New Research Shows Significant Decrease in Street Value of Oxycontin

The street value of the opioid painkiller OxyContin has decreased significantly since the drug was reformulated in 2010 to deter drug abuse, injection and overdose, according to a recent study reported by Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System. With a mean street value of 66 cents per milligram, the street price of the reformulated, abuse-deterrent version is 34 percent lower than that of the original OxyContin, valued at $1 per milligram. The original formulation is crushable and allows an abuser to snort and inject easily.

http://finance.yahoo.com/news/research-shows-significant-decrease-street-130000526.html

Source: Finance.Yahoo.com – September 9, 2013

Blog: Street-Obtained Buprenorphine: Drug of Abuse, or Proof of Limited Access?

for sale sign“In a recent article from the journal Addictive Behaviors, researchers discovered that buprenorphine was rarely, if ever, used by IV drug users to get high. In fact, the vast majority of people who reported acquiring the medication from an illicit source did so with the expressed purpose of avoiding withdrawal symptoms. This seems to contradict the common misconception that heroin users “get high” on Suboxone, therefore we should promote abstinence-based treatment. To the contrary, studies like this one could be interpreted as evidence there is not enough access to these medications – if there were, people wouldn’t be forced to seek the drugs from street dealers or friends.”

The table on the Knowledge and Use of Buprenorphine among 602 Injection Drug Users in Baltimore, Maryland can be accessed at: http://mattsub.blogspot.com/2013/08/street-obtained-buprenorphine-drug-of.html

The article abstract is available at: http://www.sciencedirect.com/science/article/pii/S0306460313002232

Source: – Substance Matters: Science and Addiction – August 24, 2013

Drug Abuse Treatment Could Save Billions in Criminal Justice Costs

Sending drug abusers to community-based treatment programs rather than prison could help reduce crime and save the criminal justice system billions of dollars, according to a new study by researchers at RTI International and Temple University.

Nearly half of all state prisoners are drug abusers or drug dependent, but only 10 percent receive medically based drug treatment during incarceration. Untreated or inadequately treated inmates are more likely to resume using drugs when released from prison, and commit crimes at a higher rate than non-abusers.

The study, published online in November in Crime & Delinquency, found that diverting substance-abusing state prisoners to community-based treatment programs rather than prison could reduce crime rates and save the criminal justice system billions of dollars relative to current levels. The savings are driven by immediate reductions in the cost of incarceration and by subsequent reductions in the number of crimes committed by successfully-treated diverted offenders, which leads to fewer re-arrests and re-incarcerations. The criminal justice costs savings account for the extra cost of treating diverted offenders in the community.

The findings were based on a lifetime simulation model of a cohort of 1.14 million state prisoners representing the 2004 U.S. state prison population. The model accounts for substance abuse as a chronic disease, estimates the benefits of treatment over individuals’ lifetimes, and calculates the crime and criminal justice costs related to policing, trial and sentencing, and incarceration.

The researchers used the model to track the individuals’ substance abuse, criminal activity, employment and health care use until death or up to and including age 60, whichever came first. They also estimated the benefits and costs of sending 10 percent or 40 percent of drug abusers to community-based substance abuse treatment as an alternative to prison.

According to the model, if just 10 percent of eligible offenders were sent to community-based treatment programs rather than prison, the criminal justice system would save $4.8 billion when compared to current practices. Diverting 40 percent of eligible offenders would save $12.9 billion.

The authors also address a concern common with diversion programs, which is that instead of being incarcerated, offenders are released into the community where they may commit additional crimes. Their analysis showed an immediate, short-lived increase in crimes, however, by the end of the first year, fewer crimes were committed, generating cost savings.

