Prescription Drugs
State Monitoring Programs May Help to Reduce Illegal Diversion Gao ID: GAO-04-524T March 4, 2004The increasing diversion of prescription drugs for illegal purposes or abuse is a disturbing trend in the nation's battle against drug abuse. Diversion can include such activities as prescription forgery and "doctor shopping" by individuals who visit numerous physicians to obtain multiple prescriptions. The most frequently diverted prescription drugs are controlled substances that are prone to abuse, addiction, and dependence, such as hydrocodone (the active ingredient in Lortab and many other drugs) and oxycodone (the active ingredient in OxyContin and many other drugs). Some states use prescription drug monitoring programs to control illegal diversion of prescription drugs that are controlled substances. GAO was asked to examine (1) how state monitoring programs compare in terms of their objectives and operation and (2) the impact of state monitoring programs on illegal diversion of prescription drugs. This testimony is based on GAO's report, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion, GAO-02-634 (May 17, 2002). In that report, the programs in Kentucky, Utah, and Nevada were selected for more in-depth study because they were the most recently established programs at the time.
GAO found that the 15 state monitoring programs in place in 2002 differed in their objectives and operation. The programs were intended to facilitate the collection, analysis, and reporting of information about the prescribing, dispensing, and use of controlled substances. They provided data and analysis to state law enforcement and regulatory agencies to assist in identifying and investigating activities potentially related to illegal drug diversion. The programs could be used by physicians to check a patient's prescription drug history to determine if the individual was doctor shopping to seek multiple controlled substances. Some programs also offered educational programs for the public, physicians, and pharmacists regarding the nature and extent of the problem and medical treatment options for abusers of diverted drugs. The programs varied primarily in terms of the specific drugs they covered and the type of state agency in which they were housed. Some programs covered only those prescription drugs that are most prone to abuse and addiction, whereas others provided more extensive coverage. In addition, most programs were administered by a state law enforcement agency, a state department of health, or a state board of pharmacy. GAO also found that state monitoring programs may have realized benefits in their efforts to reduce drug diversion. These included improving the timeliness of law enforcement and regulatory investigations. Each of the three states studied reduced its investigation time by at least 80 percent. In addition, law enforcement officials told GAO that they view the programs as a deterrent to doctor shopping, because potential diverters are aware that any physician from whom they seek a prescription may first examine their prescription drug utilization histories based on monitoring program data. For example, as drug diverters became aware of Kentucky's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states.
GAO-04-524T, Prescription Drugs: State Monitoring Programs May Help to Reduce Illegal Diversion
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Testimony:
Before the Subcommittee on Health, Committee on Energy and Commerce,
House of Representatives:
United States General Accounting Office:
GAO:
For Release on Delivery Expected at 1:00 p.m. EST:
Thursday, March 4, 2004:
Prescription Drugs:
State Monitoring Programs May Help to Reduce Illegal Diversion:
Statement of Marcia Crosse:
Director, Health Care--Public Health and Military Health Care Issues:
GAO-04-524T:
GAO Highlights:
Highlights of GAO-04-524T, a testimony before the Subcommittee on
Health, Committee on Energy and Commerce, House of Representatives
Why GAO Did This Study:
The increasing diversion of prescription drugs for illegal purposes or
abuse is a disturbing trend in the nation‘s battle against drug abuse.
Diversion can include such activities as prescription forgery and
’doctor shopping“ by individuals who visit numerous physicians to
obtain multiple prescriptions. The most frequently diverted
prescription drugs are controlled substances that are prone to abuse,
addiction, and dependence, such as hydrocodone (the active ingredient
in Lortab and many other drugs) and oxycodone (the active ingredient
in OxyContin and many other drugs).
Some states use prescription drug monitoring programs to control
illegal diversion of prescription drugs that are controlled
substances.
GAO was asked to examine
(1) how state monitoring programs compare in terms of their objectives
and operation and
(2) the impact of state monitoring programs on illegal diversion of
prescription drugs.
This testimony is based on GAO‘s report, Prescription Drugs: State
Monitoring Programs Provide Useful Tool to Reduce Diversion,
GAO-02-634 (May 17, 2002). In that report, the programs in Kentucky,
Utah, and Nevada were selected for more in-depth study because they
were the most recently established programs at the time.
