How the Abuse Happens

Part of the abuse comes from young people raiding their parent’s medicine cabinet for whatever prescription drugs may be hanging around. This is a serious problem and one of which parents ought to be aware, but it is far from the only miscreant behavior related to prescription drug abuse. Doctor shopping, in which a person seeks out many prescriptions for the same medication from multiple physicians, is a practice associated with prescription drug abuse. Once in hand, these multiple prescriptions are sold either to individuals or to drug traffickers. Statistics show that the practice of doctor shopping costs individual insurances companies between $10,000-$15,000 annually.

How the Cost of Abuse Gets Passed Along to Non-abusers

Other costs to insurance companies relating to prescription drug abuse come in the form of emergency room visits, drug rehab treatment and the like. These costs to insurance companies were estimated to be $72.5 billion for the year 2007 (the most recent year for which data has been analyzed) and have only gone up in the years since that time. Be assured that those costs get passed along to the rest of us in the form of higher insurance premiums.

Other costs associated with prescription drug abuse come in the form of greater law enforcement or criminal justice costs. These costs have been estimated to be in the vicinity of $8 million per year. Lost productivity in the workplace is another cost to the country. Experts suggest that that cost could be as high as $42 billion each year. These guesstimates were based on figures from 2006/2007. Since prescription drug abuse has escalated since that time, one can only imagine how high such costs to the nation would be today.

Which Prescriptions are Most Abused?

The most often abused prescriptions are painkillers like hydrocodone (aka Vicodin), methadone and oxycodone (aka OxyContin). Sales of these prescription medications have more than tripled just since the year 2000. The availability and abuse of these drugs has become so problematic that the national Center for Disease Control and Prevention (CDC) has termed it an epidemic. Today nearly as many Americans will die from a drug overdose as will die in an automobile accident. More than 20,000 of those deaths will be related to prescription drugs. Over 15,000 drug overdose fatalities involved prescription medications in 2008.

There are literally millions of Americans who live with chronic pain and who are dependent upon prescription painkillers in order to maintain their quality of life. The medications should be available for them. However, stronger safeguards, such as Prescription Drug Monitoring Programs in which prescriptions to patients are tracked through an online database, need to become the norm if we are to halt the spread of this terrible epidemic.

Brian Rokus of CNN writes that it can be surprisingly easy to get prescription narcotics that are highly addictive, and they’re highly profitable on the street. But detectives in Louisville, Kentucky, say most of the people they arrest aren’t in it for the money. Instead, they get pills to support their own habit, and police say they have a variety of methods for feeding their addiction.

A former nurse will use her medical training to impersonate a doctor to call in fake prescriptions to a pharmacy and simply go in and pick up her drug of choice. Others use prescription pads stolen from physicians or "doctor shop" by getting legitimate prescriptions from multiple doctors who are unaware of what other drugs their patients are already taking.

Watts sees his job as giving those he arrests a wake-up call. "If I can make this the worst day of her life so that tomorrow she will seek treatment, then I’ve won," he said. 

Kentucky is among the top states in the country for prescription pill abuse, according to the National Survey on Drug Use and Health.

"People think that, well, it’s authorized by my doctor, we can pick it up at any of the local retailers on the corner, and that prescription abuse is not really a problem," Watts said.

The vast majority of those Watts and his fellow detectives arrest start their addiction with legitimate needs for pain medication from something such as a car accident. But then they can’t stop.

That’s what worries physicians such as Dr. David Greene. "We know that narcotics are potentially addictive — we don’t know who might become addicted and who might not," he said.

Greene practices in eastern Kentucky, where he says prescription pill abuse is rampant. "It’s come to the point where there are few people who don’t have someone in their family or know someone who’s had problems with addiction, overdose or abuse," Greene said.

When patients come looking for a prescription for powerful pain medication, doctors like him are forced to determine whether the need is real or whether the patient might be an addict.

"There’s no test for pain," Greene said. "The only thing we have to go on is what they tell us, and I generally believe my patients. But most people who are going to lie to you are much better liars than you are at detecting."

One of those patients who Greene says fooled him was a 79-year-old grandmother who was selling her pills out of her nursing home.

If the patient is an addict, doctors refuse them at their own peril. In December, a man came into Dr. Dennis Sandlin’s rural clinic in Perry County, Kentucky, looking for a prescription. Sandlin demanded that he take a urinalysis test to check for drugs in his system. Later that morning, the patient returned and shot and killed Sandlin.

"My dad was writing in a chart at the nurse’s station. Someone heard my dad say, ‘You don’t want to do this. I take care of a lot of elderly people.’ And he said, ‘well you didn’t help me’ and that’s when he shot him," Sandlin’s daughter Danielle said.

Danielle is now working to raise awareness of the dilemma doctors face in prescribing pain medication. Her father, she said, was rigorous about prescribing pain medication. "He would drug test the pope if he came in asking for something."

Greene has encountered intimidating patients in his clinic as well. "Physical violence is a real fear. We have people who come in who are threatening and abusive," he said. After having one patient impersonate him, Greene no longer calls in controlled substances prescriptions into local pharmacies.

Some doctors, fearing either physical violence or contributing to addiction, have stopped prescribing pain medication altogether. That puts doctors such as Greene, who do prescribe, in a difficult position.

"No matter what you do, you’re going to have an unintended consequence," Greene said. "If you refuse to prescribe, you’ll end up with people suffering. And if you do prescribe, you’ll find patients diverting them, selling them, using them for recreation."

The solutions, police and doctors say, range from electronic prescriptions that would be difficult to forge to a national prescription database that would allow doctors to see what other drugs a pill-seeking patient is already taking.

Danielle Sandlin is pushing for some kind of reform in the wake of her father’s death. "He lost his life for something as silly as a pill."
 

The county is seeing an increase in the illegal handling of prescriptions and prescription medications. Individuals are stealing, fraudulently using and forging prescriptions. Diversion of medications is also growing as individuals seek to use medications for non-medical reasons and beyond the prescribed amount.

Det. Gentry Pinner highlighted the cost of drug diversion and the impact it has on everyone who purchases health insurance. Pinner is a member of the sheriff’s narcotics unit and has been specializing in prescription fraud and illegal drug diversion since 2006.

When claims are made against health insurance that prove to be bogus, health insurance companies lose as much as $72.5 billion a year due to opioid abuse alone. These figures are captured by the Coalition Against Insurance Fraud.

Pinner is hoping the receipt of certain grants will help in his caseload. One grant is part of an education and awareness campaign to slow the growth of prescription medication fraud in the county.

A second grant came from the National Association of Drug Diversion Investigators and was made possible from funds through the Purdue Pharma pharmaceutical corporation.

Prescription forgery is the most common form of fraud battled by detectives, according to Pinner. This forgery often begins at the emergency room or urgent care center. Those seeking to milk the system will change the number of pills prescribed or alter the prescription to be any drug desired.

As such crimes continue to mount, law enforcement everywhere must step up their efforts to stay one step ahead of the criminals or risk fighting a losing battle.