Reduce the Diversion of Prescription Drugs

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Most misuse of prescription drugs is not being done by the peopte who were prescribed the drugs by the doctors.  Therefore a core strategy for responding to the opioid crisis must include multiple ways to reduce the diversion of prescription drugs to people who are misusing them.  The details for the strategies to address this are in the supporting objectives rather than at this objective. 

Background

The Drug Enforcement Administration (DEA) has estimated that prescription drug diversion is a $25 billion-a-year industry, and that diversion can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician's office, the retail pharmacy, or the patient.[1]
One study emphasizes the impact of "pill brokers" to the drug diversion market. Pill brokers are people who routinely work with elderly patients and engage in Medicare and Medicaid fraud.[2]
Rates averaged across 2011 and 2012 show that more than one half of the nonmedical users of pain relievers, tranquilizers, stimulants, and sedatives aged 12 or older got the prescription drugs they most recently use 'from a friend or relative for free.' About 4 in 5 of these nonmedical users who obtained prescription drugs from a friend or relative for free indicated that their friend or relative had obtained the drugs from one doctor."[3]
Violent and property crime associated with controlled prescription drugs (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 and the National Drug Threat Survey. The estimated cost of CPD diversion and abuse to public and private medical insurers isP $72.5 billion a year, much of which is passed to consumers through higher health insurance premiums.
States with PDMPs have realized benefits in their efforts to reduce drug diversion. These include improving the timeliness of law enforcement and regulatory investigations. For example, Kentucky's state drug control investigators took an average of 156 days to complete the investigation of an alleged doctor shopper prior to the implementation of the state's PDMP. The average investigation time dropped to 16 days after the program was established.[4]

Bottle Tracking

National Association of Drug Diversion Investigators

In recent studies [5], it has been shown that armed robberies in pharmacies has increased from 69.4 per month to 76.2 per month. These two rates come from comparing crime rate data from January- June, 2015 and January- June, 2016. A possible aid to this, presented by the NADDI, is to incorporate technology onto medication bottles to show where these bottles were to go in the presence of a robbery.

In the event of a robbery, NADDI, proposes that giving out fake prescription bottles that have a tracking device inside of them. Police would be notified immediately and would allow them to reach the perpetrators and deal with them accordingly. This will help communities in two ways; allowing help to be given to people who have the need to rob pharmacies and lessen the amount of money lost via robberies that occur. The NADDI website has multiple tools and sources for any community interested, via this link. This hub will give ways to initiate the plan and will help lead to a better, safer community.

NADDI: Bottle Tracking[2]

 

Example Programs

Mayo Clinic
The Mayo Clinic developed a new position called the Medication Diversion Prevention Coordinator (MDPC) within the Department of Pharmacy within their larger facilities. This position requires someone familiar with the Controlled Substance supply chain and management policies who is, therefore, able to assess areas of vulnerability for potential diversion.[6] Through multiple individuals who held this position, a "best practices" list was created that identified 77 specific points that, were all the points implemented, would create what is believed to be the best possible system to date to prevent controlled substances diversion.

At larger Mayo Clinic Facilities, teams have been created to investigate suspected diversion episodes. These multidisciplinary teams, all subgroups of the Medication Diversion Prevention Committees, are called the drug diversion response teams (DDiRT). Each team consists of the MDPC, the Director of Pharmacy, a member of the Department of Safety and Security, and a physician chair of the Medication Diversion Prevention Committee. When diversion is suspected, any Mayo Clinic employee can initiate the chain of events that results in a thorough investigation. If there is concern that the diversion might involve an acutely impaired or intoxicated HCW, his or her supervisor is engaged and the HCW is immediately, but discreetly, removed from patient care duties and escorted to a new location for further evaluation including a "for cause" drug test.

Main Pathways for Prescription Drug Diversion

Major ways that prescription drugs are diverted to uses other than the intended use of the prescription include: 

  • People giving pills to a friend or relative
  • People stealing pills (from friends/relatives or strangers)
  • People buying pills from someone who was prescribed the pills or from someone who stole them.
  • People stealing pills from a pharmacy or healthcare provider

 

Tools and Resources

Details for Tools and Resources are on the more detailed objectives on Zoom Strategy Map for this topic.

 

Sources