What GAO Found:
GAO found that the 15 state monitoring programs in place in 2002
differed in their objectives and operation. The programs were intended
to facilitate the collection, analysis, and reporting of information
about the prescribing, dispensing, and use of controlled substances.
They provided data and analysis to state law enforcement and
regulatory agencies to assist in identifying and investigating
activities potentially related to illegal drug diversion. The programs
could be used by physicians to check a patient‘s prescription drug
history to determine if the individual was doctor shopping to seek
multiple controlled substances. Some programs also offered educational
programs for the public, physicians, and pharmacists regarding the
nature and extent of the problem and medical treatment options for
abusers of diverted drugs. The programs varied primarily in terms of
the specific drugs they covered and the type of state agency in which
they were housed. Some programs covered only those prescription drugs
that are most prone to abuse and addiction, whereas others provided
more extensive coverage. In addition, most programs were administered
by a state law enforcement agency, a state department of health, or a
state board of pharmacy.
GAO also found that state monitoring programs may have realized
benefits in their efforts to reduce drug diversion. These included
improving the timeliness of law enforcement and regulatory
investigations. Each of the three states studied reduced its
investigation time by at least 80 percent. In addition, law
enforcement officials told GAO that they view the programs as a
deterrent to doctor shopping, because potential diverters are aware
that any physician from whom they seek a prescription may first
examine their prescription drug utilization histories based on
monitoring program data. For example, as drug diverters became aware
of Kentucky‘s ability to trace their drug histories, they tended to
move their diversion activities to nearby nonmonitored states.
www.gao.gov/cgi-bin/getrpt?GAO-04-524T.
To view the full product, including the scope and methodology, click
on the link above. For more information, contact Marcia Crosse at
(202) 512-7119.
[End of section]
Mr. Chairman and Members of the Subcommittee:
I am pleased to be here today and thank you for the opportunity to
discuss our work on state prescription drug monitoring programs and
their use in addressing the diversion of prescription drugs for illegal
use.
The increasing diversion of prescription drugs for illegal purposes or
abuse is a disturbing trend in the nation's battle against drug
abuse.[Footnote 1] Diversion activities can include "doctor shopping"
by individuals who visit numerous physicians to obtain multiple
prescriptions, illegal sales of prescription drugs by physicians or
pharmacists, prescription forgery, and purchasing drugs from Internet
pharmacies without valid prescriptions. The most frequently diverted
prescription drugs are controlled substances[Footnote 2] that are prone
to abuse, addiction, and dependence,[Footnote 3] such as hydrocodone
(the active ingredient in Lortab and many other drugs), diazepam
(Valium), methylphenidate (Ritalin), and oxycodone (the active
ingredient in OxyContin and many other drugs). According to the Drug
Enforcement Administration (DEA), increases in the extent of
prescription drug abuse and in emergency room visits related to
prescription drug abuse, as well as an increase in the theft and
illegal resale of prescription drugs, indicate that drug diversion is a
growing problem nationwide.
Some states operate prescription drug monitoring programs as a means to
control the illegal diversion of prescription drugs. My remarks today
will focus on (1) how state monitoring programs compare in terms of
their objectives and operation and (2) the overall impact of state
monitoring programs on illegal diversion of prescription drugs. My
comments are based on our May 2002 report on state monitoring programs
and their usefulness as a tool for reducing diversion.[Footnote 4] For
that report we reviewed information from DEA and the National Alliance
for Model State Drug Laws on the features of existing programs. To gain
a more in-depth understanding of these programs and the challenges they
face, we also studied the programs in Kentucky, Nevada, and Utah. We
selected these three states because at the time they had the most
recently established programs.
