prescription payments with invalid prescriber identifications for Schedule II drugs.

Here are a few more reports of such “industrial diversion” I found over the last few years:

• Rx Drug Diversion an Issue at VA Hospitals
• Fentanyl from diversion and hidden labs
• Case of Large-Scale Opioid Diversion Puts Hospitals on Alert
• Drug Diversion: Scam put 900,000 Oxycontin on street

In other words, tens of thousands of drug thefts and hundreds of thousands of fraudulent prescriptions are occurring annually, leading to millions of prescription pills entering the illegal market. This may help explain how OxyContin entered the black market so quickly and completely.

As the opioid overdose crisis continues to evolve toward poly-drug substance abuse, drug diversion will play an increasingly significant role in the illegal supply of prescription pharmaceuticals unless the entire supply chain is secured.

This will require far more than the easy tasks of checking a prescription database or legislating pill counts. The hard part of reducing drug diversion remains to be done.

Author: Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.