Sunday, November 25, 2012

Drug Abuse and Diversion from a Retail Pharmacists Perspective

There has been  a lot of chatter surrrounding the abnormal use of pharmaceutical agents by the very custodians. The society, by virtue of our training as Pharmacists, charged us with the safe keeping of pharmaceuticals with a relatively high level of accountability.
 Below is a summary of my findings.
In 2010, there were 7 million Americans aged 12 years and older who abused prescription drugs for non-medical purposes, up from 6.2 million in 2009. This represents a 13 percent increase in just one year.

 In 2010, on average, 6,027 persons per day abused prescription pain relievers for the first time. The total number of individuals that initiated drug use with prescription drugs exceeds the number of individuals that initiated drug use with marijuana.

Every day, on average, 2,500 teens use prescription drugs to get high for the first time.

Drug Abuse:  Abnormal use of pharmaceutical agents”

As community Pharmacists we interface between 2 totally divergent worlds, the world within the pharmacy (with fellow Pharmacists, Pharmacy technicians & other store personnel); and on the other hand, we have the larger community that rely on us as the ‘know all” regarding medications.

Drug abuse, simply put, represents the “abnormal use of a pharmaceutical agent”. This involves uses of a product for purposes outside the intended purpose of a prescriber and/or of the manufacturer.

Within the confines of the retail pharmacy “the abnormal use” (drug abuse) of drugs may not be apparent (easily noticed) simply because people seldom bring “drugs” to work; but it happens. Hence some employers often conduct random drug tests to discourage the use of illicit drugs. Drug abuse is not only limited to teenagers or adolescents, the older folks are equally guilty. Oftentimes people come into the pharmacy asking if they could use “this medication” provided by a friend who had similar symptoms a while back. This in itself may not be a sign of drug abuse but it is a form of abnormal use of medicinal agents.

Factors contributing to Drug Abuse

1)      Easy access to prescription medications at home

2)      Lack of a regulated disposal channel known to customers

3)      Ease of Doctor shopping

Drug diversion: "Any criminal act involving a prescription drug"

Drug diversion can best be defined as the diversion of legal prescription products for illicit purposes. Pharmaceutical diversion often spells profits or pleasure for the traffickers, while devastation is often the end result for the abusers which eventually affects their friends, families, and their workplace. The diversion of pharmaceutical drugs can be perpetrated by obtaining prescription drugs illegally by a variety of methods including;

1)      Deception

2)       Outright theft.

 Another aspect of diversion we are beginning to see often times involves patients that are on life preserving medications, such as those to manage the signs and symptoms associated with HIV/AIDS who would rather sell the drugs on the streets and use the proceeds to support their social habits, than follow their regimen. These patients will often engage the technician or pharmacist pleading with them not to deface the outside packaging while placing the pharmacy label on the medication. This is usually seen with beneficiaries of federally funded insurance drug programs. Suspicion is that these medications are purchased by some independent pharmacies (at a fraction of the cost of acquisition) and later retailed at AWP.

Purposes of Diversion:

1)      Personal use: this often represents traffickers that obtain their illegitimate prescriptions for personal gratification. Such drugs include life-style medications such as Viagra, Cialis,

2)      Personal gain: the forgers here obtain & dispose of these prescription items for financial gain; examples include OxycontinR, PercocetR, etc

As pharmacists we see these sets of people on a daily basis, some of whom are easy to recognize while other are so sophisticated in their craft that makes them evade our ever vigilant eyes. They often befriend healthcare professionals to support their illicit “trade”

Methods of diversion

1)      Doctor Shopping

2)      Illegal Internet Pharmacies

3)      Drug theft

4)      Prescription forgery

5)      Illicit Prescription by Physicians

6)      Personal visits to Mexico, South America and the Caribbean

Strategic Measures to counter drug diversion:

Retail pharmacists, being the ultimate custodian of pharmaceutical products, the onus lies on our shoulders to continue to protect our communities by ensuring all possible loop holes for diversion (within our reach) are plugged. We should be in the vanguard of the current move to curb this societal nuisance. As a result there have been various alliances developed between Pharmacists, manufacturers, and the DEA to address this issue. Methods used so far include, but not limited to, the following:


1)      Prescription Drug Monitoring Program:


a.       The Electronic - Florida Online Reporting of Controlled Substances Evaluation program (E-FORCSE) is Florida's Prescription Drug Monitoring Program (PDMP). The PDMP was created by the 2009 legislature in an initiative to encourage safer prescribing of controlled substances and to reduce drug abuse and diversion within the state of Florida.

b.      Kentucky’s Prescription Monitoring Program (PMP). Responsibility for KASPER is with the Cabinet for Health and Family Services, Office of Inspector General. KASPER tracks most Schedule II – V controlled substance prescription data dispensed in Kentucky.


2)      Several States that have addressed PSE availability have opted for e-tracking—the creation of electronic logbooks accessible in real-time to local law enforcement to better track those criminals attempting to exceed their legal limits in PSE purchases. These states have adopted the National Precursor Log Exchange system, an interstate electronic tracking system funded by manufacturers of PSE products. The advantage to the NPLEx system is that it helps block sales across state lines, as well.


3)      Restricted access to Plan-B contraceptive by retailing such exclusively through the Pharmacy counter and not available to persons under the age of 17. This in itself perhaps need general overhauling as there have been several reported cases of minors having access through their older friends.


4)      Drug education for healthcare providers

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