Prescription Drug Abuse

[QuikSand]

I read an article in the Sunday Post about high-achiever students regularly abusing various prescription medications to use them as "focus drugs" -- particularly amphetamine-derived medications prescribed to treat a variety of psychological conditions. We're all familiar with the widespread use of narcotic painkillers like Oxycontin being used for recreational purposes -- if only through high profile cases like Rush Limbaugh. I claim ignorance on the subject generally, but it sounds like this is a very widespread phenomenon.

What intrigues me is basically: how do we actually get adequate supply such that millions of Americans can gain black market access to prescription drugs?


I presume that these medicines are by and large the actual product -- manufactured by pharmaceutical companies and distributed through the normal means, prescribed by someone with a license and obtained by the person who receives the prescription. That may not be universally true -- it may not even be the majrotiy of cases -- but I assume it's the norm.

If that's true, then I guess the availability of these drugs on a "secondary market" traces to two possible things:

-savvy "patients" who articulate symptoms necessary to obtain the prescription for this sort of medication from a doctor, for purposes of eventually selling the medication to others

-unethical doctors who basically profit from running "prescription factories" where they fulfill supply while basically knowing that the customers are turning around the drugs being presribed


It seems to me that in either case, this ought to be fairly easy to crack down on, if we had the intention to do so. But I don't know much about medical systems and accountability. And I don't know if this is considered a matter of civil liberties (or even professional deference) that keeps us [the government, I guess] from having some sort of database that tracks the distribution of medications that have a potential for abuse beyond their intended purpose.

(Incidentally, I am not an anti-drug crusader, and am generally not much of a fan of prosecuting victimless crimes... my interest here is really just motivated by curiosity, not a particular agenda)


Anyone know more about this sort of "market" and why we don't or can't seem to do much about it?

[Draft Dodger]

I also don't know much about this, but agree with your two main factors.
I'm not sure I agree that either would be easy to crack down on, though.

[QuikSand]

Well, an authoritarian view would suggest that we make a list of prescription meds with potential to be abused. Every doctor and every patient involved with such a prescription would be recorded, and any unusual trends be investigated. Docs with hundreds of patients getting oxycontin, or patients receiving ritalin from three different doctors would seem to show up pretty quickly. If we were really serious about cracking down on this sort of thing -- I'd think a system of that sort would have to be effective in identifying the serious cracks in the process -- after all, I just can't imagine that there are literally millions of faux patients gaming the prescription system just to make a few bucks.

If you want to put a stop to this, I think something along those lines would do it. I'm assuming that privacy concerns with medical information prevent it from happening... but I don't know if there is any effort made to track prescriptions of this sort.

[albionmoonlight]

EagleFan27 should be pinged if he does not see this thread. He strikes me as the man most likely to have insights here.

As for what little I can add: my friend's sister ran with a group of "bad girls" for a while there who were into recreational perscription drug abuse--mostly painkillers from what I could tell, though there are apparently some cool effects that one can get from high doses of Prozac and alcohol, too.

Anyway, there was a ring leader girl who basically supplied the group. She would go to the emergency room and know exactaly what kind of symptoms to describe in order to get sent home with a pack or two of the good stuff. She also knew "a guy" who kept her hooked up when her supply ran low---all of which is my antecdotal evidence supporting your theory that there are a few supply points through which most of these drugs flow. The only two people I knew who were supplying the drugs were this girl and that guy she knew.

As to your other points, I am a civil libertarian who does not actually have a problem with your database tracking solution. I see three problems offhand, though (in addition to the general privacy concerns that you noted above):

1.) The medical profession, from what I can tell, does not like to be regulated by external bodies. They consider themselves to be highly trained professionals who do not need external oversight. I'm not saying that they are right or wrong, but they are going to object to any oversight that is not voluntarially imposed by the AMA or some other organization.

2.) To the extent that a lot of these drugs flow through emergency rooms (at least the pain killers), it may be hard to actually implement such a system. Not everyone shows up needing morphine after a gunshot wound with proper I.D. Of course, I may be wrong that any appreciable number of drugs goes through emergency rooms.

3.) It puts an extra cost and administrative burden on an area of our lives that we all agree already costs too much and it too tied up in red tape.

[Franklinnoble]

You're forgetting the foreign market.

Pharmaceutical companies can sell new drugs in other countries much sooner than they can sell them here, because of the FDA. A lot of these meds are probably obtained from Mexican pharmacies and the like.

[dacman]

My former dentist demonstrates one form of the supply:

http://www.thestarpress.com/apps/pbcs.dll/article?AID=/20060614/NEWS01/606140318/1002/NEWS17

[Telle]

Well the incidence of "better living through chemistry" in teenagers has really been on the rise lately. I wouldn't doubt that some kids are selling off their meds to their friends rather than taking them themselves.