In brief, we found that 15 states operated monitoring programs in 2002
as a means to control the illegal diversion of prescription drugs that
are controlled substances.[Footnote 5] Although these programs were all
intended to facilitate the collection, analysis, and reporting of
information about the prescribing, dispensing, and use of controlled
substances, they differed in their objectives and operation. They all
provided data and analysis to state law enforcement and regulatory
agencies in order to assist in identifying and investigating activities
potentially related to the illegal prescribing, dispensing, and
procuring of controlled substances. Further, some programs could be
used by physicians to check a patient's prescription drug history to
determine if the individual may have been doctor shopping to seek
multiple controlled substances. Some programs also offered educational
programs for the public, physicians, and pharmacists regarding the
nature and extent of the problem and medical treatment options for
abusers of diverted drugs. The operation of the monitoring programs
varied primarily in terms of the specific drugs they covered and the
type of state agency in which they were housed. Some programs covered
only those prescription drugs that are most prone to abuse and
addiction, whereas others provided more extensive coverage. In
addition, most programs were administered by a state law enforcement
agency, a state department of health, or a state board of pharmacy.
We found that state monitoring programs realized benefits in their
efforts to reduce drug diversion. These included improving the
timeliness of law enforcement and regulatory investigations. Each of
the three states we studied reduced its investigation time by at least
80 percent. In addition, law enforcement officials told us that they
view the programs as a deterrent to doctor shopping, because potential
diverters are aware that any physician from whom they seek a
prescription may first examine their prescription drug utilization
histories based on monitoring program data. For example, as drug
diverters became aware of Kentucky's ability to trace their drug
histories, they tended to move their diversion activities to nearby
nonmonitored states.
Background:
The diversion and abuse of prescription drugs are associated with
incalculable costs to society in terms of addiction, overdose, death,
and related criminal activities. DEA has stated that the diversion and
abuse of legitimately produced controlled pharmaceuticals constitute a
multibillion-dollar illicit market nationwide. One recent example of
this growing diversion problem concerns the controlled substance
oxycodone, the active ingredient in over 20 prescription drugs,
including OxyContin, Percocet, and Percodan. OxyContin is the number
one prescribed narcotic medication for treating moderate-to-severe pain
in the United States.[Footnote 6] Currently, a single 20-milligram
OxyContin tablet legally selling for about $2 can be sold for as much
as $25 on the illicit market in some parts of Kentucky.
Combating the illegal diversion of prescription drugs while ensuring
that the pharmaceuticals remain available for those with legitimate
medical need involves the efforts of both federal and state government
agencies. The Controlled Substances Act of 1970[Footnote 7] provides
the legal framework for the federal government's oversight of
transactions involving the sale and distribution of controlled
substances at the manufacturer and wholesale distributor levels. The
states address these issues through their regulation of the practice of
medicine and pharmacy.
Controlled Substances Act:
The Controlled Substances Act established a classification structure
for drugs and chemicals used in the manufacture of drugs that are
designated as controlled substances.[Footnote 8] Controlled substances
are classified by DEA into five schedules on the basis of their
medicinal value, potential for abuse, and safety or dependence
liability. Schedule I drugs--including heroin, marijuana, and
hallucinogens such as LSD and PCP--have a high potential for abuse and
no currently accepted medical use. Schedule II drugs--including
methylphenidate (Ritalin) and opiates such as hydrocodone, morphine,
and oxycodone--have a high potential for abuse among drugs with an
accepted medical use and may lead to severe psychological and physical
dependence. Drugs on schedules III through V have accepted medical uses
and successively lower potentials for abuse and dependence. Schedule
III drugs include anabolic steroids, codeine, hydrocodone in
combination with aspirin or acetaminophen, and some barbiturates.
Schedule IV contains such drugs as the antianxiety medications diazepam
(Valium) and alprazolam (Xanax). Schedule V includes preparations such
as cough syrups with codeine. All scheduled drugs except those in
schedule I are legally available to the public with a
prescription.[Footnote 9]
Under the act, DEA provides legitimate handlers of controlled
substances--including manufacturers, distributors, hospitals,
pharmacies, practitioners, and researchers--with registration numbers,
which are used in all transactions involving controlled substances.
Registrants must comply with a series of regulatory requirements
relating to drug security and accountability through the maintenance of
inventories and records. Although all registrants, including
pharmacies, are required to maintain records of controlled substance
transactions, only manufacturers and distributors are required to
report their transactions involving schedule II drugs and schedule III
narcotics, including sales to the retail level, to DEA. The data
provided to DEA are available for use in monitoring the distribution of
controlled substances throughout the United States, in identifying
retail-level registrants that received unusual quantities of controlled
substances, and in investigations of illegal diversions at the
manufacturer and wholesaler levels. Although data are reported to DEA
regarding purchases by pharmacies, the act does not require the
reporting of dispensing information by pharmacies at the patient level
to DEA.
