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 Post subject: Diversion stat
PostPosted: Sat Sep 28, 2013 10:31 am 
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I finished Dr Junig's book (excellent and highly recommended and on kindle!). Now I'm reading one by James Schaller and in it is this statistic: ". . . DEA reports 90% of diverted street pain medications come from sources other than physician prescriptions e.g, pharmacy theft."
Well, I'll be damned. I'm sure most of you already knew this, but I'm new to the whole addiction education thing. This blew me away.

So, this begs the question- why are physicians having to jump through ridiculous hoops to adequately treat true pain patients? Sounds to me like focus should be on other sources" and the fox in the henhouse.

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 Post subject: Re: Diversion stat
PostPosted: Sat Sep 28, 2013 2:16 pm 
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So where does it say they come from? I'm guessing that kids/relatives steal them from their parents/relatives. Unless that counts as a physician script.

Care to clarify?

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 Post subject: Re: Diversion stat
PostPosted: Sat Sep 28, 2013 3:48 pm 
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Well, that's kind of my question. The author alluded to the fact that pharmacies were the major source. Which means techs and pharmacists I assume?

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 Post subject: Re: Diversion stat
PostPosted: Sat Sep 28, 2013 3:50 pm 
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Or pharmacy "hold ups" maybe? Factory theft? Mail theft?
I mean how many other access points are there besides prescription?

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 Post subject: Re: Diversion stat
PostPosted: Sat Sep 28, 2013 5:29 pm 
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Dr J's book is a must read imo...so much good in there.
also, in the 5 years i was a pillhead, all of my drugs came from people who sold there own scrips. I was amazed i found so many. It was like clockwork all month loug....man, glad thats over.
Same with Subs on the street. At least in my town..
my 2 cents...raz.....


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 Post subject: Re: Diversion stat
PostPosted: Sat Sep 28, 2013 7:35 pm 
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You nailed it razor. So many times I've heard people in my clinic "class" say that they got their meds on the 4th and 18th monthly.... But it didn't come from them lol.

It's crazy how many people go see a doctor for pain or sub that don't even need or take it! Thats why I'm glad (at least at mine) that my clinic is a Little more intensive and some accountability.

Illegal Rx drugs are going to get so expensive over time due to possible "cracking down". Even suboxone has doubled in price according to new addicts in my group in like a year.

So. I think there needs to be more accountability in pain/sub clinics to force out most diversion. Not just random drug screening and lightly requiring NA meetings. But. Questions from the doctor. What are you doing in recovery these days? Ect. How is your level of pain these days? Ect. I guess this is more for sub docs but around here some are both. The only thing that finally worked for me and many others (not just young folks) was being held accountable. Not just for actions but for words. If I told the doctor that I went to 6 meetings, he asked me what we talked about. If I said I have been working really hard on my recovery lately, he asked for fine details. So. Basically calling bs when needed. Lol. That is what I see a lack of these days around my way. When asked people spew out their rehearsed statement about how number 2 helped them so much. (meaning step two). But never say what the step was, have never been to a meeting, don't have a sponsor, and have no idea what they just said because they read it online on their phone before walking into the room. The doctor pats them on the back and praises all their great efforts... Knowing how full of shit they are. So. Being blunt doctors would help a lot of people tremendously and weed out a lot of possible diversion IMHO.

Sorry for rambling but Thats something that I wish we still had more of. The one woman that would legit tell you straight up that you were full of shit in so many ways or words... Has retired and now nobody has filled the bad cop shoes. Lol.

That is all.

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 Post subject: Re: Diversion stat
PostPosted: Sun Sep 29, 2013 2:17 pm 
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Oh I'm right there with you Movie Maker. I just didn't understand what this DEA statistic meant. It seems to contrast what I've seen in real life.

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 Post subject: Re: Diversion stat
PostPosted: Sun Sep 29, 2013 2:22 pm 
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razor53 wrote:
Dr J's book is a must read imo...so much good in there.
also, in the 5 years i was a pillhead, all of my drugs came from people who sold there own scrips. I was amazed i found so many. It was like clockwork all month loug....man, glad thats over.
Same with Subs on the street. At least in my town..
my 2 cents...raz.....


