This issue focuses on the challenge of managing chronic pain. Commentaries present various treatment options, including opioids, nonopioid medications, surgery, and alternative therapies. Authors also address the problems of opioid misuse and abuse and discuss ways to lessen these risks. Original articles examine health professionals’ communication with adolescents about smoking, as well as children's immunization status as verified by practice records and by the North Carolina Immunization Registry.
Prescription Drug Diversion: A Law Enforcement Perspective
The Diversion and Environmental Crimes Unit (DECU) of the North Carolina State Bureau of Investigation (SBI) is the only statewide law enforcement group that is dedicated to investigating all criminal violations involving prescription drugs and controlled substances, including the diversion of these substances. (Readers can learn more about the North Carolina SBI at http://www.ncdoj.gov/SBI.aspx.) This role gives DECU a unique perspective on the growing epidemic of prescription drug diversion, which affects not only the criminal justice system but also health care professionals and citizens.
For many years, hydrocodone was the most commonly diverted drug, and it continues to be one of the most popular medications among individuals who commit these violations. Over the past 2 years, however, oxycodone (in a 30-mg dose) has far surpassed all other prescription narcotics as the drug of choice among drug seekers and those who abuse prescription drugs. DECU has also witnessed a disturbing increase in the number of young people in the high school and college populations who buy, sell, and trade amphetamine/dextroamphetamine (a stimulant that is indicated for the treatment of attention deficit hyperactivity disorder). Finally, benzodiazepines such as alprazolam are frequently diverted by a wide range of individuals.
From 2004 to 2009, DECU saw a 400% increase in the total number of investigations of diversion; additionally, from 2010 to 2012, the number of investigations that involved health care professionals increased 35%. DECU’s resources were nearly overwhelmed by the number of organized drug rings that used forged computer-generated prescriptions to obtain large amounts of controlled substances, and these drugs then quickly found their way onto the streets and into the hands of citizens. These highly profitable criminal groups, which operate in multiple jurisdictions, no longer need to “doctor shop” to obtain these powerful and addictive drugs; they only need to steal a prescriber’s Drug Enforcement Administration (DEA) number and use it to produce fraudulent prescriptions. These groups normally consist of 10–30 members and fraudulently obtain more than 4,000 dosage units per week; this amount is easily worth more than $120,000 when sold on the street.
The consequences of diversion and subsequent investigations are often severe and can extend far beyond the individual who has committed the violation. A person who is found guilty of diverting a Schedule II drug will often be charged with and convicted of trafficking opium-based substances, and he or she may face several years of mandatory prison time. In addition to criminal penalties, having vast amounts of powerful and potentially deadly narcotics available for sale on the streets poses considerable dangers. DECU is now dealing with a 300% jump in the number of overdose deaths that are being investigated as homicides and manslaughter cases. Furthermore, my colleagues and I recently gave a presentation at a local high school that is suspending or charging 3 students per week due to violations involving the possession of prescription drugs at school.
DECU has often stated that arrests alone are not the solution to this problem. We know that we must use a multidisciplinary partnership to combat these trends. We are therefore working closely with regulatory groups such as the North Carolina Medical Board, the North Carolina Board of Nursing, and the North Carolina Board of Pharmacy in an effort to curtail this growing problem. DECU has given awareness training to more than 4,000 individuals over the past year and will continue to provide this service in the future.
We also advise citizens to take full advantage of medicine take-back programs, such as Operation Medicine Drop, in order to remove unused medications from their homes. Most young people who use prescription controlled substances obtain these drugs in their own home or in the home of a friend. Over the past 3 years, DECU, the DEA, and Safe Kids North Carolina have collected and destroyed more than 20 million dosage units of medication. In addition, we strongly suggest that health care professionals check their own prescription profiles in the North Carolina Controlled Substances Reporting System (NCCSRS). We have had several physicians check the NCCSRS and learn that someone had fraudulently written hundreds of controlled substance prescriptions using their DEA number.
Diversion of prescription drugs is undoubtedly the fastest growing and most severe drug problem in America today. Only by working together will we be able to combat these trends and better protect the citizens of North Carolina.
Potential conflicts of interest. D.R.V. is an employee of the Diversion and Environmental Crimes Unit of the North Carolina State Bureau of Investigation.
Donnie R. Varnell, BS special agent in-charge, Diversion and Environmental Crimes Unit, North Carolina State Bureau of Investigation, Raleigh, North Carolina.
Address correspondence to Mr. Donnie R. Varnell, PO Box 2788, Kill Devil Hills, NC 27948 (email@example.com).