[Glengoyne]

The Industry itself compiles lists of every prescription drug purchased with the assistance of insurance companies. Doctors that are over prescribing narcotics, or even expensive products, are easilly identified. I honestly don't know if that info is shared with the government, but I know it exists.

From the Insurance side there are a number of ways to identify patients who are doctor shopping and/or pharmacy hopping. I'm guessing most of these folks supplying this stuff are simply not using their insurance to pay for this at all. In short you get a doc to diagnose you take the script to pharmacy A. Then you get another doc to diagnose you with the condition, and take his prescription to Pharmacy B. Do that a few times, and you have a decent sized supply to sell. If you pay for it all with cash, there is much less tracking that can be done. A handful of Fake IDs would make the tracking even more difficult.

[Eaglesfan27]

Just have a time for a quick reply at the moment, but will post more later if I have other thoughts:

This is an issue I think about quite often. I'm often suspicious of patients, particularly if they are older patients who have never been previously diagnosed with ADHD, manufacturing ADHD symptoms in order to get a prescription from me in order to personally profit by selling the medications. I've actually caught one dumbass who did this because the einstein sold the whole freaking prescription in its original bottle. The police caught the guy he sold it to on another drug matter and called me to ask me about the prescription telling me this guy had a bottle of medications of one of my patients. I questioned my patient about it, and he said he lost it at school, except there was no reason for him to take it to school since it was a medication that was to be taken at home and supervised by his parents.

Which brings me to another related tangent, I think a fair percentage of the patients I see have their parents colluding with them or even more often without the child's desire to get their kids medications. Amphetamines will help just about anyone focus better and do better academically. Therefore, there are some parents who are just so focused on their kids achieving at a high academic level that they are willing to exagerate symptoms to make their child appear to have ADHD. I certainly don't think this is a majority of parents or children that I see, but it is a significant enough number that this is something I worry about.

Unfortunately, there is no definitive test that can absolutely say yes this child has ADHD or no this child doesn't. I used to do some research with Quantitivate Computerized EEG's, but that research was not conclusive and I'm not sold on the computerized EEG as a reliable tool to diagnose ADHD. I do think that there are a good battery of tests that a skilled psychologist or preferably a neuropsychlogist can do which are more helpful than just a clinical interview. However, unfortunately, that is a very costly battery of tests to run. In the public clinic setting where I work, none of my patients can afford to pay for that testing and the state doesn't pay for it either. Therefore, I just have to go off of my clinical diagnosis from the history that the patient, parents, and teachers tell me. Back when I worked at a big college, I did utilize the battery of tests and I found several college students who were reciting all of the symptoms of ADHD, but when subjected to objective testing by a skilled psychologist showed no signs of ADHD. The bottom line is I think this is a significant problem.

[st.cronin]

I have no way of knowing, but I doubt it's as widespread a phenomenon as some people say it is.

[albionmoonlight]

Just have a time for a quick reply at the moment, but will post more later if I have other thoughts:

EF27--As a doctor, what do you think of the "database" idea floated in this thread? Do you think that it would improperly cross a doctor/patient privacy line? Would it do any good? Is it even possible to do something like this?

[SunDevil]

:waves to Fritz

[QuikSand]

I have no way of knowing, but I doubt it's as widespread a phenomenon as some people say it is.

One quote from the original Post article:

The bootleg use even in her high school years was erupting, according to a study published in February in an international biomedical and psychosocial journal, Drug and Alcohol Dependence. Mining 2002 data, it noted that even then, more than 7 million Americans used bootleg prescription stimulants, and 1.6 million of those users were of student age. By the time students reach college nowadays, they're already apt to know about these drugs, obtained with or without a prescription.

Another:

In May, the Partnership for a Drug-Free America issued its annual attitude-tracking study on drug use. It is a survey of more than 7,300 seventh- through 12th-graders, designed to be representative of the larger U.S. population and with an accuracy of plus or minus 1.5 percent, according to Thomas A. Hedrick Jr., a founding director of the organization. It reported that among kids of middle school and high school age, 2.25 million are using stimulants such as Ritalin without a prescription.

That's about one in 10 of the 22 million students in those grades, as calculated by the U.S. Department of Education.

I can't vouch for these studies, but those numbers are part of what got me thinking... where is all this stuff coming from?