Exactly! That's what I saw more than anything. People selling their script. But this would still fall under the umbrella of "diversion through physician prescription". And that makes up only 10% of diversion? What am I missing here when trying to understand this 90% thing?

THe author writes: The DEA and Media-addicted district attorneys like to portray pain medicine on the street as coming from physicians, but this is false and has ended medical pain care and increased suicides due to pain. Here is a source he cites: the website has changed but the pdf is the same

http://www.medsch.wisc.edu/painpolicy/p ... 05jpsm.pdf

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 Post subject: Re: Diversion stat
PostPosted: Sun Sep 29, 2013 4:59 pm 
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Minnie,

I would have to call BS on that statistic. In my experience it's the people who are legally obtaining the meds and selling them that are flooding the streets with them. I'm sure there are some instances where theft from a pharmacy are involved. But I don't see how it's possible that 90% of the drugs being sold on the street are obtained in that way.

I'll bet we have a pretty good sample of addicts right here on our forum that are from different areas around the world. Is there ANYONE here who has noticed a large percentage of drugs available from a source other than them selling their own script, or one they bought from someone that had a script for it? I bet we don't see 90% yes votes on this one. BTW, don't incriminate yourself if you do choose to answer...a simple yes or no will do. :wink:

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 Post subject: Re: Diversion stat
PostPosted: Sun Sep 29, 2013 10:02 pm 
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i have to say again that ive never seen or bought
From anyone who didnt have a script.
I feel badly,badly becuz there are so many people in real pain that can not get medicine.
Treating pain in America is writing scrips. Thats how we do it here.
Is it any wonder today the streets are full of pills.


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 Post subject: Re: Diversion stat
PostPosted: Mon Sep 30, 2013 10:54 pm 
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The article quoted by the original poster makes the point that (in the US) -"An important but ... overlooked diversion source involves thefts, including robberies, break-ins, etc." - That is, before ever being dispensed to patients. And this source is rarely discussed in the mass media.

"Theft/losses were primarily from pharmacies (89.3%), with smaller portions from medical practitioners, manufacturers, distributors, and some addiction treatment programs that reported theft of methadone."

That is, of all pre-prescription stolen/diverted opioids, 89.3% comes from (presumably retail) pharmacy theft. The remaining 10.7% is stolen from manufacturers, distributors, doctors' offices, addiction treatment programs (methadone clinics), etc.

http://www.medsch.wisc.edu/painpolicy/publicat/05jpsm/05jpsm.pdf

Loss or theft of 'Controlled Substances' (Scheduled under the Controlled Substances Act) must be reported to DEA - by manufacturers, by retail pharmacies, by dispensing practitioners, etc. If your stuff goes missing, the loss must be reported - One of many mechanisms for 'control' of 'Controlled Substances'
Registrants report in detail "theft or significant loss" on DEA Form 106. "Breakage or spillage" is reported on DEA Form 41. Stolen prescription blanks have to be reported also. And so on ...

The authors looked at data for;
    --Six drugs (oxycodone, morphine, methadone, hydromorphone, meperidine and fentanyl) -
    But not hydrocodone which is prescribed about ten-times more frequently than those six combined
    --From 22 Eastern states (representing 53% of the USA population)
    --Over 4-years (2000, 2001, 2002, 2003)

Using numbers from the article for instance,
DEA knows that a total of 4.435 million dosage units of oxycodone were stolen (in these 22 states during the 4-years studied). Likewise, 1.02 million dosage units of morphine were stolen during the same period. Combining all 6-drugs over all 4-years, a total of 6.456 million dosage units were stolen.

The authors don't mention that...
The number of prescriptions written during the same period for five of the drugs (meperidine excluded), in the 22 Eastern states, was roughly 400-million, corresponding to billions of dosage units. And that's not including hydrocodone (Vicodin, Lortab, etc.) and codeine.

