Introduction
Drug abuse in the United States has reached epidemic proportions. Drug overdoses are one of the leading causes of death for Americans under the age of 50. According to a
2017 study by the Centers for Disease Control and Prevention (CDC), overdoses killed approximately 64,000 people in the United States in 2016.1 This represents an increase of more than 22 percent over the 52,404 drug deaths recorded in 2015. Almost 50,000 of those deaths were attributed to opioid drugs, including prescription opioids like OxyContin and Vicodin and synthetic opioids like fentanyl and heroin2.
Drug Diversion Overview
Drug diversion is the unlawful distribution or use of prescription drugs in any manner not intended by the prescriber. With an ever-growing population of drug abusers, demand for prescription drugs, and controlled substances in particular, is skyrocketing. Prescription drugs are valued by abusers because of their purity and uniform strength. Street values for many controlled substances are significantly higher than their retail value. In addition, pharmaceutical manufacturers continue to develop new specialty and lifestyle drugs, which often come with high retail prices. The financial gains from reselling these drugs make them attractive targets for diversion.
The drugs with the highest potential for drug diversion and abuse are controlled substances, which are classified as such by the U.S. Drug Enforcement Administration (DEA) based on their intended medical use as well as their potential for dependence or abuse. Drugs in this class include opioids, anabolic steroids, depressants, hallucinogens and stimulants.3 The public health consequences of drug diversion are significant. Drug diversion has contributed to the increase in drug-related hospitalizations, substance abuse admissions, and drug overdose deaths, which in turn contribute to rising medical and insurance costs. Diversion can also be a driver of disease outbreaks, as in cases of infected addicts spreading disease through the sharing of needles and other drug paraphernalia.
Methods for prescription drug diversion are varied. Patients become engaged in drug diversion by selling their legally obtained prescription drugs, “doctor shopping” by soliciting multiple physicians using false pretenses to receive prescriptions for controlled substances, or altering a prescription to obtain an unlawful quantity of a controlled substance. Diversion also occurs when prescription pads are stolen or forged in order to obtain drugs fraudulently. Physicians and other providers can become actively involved in drug diversion by operating pain clinics, or “pill mills,” and intentionally prescribing unnecessary medications or prescribing larger quantities than is medically necessary.
(1) U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, Vital Statistics Rapid Release, Provisional Drug Overdose Death Counts, November 2017, https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm(accessed December 15, 2017).
(2) Ibid.
(3) U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services, What is a Prescriber’s Role in Preventing the Diversion of Prescription Drugs? January 2014,
https://www.cms.gov/medicare-medicaid-coordination/fraud-prevention/medicaid-integrity-education/provider-education-toolkits/downloads/prescriber-role-drugdiversion.pdf (accessed December 21, 2017).