The study builds on previous research led by RTI indicating that increased investment in treatment for substance-abusing prisoners can reduce crime rates and cut criminal justice spending. In a study released earlier this year, Zarkin and colleagues found that increasing and improving prison-based drug treatment programs could save up to $17 billion in criminal justice system costs.

http://www.newswise.com/articles/study-replacing-prison-terms-with-drug-abuse-treatment-could-save-billions-in-criminal-justice-costs

Source: RTI International – January 9, 2013

NYPD Will Implant GPS Chips Into Pill Bottles To Combat Prescription Drug Abuse

“In an effort to curb the growing epidemic of Americans abusing prescription drugs, the New York Police Department will begin asking pharmacies in the city to mix in so-called “bait bottles” containing GPS locator chips into their stocks of prescription drug medications, CBS News reports. Police hope that putting locator chips in some medication bottles will allow them to effectively track stolen bottles and uncover large-scale prescription drug stash houses.”

http://thinkprogress.org/health/2013/01/15/1448561/prescription-drug-gps-chips/

Source: ThinkProgress.org – January 15, 2013

One-Half of Buprenorphine-Related Emergency Department Visits for Nonmedical Use

Slightly more than one-half (52%) of the estimated 30,135 buprenorphine-related emergency department visits in the U.S. in 2010 were for nonmedical use of the drug, according to data from the Drug Abuse Warning Network (DAWN). Approximately one-fourth of these visits, in which buprenorphine was involved as either a direct cause or a contributing factor, were related to seeking detoxification and 13% were for adverse reactions. The estimated number of emergency department visits related to the nonmedical use of buprenorphine has more than tripled since 2006 (see CESAR FAX, Volume 21, Issue 31).

Types of U.S. Buprenorphine-Related Emergency Department Visits, 2010

(N=30,135)

NOTES:  Nonmedical use of buprenorphine includes taking more than the prescribed dose; taking buprenorphine prescribed for another individual; deliberate poisoning with buprenorphine by another person; and documented misuse or abuse of buprenorphine. Adverse reaction includes visits related to adverse reactions, side effects, drug-drug interactions, and drug-alcohol interactions resulting from using buprenorphine for therapeutic purposes. Seeking detox includes patients seeking substance abuse treatment, drug rehabilitation, or medical clearance for admission to a drug treatment or detoxification unit. Accidental ingestion includes childhood drug poisonings, individuals who take the wrong medication by mistake, and a caregiver administering the wrong medicine by mistake. It does not include a patient taking more medicine than directed because the patient forgot to take it earlier. Suicide includes visits for overdoses, as well as suicide attempts by other means if drugs were involved or related to the suicide attempt.

*The number of buprenorphine-related ED visits categorized as accidental ingestion and as suicide attempts did not meet DAWN’s standards of precision (i.e., the estimate had a standard of error greater than 50% or the unweighted count or estimate was less than 30).  For this analysis, the two categories were combined and the percentage derived from the difference remaining after accounting for the categories that were known. Percentages do not sum to 100 due to rounding.

Adapted by CESAR from data from the Substance Abuse and Mental Health Services Administration (SAMHSA), Drug Abuse Warning Network, 2010: Selected Tables of National Estimates of Drug-Related Emergency Department Visits.

Source:  Cesar Fax, Vol. 21, Issue 47, November 26, 2012

Federal Government Tests New PDMP Projects in Indiana and Ohio

A new pilot program launched by the federal Department of Health and Human Services (HHS) will make prescription drug data available to prescribers and pharmacists in both ambulatory and emergency departments in Indiana and Ohio. The pilot projects, which will be run by the Office of the National Coordinator for Health Information Technology (ONC), will measure how expanding prescription drug monitoring programs (PDMPs), as the government refers to them, will help reduce prescription drug abuse.

Farzad Mostashari, MD, national coordinator for Health Information Technology (Health IT), said that the pilot projects will help emergency department staff identify a patient’s controlled substance history “at the point of care, to enable better targeting appropriate treatments and reduce the potential of an overdose, or even death.”