State Regulation of the Practice of Medicine and Pharmacy:
State laws govern the prescribing and dispensing of prescription drugs
by licensed health care professionals. State medical practice laws
generally delegate the responsibility of regulating physicians to state
medical boards, which license physicians and grant them prescribing
privileges.[Footnote 10] In addition, state medical boards investigate
complaints and impose sanctions for violations of the state medical
practice laws. States regulate the practice of pharmacy based on state
pharmacy practice acts and regulations enforced by the state boards of
pharmacy. The state boards of pharmacy are also responsible for
ensuring that pharmacists and pharmacies comply with applicable state
and federal laws and for investigating and disciplining those that fail
to comply. According to the National Association of Boards of Pharmacy,
all state pharmacy laws require that records of prescription drugs
dispensed to patients be maintained and that state pharmacy boards have
access to the prescription records.
State Monitoring Programs Varied in Objectives and Operation:
State prescription drug monitoring programs varied in their objectives
and operation. While all programs were intended to help law enforcement
identify and prevent prescription drug diversion, some programs also
included education objectives to provide information to physicians,
pharmacies, and the public. Program operation also varied across
states, in terms of which drugs were covered and how prescription
information was collected. Which agency, such as a pharmacy board or
public health department, was given responsibility for the program also
varied across states. Additionally, methods for analyzing the data to
detect potential diversion activity differed among state programs.
State monitoring programs are intended to facilitate the collection,
analysis, and reporting of information on the prescribing, dispensing,
and use of prescription drugs within a state. The first state
monitoring program was established in California in 1940, and the
number of programs has grown slowly. We reported that the number of
states with programs has grown from 10 in 1992 to 15 in 2002; the
number of programs stands at 16 in 2004.
We found that state programs varied in their objectives. All states
used monitoring programs primarily to assist law enforcement in
detecting and preventing drug diversion, and but some also used the
programs for educational purposes. Programs assisted law enforcement
authorities both by providing information in response to requests for
assistance on specific investigations and by referring matters to law
enforcement officials when evaluations of program data revealed
atypical prescribing or dispensing patterns that suggested possible
illegal diversion. The programs evaluated prescribing patterns to
identify medical providers who may have been overprescribing and inform
them that their patterns were unusual. They also identified patients
who may have been abusing or diverting prescription drugs and provided
this information to practitioners. For example, the programs in Nevada
and Utah sent letters to physicians containing patient information that
could signal potential diversion activity, including the number and
types of drugs prescribed to the patient during a given time period and
the pharmacies that dispensed the drugs. Monitoring programs have also
been used to educate physicians, pharmacies, and the public about the
existence and extent of diversion, diversion scams, the drugs most
likely to be diverted by individuals, and ways to prevent drug
diversion.
Monitoring programs also differed in operational factors, some of which
have cost implications. These factors included the choice of controlled
substance schedules monitored, approaches to analyzing and using data,
computer programming choices, number and type of staff and contractors,
turnaround times and report transmittal methods, and number and type of
requests for information.
State programs varied in the controlled substances they covered, in
part because of differences in available resources and other state-
specific factors such as level of drug abuse. Two of the states we
studied--Kentucky and Utah--covered schedules II through V. These
states' program officials told us that covering those schedules allowed
them flexibility to respond if drugs on other schedules became targets
for diversion. Most experts agree that covering all controlled
substance schedules prevents drug diverters from avoiding detection by
bypassing schedule II drugs and switching to drugs in other schedules.
States used different approaches to analyze the prescription
information they received. A few states used a proactive approach,
routinely analyzing prescription data collected by the programs to
identify individuals, physicians, or pharmacies that had unusual use,
prescribing, or dispensing patterns that could suggest potential drug
diversion, abuse, or doctor shopping. Trend analyses were shared with
appropriate entities, such as law enforcement, practitioners, and
regulatory and licensing boards. In contrast, most state programs
generally used the prescription data in a reactive manner to respond to
requests for information. These requests may have come from physicians
or from law enforcement or state officials based on leads about
potential instances of diversion. According to state program officials,
most programs operated in a reactive fashion because of the increased
amount of resources required to operate a proactive system.