Now I forget why I went through that exercise ... Oh, yeah ...
A very small proportion of all misused pharmaceutical opioid winds up in the 'wrong hands' as a result of theft.

Meaning, you were all correct in thinking "That doesn't make sense" - I mean, sort of - aside from not actually reading what was written (Snarky, I know). But what was written is fairly useless, at best, but actually sort of misleading in that the authors didn't look at the relevant data.


Last edited by AddictionPhysician on Tue Oct 01, 2013 1:10 am, edited 1 time in total.

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 Post subject: Re: Diversion stat
PostPosted: Tue Oct 01, 2013 12:57 am 
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rule62 wrote:
So where does it say they come from? I'm guessing that kids/relatives steal them from their parents/relatives. Unless that counts as a physician script.

Care to clarify?


"Theft/losses were .... from pharmacies (89.3%), with smaller portions from medical practitioners, manufacturers, distributors, and some addiction treatment programs that reported theft of methadone."
This means, before being in patients' possession.

I tried to explain this in my posting above.


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 Post subject: Re: Diversion stat
PostPosted: Tue Oct 01, 2013 8:03 am 
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Oh, ok....now THAT makes sense! Thanks for clearing that up Doc!

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 Post subject: Re: Diversion stat
PostPosted: Tue Oct 01, 2013 1:09 pm 
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Thank you addiction physician! I admit I didn't read the entire study that the author (Shaller) linked. Forgive me and snark duly deserved, but studies are so technical and dry I just couldn't get through it. Besides, that's what we have you for right?
Thanks again!

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 Post subject: Re: Diversion stat
PostPosted: Tue Oct 01, 2013 1:24 pm 
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LOL Minnie!

I wouldn't have gotten through the whole thing either! I'm glad to see I'm not the only one who finds those articles to be a snoozefest! You get props for trying to read it at all in my book!

Maybe one day doctors will begin speaking in ENGLISH so all of us normal people can follow along with them!

Q

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 Post subject: Re: Diversion stat
PostPosted: Wed Oct 02, 2013 7:21 am 
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My doctor appt was yesterday..and she actually agreed with me when I mentioned the stigma associated with Suboxone. I told her that the NA crowd has a deep hatred for ORT, and they are constantly saying "you're not really clean" or "you're just swapping one drug for another.."
And she totally agreed. She said "why does it matter if someone is living a better life and staying clean/changed the lifestyle from what they were doing?"...

I finally mentioned to her, after our discussion led to the brain changing in ways that some say are permanent (she said that, not me), that I was all for life-long treatment with Suboxone....and she also agreed with the logic in it. So for the first time, I am seeing a doctor who agrees that being on Suboxone consistently as a maintenance option is viable and actually considered to be the patient's decision, she said it wasn't up to her to determine when someone should just "stop"....

And after we talked..and she realized that she wasn't dealing with someone who just came in, paid, and got their script -- and that I actually took time to read about Suboxone and that I'm very pro-Suboxone...she asked me if I felt comfortable with coming every other month and having a refill...since I've been a patient for 4 months without any problem, tox screen shows what should be there (bupe)...and haven't given them a reason to not trust me, like "hey doc, my dog ate my meds..." or "I got held up, at gun-point, when i came out of the pharmacy and they took 32 1/2 of my Suboxone films from me"....
She gave me a two month supply at that point and said if I needed to, or had probs, to just call..otherwise, she would see me in November. I also complimented her, by saying that it's not fair for doctors to have to jump through the hoops they are forced to jump through just to help us folks who are trying to get clean/stay clean....and that I can understand why some doctors just decide it's not worth the trouble. But just like any other drug, people are GOING TO abuse it, divert it, etc...and some are going to do what they are supposed to do. And we all get punished for the acts of a few, but that's just how the system works....
Maybe they'll figure out a way to track it back to the people diverting -- I think the biggest element to doing that, teaching law enforcement what to look for. Some of the cops around here, if you said the word "Suboxone" they would look at you like you just invented a new word and ask what you're talking about.
At any rate....

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