“Technology plays a critical role in our comprehensive efforts to address our nation’s prescription drug abuse epidemic,” said Gil Kerlikowske, director of The Office of National Drug Control Policy (ONDCP), in a press statement issued June 21 as the programs were launched. “We hope these innovative pilots will help usher in an era of ‘PDMPs 2.0’ across the nation,” he said. The goals are to improve real-time data sharing, increase interoperability among states, and increase the number of people using PDMPs.

http://www.govhealthit.com/news/onc-tests-health-it-reduce-prescription-drug-abuse

WVU Study Finds Link Between ‘Doctor Shopping,’ Overdose Deaths

 A published study conducted by researchers at West Virginia University (WVU) has found that doctor and pharmacy shoppers are at a greater risk for drug-related death.

Marie Abate, Phar.D., professor in the WVU School of Pharmacy and faculty affiliate with the WVU Injury Control Research Center, was part of a team of researchers who explored prescription and drug-related death data to determine how many subjects visited multiple doctors and pharmacies to obtain medications.

The study examined information from the West Virginia Controlled Substance Monitoring Program (WV CSMP) and drug-related death data compiled by the Forensic Drug Database from July 2005 through December 2007. Of the more than one million subjects 18 years and older, 698 were categorized as deceased. Doctor shoppers accounted for about 25 percent of deceased subjects, while nearly 17.5 percent of the deceased were pharmacy shoppers.

In addition, approximately 20 percent of doctor shoppers were also pharmacy shoppers, and 55.6 percent of pharmacy shoppers were doctor shoppers. Younger age and greater number of prescriptions dispensed also contributed to having greater odds of drug-related death.

The article reporting this research, “Doctor and Pharmacy Shopping for Controlled Substances,” appeared in the June 2012 issue of “Medical Care.” It concludes that prescription monitoring programs may be useful in identifying potential shoppers at the point of care.

The press release is available at: http://wvuhealthcare.com/wvuh/Content/Media/News-Releases/2012/SEPTEMBER/WVU-study-finds-doctor-and-pharmacy-shopping-are-l

Source: West Virginia University – September 6, 2012

Congressional Research Service Report on Prescription Drug Monitoring Programs

The Congressional Research Service has created a report for Congress on Prescription Drug Monitoring Programs (PDMPs).  The report issued in July provides an overview of prescription drug abuse, overview of current PDMPs, PDMP effectiveness, Federal grant programs for PDMPs, and information on some key policy issues such as balancing stakeholder concerns.

The available evidence suggests that PDMPs are effective in reducing the time required for drug diversion investigations, changing prescribing behavior, reducing “doctor shopping,” and reducing prescription drug abuse; however, research on the effectiveness of PDMPs is limited.

Assessments of effectiveness may take into consideration potential unintended consequences of PDMPs, such as limiting access to medications for legitimate use or pushing drug diversion activities over the border into a neighboring state. Experts suggest that PDMP effectiveness might be improved by increasing the timeliness, completeness, consistency, and accessibility of the data.

The report can be found online at:  http://www.fas.org/sgp/crs/misc/R42593.pdf

Source: Congressional Research Service – July 11, 2012

Majority of Buprenorphine-Certified Physicians Think Buprenorphine Is Easier to Get Illegally Than Methadone

Physicians who are certified to prescribe buprenorphine are increasingly likely to perceive diversion and abuse of the drug, according to a survey funded by the manufacturer as part of a national post-marketing surveillance program*. Nearly one-half (46%) of physicians certified to prescribe buprenorphine in 2009 knew of buprenorphine products being bought or sold on the street, compared to 27% in 2005. In addition, a majority (81%) of the physicians surveyed believed that buprenorphine was easier than methadone to buy on the street in their community in 2009, a 56% increase from 2005 (see figure).

Forty-four percent reported that they knew someone who used illegal buprenorphine/naloxone to manage opioid withdrawal, 34% for maintenance until entering treatment, 17% to try out its effect, and 7% to get high (data not shown). The authors suggest that “the increase in diversion may be driven by the increase in abuse” as evidenced by the increasing percentage of treatment applicants who said they knew of buprenorphine being used to get high (from 5% in 2005 to 21% in 2009; see CESAR FAX, Volume 21, Issue 25). However, the increase in diversion may also “be driven by therapeutic demand, suggesting treatment expansion may be necessary. Finding a balance between diversion and abuse of a medication versus expanded treatment remains a challenge”.