Some state programs had electronic reporting systems, while others were
paper-based. If data are reported electronically, there are ongoing
computer maintenance and programming choices and their attendant costs.
Similarly, some state programs engaged private contractors to collect
and maintain the data, while others did so in-house. If a private
contractor collects the raw data from dispensers and converts them to a
standardized format, the program pays annual contracting costs for
database maintenance. Kentucky and Nevada privately contracted with the
same company to collect data for their program databases. Utah, in
contrast, collected and maintained drug dispensing data in-house, using
its own software and hardware.
The number and type of staff a state chose to operate its monitoring
program also varied. In 2002, Kentucky's program employed four full-
time and four part-time staff to help ensure the accuracy of its
reports, including a pharmacist-investigator who reviewed each report
before it was sent. Nevada's program operated with one employee because
a private contractor collected the data. In contrast, in 2002 Utah's
program, with three full-time employees and no private contractor, had
one program administrator who collected all dispensing data, converted
them to a standardized format for monitoring, and maintained the
database. The two other staff answered requests.
If the program seeks to provide more timely responses to report
requests, such as same-day responses, the costs involved in returning
the response to the requester may increase. For example, in 2001
Kentucky spent up to $12,000 in 1 month for faxing reports. Monitoring
program officials from Kentucky, Nevada, and Utah told us in 2002 that
they estimated 3-to 4-hour turnaround times for program data requests,
and all mainly used faxing, rather than more costly mailing, to send
reports to requesters. Same-day responses may be preferable for
physicians who want the prescription drug history for a patient being
seen that day and for law enforcement users who need immediate data for
investigations of suspected illegal activity.
As users become more familiar with the benefits of monitoring program
report data, requests for information and other demands on the programs
may increase. In Kentucky, Nevada, and Utah, use had increased
substantially, mostly because of an increase in the number of requests
by physicians to check patients' prescription drug histories. In
Kentucky, these physician requests increased from 28,307 in 2000, the
first full year of operation, to 56,367 in 2001, an increase of nearly
100 percent. Law enforcement requests increased from 4,567 in 2000 to
5,797 in 2001, an increase of 27 percent. Similarly, Nevada's requests
from all authorized users also increased--from 480 in 1997, its first
full year, to 6,896 in 2001, an increase of about 1,300 percent.
Additionally, as drug marketing practices change and monitoring
programs mature, the operational needs may shift as well. For example,
states face new challenges with the advent of Internet pharmacies,
because they enable pharmacies and physicians to anonymously reach
across state borders to prescribe, sell, and dispense prescription
drugs without complying with state requirements.[Footnote 11] In
addition, if users want program reports to reflect more timely
information, dispensing entities would have to report their data at the
time of sale, rather than submitting data biweekly or monthly, to
capture the most recent prescription dispensing. If users want to be
alerted if a certain drug, practitioner, or pharmacy may be involved in
a developing diversion problem, programs would have to initiate
periodic data analysis to determine trends or patterns. Such program
enhancements would entail additional costs, however, including costs
for computer programming, and data analysis.
States that are considering establishing or expanding a monitoring
program face a variety of other challenges. One challenge is the lack
of awareness of the extent to which prescription drug abuse and
diversion is a significant public health and law enforcement problem.
States also face concerns about the confidentiality of the information
gathered by the program, voiced by patients who are legitimately using
prescription drugs and by physicians and pharmacists who are
legitimately prescribing and dispensing them. Another challenge states
face is securing adequate funding to initiate and develop the program
and to maintain and modify it over time.[Footnote 12]
State Monitoring Programs Have Helped Shorten Investigation Times and
May Reduce Illegal Drug Diversion:
We found that states with monitoring programs have experienced
considerable reductions in the time and effort required by law
enforcement and regulatory investigators to explore leads and the
merits of possible drug diversion cases. We also found that the
presence of a monitoring program in a state may help reduce illegal
drug diversion there, but that diversion activities may increase in
contiguous states without programs.