Here's the entire article, requiring a sign-in, I think:

http://www.washingtonpost.com/wp-dyn/content/article/2006/06/10/AR2006061001181.html

[sabotai]

I knew a woman who was addicted to pain killers. She used to (and may still) buy them in New York City. It's as easy to get as heroin or pot in the city (maybe easier).

I also knew kids in high school 10-15 years ago that sold their prescription drugs to other kids in school. It's hardly a new thing. One chick sold her diet pills (and they wondered why she was always fat) and another kid sold his pain killers. He was in a car accident and the doctors loaded him up on pain killers for his leg. He just kept saying "yeah it hurts" and they kept giving him pain killers....It's been 10 years since I graduated high school....god damn I'm old. Someone pass the Oxy, I got some pain to kill... :)

[Radii]

Back when I worked in a pharmacy, only the top end drugs (I think schedule I and schedule II, I forget), were kept under lock and key. That does cover the big ones like Percocet and the like, but there was still some very good stuff that was sitting out on the shelves. Something like Tylenol w/ Codeine was sitting out on the shelves, and was ordered in large bottles of 500. I worked at a larger pharmacy where we kept two bottles on hand at all times. We fired one girl who got caught stealing an entire bottle. She had been skimming a few a day, and probably could have taken 10-15 a day or more and never, ever been caught, she just got greedy.

I believe most sleep aids were available, as well as all anti-depressents(though I'm not sure if there's any sort of black market for that at all). Some strong anti-nausea drugs that will knock most people out were out and available often, but it was only the *really* highly prescribed codeine derivatives that came in bottles of 500 that were so easy to skim.

[Airhog]

Speaking from close personal experience about oxycontin, most dealers are very sick people, that get a regular supply of them. At least all of the people I knew that sold them.

[Eaglesfan27]

EF27--As a doctor, what do you think of the "database" idea floated in this thread? Do you think that it would improperly cross a doctor/patient privacy line? Would it do any good? Is it even possible to do something like this?

As most lawyers know, HIPPA and privacy is a big issue, as well it should be. I think the issue of privacy is the biggest obstacle to the idea of that type of database. However, I really think a unified medical chart that was easily accessible (but properly protected by whatever electronic security measures was necessary) would greatly serve patients in so many ways. Certainly, it would help doctors to be able to detect the drug seeking behavior that we are discussing in this thread. However, it would also greatly improve communication between various physicians which I think is one of the greatest weaknesses in our current health care system. Of course, that is just a pipe dream of mine as privacy issues will almost certainly prevent this from ever happening.

[Eaglesfan27]

To answer your last question, I think it is possible to do. Certainly every prescription I write is tracked via one agency or another, and it would be possible to track the other things mentioned as well. However, it would certainly involve a significant potential for invasion of privacy.

[DeToxRox]

I know so many people using Adderol its ridiculous.

Not sure what the fun in it is.

The best part about being 20 is being able to burn the candle at both ends without assisstance. Those pussies.

[Radii]

As most lawyers know, HIPPA and privacy is a big issue, as well it should be. I think the issue of privacy is the biggest obstacle to the idea of that type of database. However, I really think a unified medical chart that was easily accessible (but properly protected by whatever electronic security measures was necessary) would greatly serve patients in so many ways. Certainly, it would help doctors to be able to detect the drug seeking behavior that we are discussing in this thread. However, it would also greatly improve communication between various physicians which I think is one of the greatest weaknesses in our current health care system. Of course, that is just a pipe dream of mine as privacy issues will almost certainly prevent this from ever happening.

I don't know how far down the pipe it is(certainly a year+ away), but my boss has mentioned a number of times the possibility of offering a service to physicians to provide easy access to EHR's(patients' Electronic Health Records) among different doctors, but at this point I know very few details, and it would require the patient's consent, so it doesn't address this problem.

I do think though that in the next few years we're going to see a dramatic increase in the types of healthcare services that can be provided in real time and electronically, including the sharing of patient history and patient records . Nothing at all is standardized in healthcare, even after HIPAA arrived, but there are a lot of companies trying to make it big by fighting this and trying to convince healthcare related providers at all levels that it really is in their best interests to move into the 21st century.

The leap from the above added services to checking a patient's drug history without his or her consent(that no one trying to beat the system will give), but I believe the technology will be there if something in the legislation ever does change.

[Glengoyne]

EF27--As a doctor, what do you think of the "database" idea floated in this thread? Do you think that it would improperly cross a doctor/patient privacy line? Would it do any good? Is it even possible to do something like this?

The database(s) exists. The drug companies collect all of this information, not only their own drugs, but all drugs. They pay insurance companies rebates based on usage of their products. They quantify the usage by an accounting of the prescription count. They know what the doctors are prescribing. They know what the patients are taking.