Perceptions of Buprenorphine Diversion/Misuse, Physicians Federally Certified
to Prescribe Buprenorphine
(n=8,194 from 2005 to 2009)

*Conducted by an independent contractor for Reckitt Benckiser Pharmaceuticals, the Surveillance of Diversion and Abuse of Therapeutic Agents (SODATA) utilizes several national indicators of diversion and abuse combined with a survey of applicants to substance abuse treatment programs and a survey of CSAT-certified physicians. A total of 8,194 quarterly surveys were conducted with randomly-selected physicians federally-certified to prescribe buprenorphine from 2005 to 2009.

See Wish, ED, Artigiani, E, Billing, A, Hauser, W, Hemberg, J, Shiplet, M, and DuPont, R, “The Emerging Buprenorphine Epidemic in the United States,” Journal of Addictive Diseases 31(1):3-7, 2012 for more information on buprenorphine diversion and abuse.

Source: Adapted by CESAR from Johanson, C-E; Arfken, C. L.; di Menza, S.; and Schuster, C. R., “Diversion and Abuse of Buprenorphine: Findings from National Surveys of Treatment Patients and Physicians,” Journal of Drug and Alcohol Dependence 120:190-195, 2012. For more information, contact Chris-Ellyn Johanson at cjohans@med.wayne.edu.

Kentucky – Prescription Drug Abuse Bill Making Its Mark Just Days After Going Into Effect, Officials Say

prescription drugsDays after a landmark prescription drug abuse law took effect, the law appears to have already effected changes in the medical field and positioned Kentucky as a leader in battling prescription drug abuse.

“The enforcement of this bill began just a couple of days ago, and yet we already know that four ‘pain management clinics’ in Kentucky have waved the white flag and notified us they will shut their doors,” said Gov. Steve Beshear, who joined Attorney General Jack Conway, lawmakers and medical providers in hailing the law’s impact.

House Bill 1, sponsored by House Speaker Greg Stumbo, passed in a special legislative session this spring. The bill included multiple elements to prevent the abuse and diversion  of prescription drugs and to enhance law enforcement’s tools to investigate illegal prescribing practices.

“We know that more than 9,000 medical providers have signed up for electronic prescription monitoring just since this law passed in April – more than doubling the number registered.

http://www.kyforward.com/2012/07/prescription-drug-abuse-bill-making-its-mark-just-days-after-going-into-effect-officials-say/

Source: KYForward.com – July 25, 2012

U.S. Treatment Applicants Report Buprenorphine/Naloxone Sold on Street; One-Fifth Report the Drug Is Used to Get High

“Diversion and abuse of buprenorphine/naloxone have steadily increased since 2005 through 2009,” according to data from a national post-marketing surveillance program* funded by the manufacturer. One of the indicators of diversion and abuse utilized by the surveillance program is a survey of nearly 19,000 applicants to 86 substance abuse treatment programs in 30 states.

Both the percentage of applicants who reported knowing that buprenorphine/naloxone, which has been approved for opioid therapy since 2002, was sold on the street and those that reported knowing that the drug was used to get high increased from 2005 to 2009, reaching 33% and 21%, respectively. In comparison, the percentage who reported that methadone, which has been used since the 1950s for opioid therapy, was sold on the street or used to get high has remained relatively stable over the past three years (see figure below). The authors note that “the increases in diversion and abuse measures indicate the need to take active attempts to curb diversion and abuse as well as continuous monitoring and surveillance of all buprenorphine products.”

Percentage of Applicants to U.S. Treatment Programs Who Knew of
Methadone and Buprenorphine/Naloxone Being Sold on the Street or Being Used to Get High, 2005-2009
(n=18,956 from 2005 to 2009)

*Conducted for Reckitt Benckiser Pharmaceuticals by an independent contractor, the Surveillance of Diversion and Abuse of Therapeutic Agents (SODATA) utilizes several national indicators of diversion and abuse combined with a survey of applicants to substance abuse treatment programs and a survey of CSAT-certified physicians.