The ability of the programs to focus law enforcement and regulatory
investigators who are working on suspected drug diversion cases on
specific physicians, pharmacies, and patients who may be involved in
the alleged activities is crucial to shortened investigation time and
improvements in productivity. States that do not have programs must
rely on tips from patients, practitioners, or law enforcement
authorities to identify possible prescription drug abuse and diversion.
Following up on these leads requires a lengthy, labor-intensive
investigation. In contrast, the programs can provide information that
allows investigators to pinpoint the physicians' offices and pharmacies
where drug records must be reviewed to verify suspected diversion and
thus can eliminate the need to search records at physicians' offices
and pharmacies that have no connection to a case.
In each of the three states we studied, state monitoring programs led
to reductions in investigation times. For example, prior to
implementation of Kentucky's monitoring program, its state drug control
investigators took an average of 156 days to complete the investigation
of alleged doctor shoppers. Following the implementation, the average
investigation time dropped to 16 days, or a 90 percent reduction in
investigation time. Similarly, Nevada reduced its investigation time
from about 120 days to about 20 days, a reduction of 83 percent, and a
Utah official told us that it experienced an 80 percent reduction in
investigation time.
Officials from Kentucky, Nevada, and Utah told us in 2002 that their
programs may have helped reduce the unwarranted prescribing and
subsequent diversion of abused drugs in their states. In both Kentucky
and Nevada, an increased number of program reports were being used by
physicians to check the prescription drug use histories of current and
prospective patients when deciding whether to prescribe certain drugs
that are subject to abuse. Law enforcement officials told us that they
view these drug history checks as initial deterrents--a front-line
defense--to prevent individuals from visiting multiple physicians to
obtain prescriptions, because patients are aware that physicians can
review their prescription drug history. For an individual who may be
seeking multiple controlled substance prescriptions, the check allows a
physician to analyze the prescription drug history to determine whether
drug treatment appears questionable, and if so, to verify it with the
listed physicians. In Kentucky, a physician could request a drug
history report on the same day as the patient's appointment, and
usually received the report within 4 hours of the request. In 2002,
Kentucky's program typically received about 400 physician requests
daily, and provided data current to the most recent 2 to 4 weeks.
The presence of a monitoring program may also have an impact on the
prescribing of drugs more likely to be diverted. For example, DEA
ranked all states for 2000 by the number of OxyContin prescriptions per
100,000 people.[Footnote 13] Eight of the 10 states with the highest
numbers of prescriptions--West Virginia, Alaska, Delaware, New
Hampshire, Florida, Pennsylvania, Maine, and Connecticut--had no
monitoring programs, and only 2 did--Kentucky and Rhode Island. Six of
the 10 states with the lowest numbers of prescriptions--Michigan, New
Mexico,[Footnote 14] Texas, New York, Illinois, and California--had
programs, and 4--Kansas, Minnesota, Iowa, and South Dakota--did not.
Another indication of the effectiveness of a monitoring program is that
its existence in one state appears to increase drug diversion
activities in contiguous states without programs. When states begin to
monitor drugs, drug diversion activities tend to spill across
boundaries to states without programs. One example is provided by
Kentucky, which shares a boundary with seven states, only two of which
had programs in 2002--Indiana and Illinois. As drug diverters became
aware of the Kentucky program's ability to trace their drug histories,
they tended to move their diversion activities to nearby nonmonitored
states. OxyContin diversion problems worsened in Tennessee, West
Virginia, and Virginia--all contiguous states without programs--
because of the presence of Kentucky's program, according to a 2001
joint federal, state, and local drug diversion report.[Footnote 15]
Concluding Observations:
Although monitoring programs can enhance the ability of states to
detect and deter illegal diversion of prescription drugs, the number of
states with such programs has grown only slightly over the past 12
years from 10 in 1992 to 16 in 2004. A lack of awareness of the
magnitude of the problem; concerns about confidentiality on the part of
patients, physicians, pharmacists, and legislators; and difficulty in
accessing funding have kept the numbers of monitoring programs low.
Cooperative efforts at the state and national levels are seeking to
overcome these challenges and increase the number of states with
programs.
Mr. Chairman, this concludes my prepared statement. I would be pleased
to respond to any questions you or other Members of the Subcommittee
may have.
