PILLS CAN KILL

Diverted Rx Drugs of Greatest Concern & Sources

Hydrocodone (Lortab, Lorcet, Vicodin and generic equivalents), oxycodone (OxyContin, Roxicodone, and generic equivalents), and alprazolam (Xanex) are the top three most prescribed drugs and primarily are among the most commonly diverted and abused pharmaceuticals in the State of Tennessee. These three drugs prescribed and taken together form what is known to law enforcement as “the cocktail.” Oftentimes “the cocktail” will also include carisoprodol (Soma), now a Schedule IV drug. Carisoprodol is metabolized to meprobamate, a CNS depressant, thereby potentiating or amplifying the euphoric effects of the cocktail. Since 2008 hydrocodone has been the number one most prescribed controlled substance in Tennessee and is prescribed in amounts more than twice that of alprazolam and oxycodone combined. Information available from DEA has consistently ranked Tennessee #2 in the per capita consumption of hydrocodone, with a consumption rate at 2 times the national average. Methadone is becoming increasingly popular for pain treatment due to its low cost and longer acting duration. In 2008 and 2009 methadone was the 10^th most prescribed controlled substance in Tennessee. Methadone has a high oral bioavailability and a rapid gastrointestinal absorption rate, but with slower longer acting qualities. Because of this, abusers unfamiliar with its effects oftentimes overdose. According to the State Medical Examiner’s Office, in 2006 methadone was the number one prescription drug cited in overdose deaths.

In Tennessee, the primary sources of prescription drug diversion include “doctor shopping” activities of abusers and traffickers, indiscriminate and/or illegal over-prescribing, fraudulent and forged prescriptions, thefts, the Internet, and even your medicine cabinet.

Doctor shopping and illegal overprescribing transcend state lines. Tennessee sits in the middle of a pill trafficking pipeline that stretches from south Florida into West Virginia and Ohio. Professional doctor shoppers and other drug traffickers make frequent visits to Florida’s growing number of storefront pain clinics, or “pill mills,” where doctors indiscriminately write prescriptions to cash-paying walk-in patients and then dispense prescription pain medications from on-site pharmacies. These pills are then distributed northward, primarily into the Appalachian regions of Tennessee, Kentucky, and West Virginia where they can be sold for a large profit. In parts of Appalachia, one 80mg OxyContin pill can be sold illegally for $125.00. 

Retail pharmacies have reported losses of controlled substances through internal pilferage, burglaries, and armed robberies. In addition, clever abusers and traffickers call in fraudulent prescriptions to pharmacies hoping to obtain controlled drugs from an unsuspecting pharmacist or pharmacy employee.

The Internet is fast becoming a primary source for controlled substances, particularly hydrocodone and various benzodiazepines such as alprazolam (Xanex) and diazepam (Valium). Pharmacies in other states distribute controlled substances to individuals located in Tennessee pursuant to prescriptions issued by physicians employed by Internet web sites. “Patients” fill out on-line questionnaires which are ‘reviewed” by the prescribing physician without a physical examination. 

Nationally, the non-medical use of prescription drugs among persons aged 12 to 25 is at epidemic proportions. Because prescription drugs are widely advertised directly to consumers in the print and electronic media, young people might have the mistaken impression that these drugs are safe.  According to a study published in the August 2009 issue of the Journal of the American Academy of Child and Adolescent Psychiatry, among adolescents who obtain prescription drugs for illicit use, approximately 50% of the drugs are obtained free from friends and family members. The medicine cabinet in your home could be the source of drugs for a young person in your family or for their friends.  Unused prescription drugs thrown in the trash can be retrieved and abused or sold illegally, and flushing them contaminates our water supply. Therefore proper disposal of unused unwanted drugs is very important. Take Back programs sponsored in Tennessee by state and local law enforcement are the best way to dispose of them:

 http://www.deadiversion.usdoj.gov/drug_disposal/takeback/index.html.

If one is not available in your area, mix the drugs with something unappealing like used cat litter or coffee grounds, then seal them in a bag or disposal container and throw them away.

In an emergency, call local law enforcement or 911.