**Surveys were conducted at 86 treatment programs (both providing and not providing pharmacotherapy) from 30 states providing a total of 18,956 completed surveys from 2005 to 2009. While the treatment applicant survey was not a probability sample, the demographic characteristics of the applicant sample were similar to that of the national census of publicly-funded treatment admissions. The applicant survey does not estimate either the incidence or the prevalence of diversion/abuse, but it is an indication of changes in perception of diversion/abuse among a population likely to be knowledgeable about illegal markets through their own experiences, that of others, and direct observations.

See Wish, ED, Artigiani, E, Billing, A, Hauser, W, Hemberg, J, Shiplet, M, and DuPont, R, “The Emerging Buprenorphine Epidemic in the United States,” Journal of Addictive Diseases 31(1):3-7, 2012 for more information on buprenorphine diversion and abuse.

Source: Cesar Fax – June 25, 2012

Study Describes Illicit Use of Buprenorphine Among Nonmedical Users of Opioids in Ohio

“Our study clearly indicates that non-medical use of buprenorphine has found a niche in the streets among illicit users of pharmaceutical opioids” (p. 206).

While buprenorphine misuse has been reported in many states, most studies have focused on opioid-dependent individuals, heroin users, and/or those in treatment. For example, an Ohio study of treatment providers, law enforcement officials, and drug users recruited through treatment programs found evidence of increasing buprenorphine misuse (see CESAR FAX, Volume 21, Issue 2). New research in Ohio now provides evidence of illicit use of buprenorphine among a population not previously studied—young adults not involved with heroin or injection drug use nor dependent on pharmaceutical opioids. Following are findings from this community-recruited sample* of young adults from the Columbus, Ohio area:

Knowledge About Buprenorphine: The majority of users reported that when they were first introduced to buprenorphine they had limited knowledge about the drug. Some had no idea it was used to treat opioid dependence and were told that it would work like any other pain pill.

Street Availability: While the majority of respondents reported that buprenorphine was more difficult to obtain than more commonly used prescription opioids (such as oxycodone or hydrocodone), several respondents reported that they felt the popularity of and demand for buprenorphine has been rising. Friends or acquaintances who were addicted to prescription opioids or heroin and networks of users with legitimate prescriptions were the most common sources of illicitly used buprenorphine. In fact, some users “expressed a belief that buprenorphine doses prescribed by physicians were too high for most patients who needed much lower amounts to control their withdrawal symptoms” (p. 205).

Use to Get High: While approximately one-half said that they took buprenorphine to get high, the reported effects ranged from no effect to too intense. Those who used buprenorphine to get high typically used it on very few occasions, either because the street availability was limited or they did not get the euphoric effects they expected or wanted. Some believed that you need to inhale buprenorphine and/or have a low tolerance to opiates to get high.

Use to Self-Medicate: About one-half reported using buprenorphine to self-medicate withdrawal symptoms*, using the drug regularly to replace their preferred opiates, to reduce their illicit pain pill use, or to quit altogether. Self-medication was preferred to going to a substance abuse treatment program because of the high cost of buprenorphine-based treatment at primary care, waiting lists at publicly-funded facilities, and the stigma related to seeking drug treatment.

*A total of 396 nonmedical users of pharmaceutical opioids ages 18-23 years old who were living in the Columbus, Ohio area were recruited using respondent-driven sampling. Participants had to 1) self-report the nonmedical use of prescription opioids at least 5 times in the  past 90 days; 2) have no lifetime dependence on opioids; 3) have no history of heroin or injection drug use; 4) not have been in formal treatment in the last 30 days; 5) intend to use again nonmedically; and 6) not currently be awaiting trial or have pending criminal charges. Quantitative data were collected on all participants, qualitative data was collected on a subset of 51 individuals, and 20 of these were also interviewed 12-18 months after baseline.