Contact and Acknowledgments:
For more information regarding this testimony, please contact Marcia
Crosse at (202) 512-7119. Individuals making key contributions to this
testimony include Martin T. Gahart, Roseanne Price, and Opal
Winebrenner.
FOOTNOTES
[1] Office of Drug Control Policy, "U.S. Drug Prevention, Treatment,
Enforcement Agencies Take on 'Doctor Shoppers', 'Pill Mills'," Mar. 1,
2004, www.whitehousedrugpolicy.gov (downloaded Mar. 2, 2004).
[2] Under the Controlled Substances Act, which was enacted in 1970,
drugs are classified as controlled substances and placed into one of
five schedules based on their medicinal value, potential for abuse, and
safety or dependence liability.
[3] According to the National Institute on Drug Abuse, addiction is a
chronic, relapsing disease, characterized by compulsive drug seeking
and use and by neurochemical and molecular changes in the brain,
whereas physical dependence is an adaptive physiological state that can
occur with regular drug use and results in withdrawal symptoms when
drug use is discontinued.
[4] For more details on these programs, see U.S. General Accounting
Office, Prescription Drugs: State Monitoring Programs Provide Useful
Tool to Reduce Diversion, GAO-02-634 (Washington, D.C.: May 17, 2002).
[5] The 15 states were California, Hawaii, Idaho, Illinois, Indiana,
Kentucky, Massachusetts, Michigan, Nevada, New York, Oklahoma, Rhode
Island, Texas, Utah, and Washington. In 1998, West Virginia terminated
its monitoring program, but began operating a program again in 2003,
bringing the total of state programs to 16. In addition, Virginia began
operating a pilot program in the southwestern part of the state in fall
2003.
[6] U.S. General Accounting Office, Prescription Drugs: OxyContin
Abuse and Diversion and Efforts to Address the Problem, GAO-04-110
(Washington, D.C.: Dec. 23, 2003).
[7] Title II of the Comprehensive Drug Abuse Prevention and Control
Act of 1970 (Pub. L. No. 91-513, §§100 et seq., 84 Stat. 1236, 1242 et
seq.).
[8] Section 201, classified to 21 U.S.C. § 811.
[9] Some schedule V drugs that contain limited quantities of certain
narcotic and stimulant drugs are available over the counter without a
prescription.
[10] The types of practitioners who prescribe drugs and may be
monitored by a state program vary among states. Physicians are the
majority of covered practitioners, but in most states many
nonphysicians who also have prescribing authority may be covered,
including physician assistants, dentists, optometrists, podiatrists,
veterinarians, and certain types of nurses, such as nurse
practitioners and advanced practice nurses.
[11] For more details on Internet pharmacies, see U.S. General
Accounting Office, Internet Pharmacies: Adding Disclosure Requirements
Would Aid State and Federal Oversight, GAO-01-69 (Washington, D.C.:
Oct. 19, 2000).
[12] Federal grants are available to states to establish new
monitoring programs and to enhance existing programs under the Harold
Rogers Prescription Drug Monitoring Program. DEA's Office of Diversion
Control, in collaboration with the Department of Justice's Bureau of
Justice Assistance, provides grants to states to establish new programs
and to enhance existing monitoring programs through the Harold Rogers
Prescription Drug Monitoring Program. The fiscal year 2003 grantees are
Alabama, Florida, Maine, New Mexico, and Wyoming for new programs, and
California, Idaho, Nevada, and New York for enhanced programs. The
grantees in fiscal year 2002 were Ohio, Pennsylvania, Virginia, and
West Virginia for new programs, and California, Kentucky,
Massachusetts, Nevada, and Utah for enhanced programs.
[13] OxyContin, Hearings Before the Subcommittee on the Departments of
Commerce, Justice, and State, the Judiciary, and Related Agencies,
House Committee on Appropriations, 107th Cong. Part 10., pp. 21, 22
(2001) (Statement of Asa Hutchinson, Administrator of the Drug
Enforcement Administration).
[14] New Mexico's monitoring program was terminated in June 2000.
[15] Appalachia High Intensity Drug Trafficking Area Investigative
Support Center, with the assistance of the National Drug Intelligence
Center, The OxyContin Threat in Appalachia (London, Ky.: Aug. 2001).