As for the HIPAA considerations of sharing this information. I have two words.....Business Associates.

[Logan]

I know so many people using Adderol its ridiculous.

Not sure what the fun in it is.

The best part about being 20 is being able to burn the candle at both ends without assisstance. Those pussies.

This was going to be my response to the "I have a feeling it's not as widespread as they say" that was posted above.

When I was in school, I knew more people who sold adderol than who sold weed, cocaine, or any other drug combined. By far, it was the easiest drug to get a hold of.

I never personally used it (the ones I know who did use it were the types who "studied" by sitting in the student center with an open book in front of them while talking to anyone and everyone for hours), but I know plenty of people who took it so much that they couldn't concentrate on anything without taking at least one.

[st.cronin]

This was going to be my response to the "I have a feeling it's not as widespread as they say" that was posted above.

When I was in school, I knew more people who sold adderol than who sold weed, cocaine, or any other drug combined. By far, it was the easiest drug to get a hold of.

I never personally used it (the ones I know who did use it were the types who "studied" by sitting in the student center with an open book in front of them while talking to anyone and everyone for hours), but I know plenty of people who took it so much that they couldn't concentrate on anything without taking at least one.

Well, I don't think the use of weed/coke/etc. is as widespread as the alarmists would have us believe, either. My opinion is based mainly on the fact that I have known very few succesful people who abused drugs other than coffee and nicotine.

[DeToxRox]

Well, I don't think the use of weed/coke/etc. is as widespread as the alarmists would have us believe, either. My opinion is based mainly on the fact that I have known very few succesful people who abused drugs other than coffee and nicotine.

Eh, depends on where you live.

Case in point, Western Michigan has probably 1 out of every 30 students who use coke on a party basis. It's huge there. Absolutely massive. In a town with not much to do, I guess thats how they have fun.

[Rizon]

Perscription drug use is rampant here. All the teens I know can get almost anything through connections with the local hospitals pharamacy deparments, who, oddly enough, must have absolutely no control over what goes in and out of there.

[Franklinnoble]

Well, when I went to school in Arizona, a lot of that stuff came from over the border. Mexican pharmacies aren't too particular who they sell to.

[BishopMVP]

Well, I don't think the use of weed/coke/etc. is as widespread as the alarmists would have us believe, either. My opinion is based mainly on the fact that I have known very few succesful people who abused drugs other than coffee and nicotine.Eh, depends on where you live.

Case in point, Western Michigan has probably 1 out of every 30 students who use coke on a party basis. It's huge there. Absolutely massive. In a town with not much to do, I guess thats how they have fun.Eh... 1 in 30 isn't that big. Yay is the one that's real under the radar unless you are in the circle and all of a sudden you wonder how you could have missed something so obvious in retrospect. Marijuana is easily the most widely used to the point where no one even tries to hide it. Most kids really don't differentiate between marijuana/alcohol when it comes to being bad for you (and in fact, I'd actually agree with them in that alcohol is much more likely to lead to problems.) And I know plenty of "successful" people who do/have done coke or weed.

"Prescription drugs" is a very wide category, so it depends on which type you are talking about. Something like OC is easily the most addictive, but also the hardest to get - that's why at least here there have been armed robbery's for OC, but you're never going to see the same for ritalin/adderol. Because of that factor, more attention gets focused on it even though it's the least prevalent. Then you have two categories that a lot of kids do; the (lesser) painkillers - something like percoset, or more typically Vicodin/Codeine - and ADD medicine like ritalin/adderol. In both these cases, I haven't seen any formal network, it's just more of an over-prescribed availability. The number of diagnosis/prescriptions for ADHD is astounding, and most of the kids don't really need the pills. When I got my tonsils removed I got 3 bottles combined of Vicodin and Tylenol w/Codeine, much more than I needed. I've probably got 2 sitting in the cabinet still 2 years later. So, at least in my experience, it's usually not any one kid going in with fake symptoms and trying to score prescription drugs to sell, but someone with a legitimate prescription getting more than they need and figuring, hey, why not get $5 here for each extra pill if someone is willing to pay.

So I don't know, I think a centralized database could pick out a few people here and there, and cut down on the supply points when it comes to harder things like OxyContin or Morphine, but on the lighter stuff like ritalin/vicodin they're so over-prescribed that the supply points are endless any enforcement program would cost more than it's worth. (Snide note - not that that'd be any different than the rest of the War on Drugs.)

[Galaxy]

A thread that's a few weeks old, but it's amazing the lack of control of the prescipation drug supply.


For those who know "successful" people, what does that mean, and does it mean they still use it or used to (coke, ect)?