Source: Adapted by CESAR from Daniulaityte, R., Falck, R., and Carlson, R.G., “Illicit Use of Buprenorphine in a Community Sample of Young Adult Non-Medical Users of Pharmaceutical Opioids,” Drug and Alcohol Dependence 122(3):201-207, 2012. For more information, contact Raminta Daniulaityte at raminta.daniulaityte@wright.edu. – April 30, 2012

Buprenorphine Now More Likely than Methadone to Be Found in U.S. Law Enforcement Drug Seizures

Buprenorphine is now more likely than methadone to be found in law enforcement drug seizures that are submitted to and analyzed by forensic laboratories across the country, according to data from the National Forensic Laboratory Information System (NFLIS). NFLIS monitors illicit drug abuse and trafficking, including the diversion of legally manufactured pharmaceuticals into illegal markets. From 2003 to 2009, the number of methadone reports increased gradually, reaching a peak of 10,016 in 2009, and then decreased slightly to 9,477 in 2010. In contrast, the number of buprenorphine reports has increased dramatically, from 90 in 2003, to 10,537 in 2010.

Regardless of whether diverted buprenorphine is being used nonmedically to self-treat opiate addiction or to get high, unsupervised use of diverted buprenorphine places users at serious risk for potential adverse health effects, especially when taken in combination with other opioids or with depressants such as sedatives, tranquilizers, or alcohol.

Estimated # of Total Methadone and Buprenorphine Reports U.S. Law Enforcement-Seized Drug Exhibits Analyzed by Forensic Laboratories,2003-2010 

Notes: Estimates are calculated using the National Estimates Based on All Reports (NEAR) methodology (see www.nflis.deadiversion.usdoj.gov/Reports.aspx). Annual data are based on drugs submitted to laboratories during the calendar year and analyzed within three months of the end of the calendar year. Up to three drugs can be reported for each drug item or exhibit analyzed by a laboratory. State and local policies related to the enforcement and prosecution of specific drugs may affect drug evidence submissions to laboratories for analysis. Laboratory policies and procedures for handling drug evidence may also vary. For example, some analyze all evidence submitted, while others analyze only selected items.

Sources: Cesar Fax – April 2, 2012. Adapted by CESAR from data provided by the U.S. Drug Enforcement Administration (DEA), Office of Diversion Control, Drug and Chemical Evaluation Section, Data Analysis Unit on 3/21/2012.

New Prison Drug Test for Suboxone Has Smugglers Scrambling

drug testInmates in the county correctional facility in Doylestown, Pennsylvania have always been subject to random drug tests, especially inmates with work release privileges who leave the jail to go to their jobs. But those tests didn’t pick up every illicit substance, including Suboxone.

Prisoners knew the drug was undetectable, said Director of Corrections William Plantier, and were cashing in, charging $20 to $30 a dose on the prison black market. Beginning in January, the facility will start using a new test that screens for 13 drugs, including Suboxone.

http://www.phillyburbs.com/news/local/courier_times_news/new-prison-drug-test-has-smugglers-scrambling/article_1f4bb717-8119-569a-86e4-b5a97deaac34.html

Source: www.PhillyBurbs.com – December 15, 2011

New OxyContin Has Lower Street Price Than Old Crushable Formulation


The new harder to crush version of OxyContin has a lower street price than the original, according to research revealed at a conference of law enforcement officers November 15. A new formulation of the opioid pain reliever OxyContin was launched in 2010, accompanied by hope that it would deter drug abuse, injection and overdose. A year later, researchers have shown that the new formulation sells for 28% less than the original OxyContin on the black market, using street price data from the RADARS® System StreetRx.com. The price per milligram of the new difficult to crush OxyContin is $0.56, compared to $0.78 for the original during the first half of this year. Similar results were seen in a survey of law enforcement officers from the RADARS System Drug Diversion program.

http://www.marketwatch.com/story/new-oxycontin-has-lower-street-price-than-old-crushable-formulation-2011-11-15

Source: RADARS System StreetRx.com – November 15, 2011

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