| Body: | Practitioner Diversion
Awareness Conference
Drugs of Abuse and Trends
Scott Brinks, Staff Coordinator
Policy Unit
The following presentation was accompanied by an oral
presentation on May 5 and 6, 2018, and does not
purport to establish legal standards that are not
contained in statutes, regulations, or other competent
law. Statements contained in this presentation that are
not embodied in the law are not binding on DEA.
Summaries of statutory and regulatory provisions that
are summarized in this presentation do not purport to
state the full extent of the statutory and regulatory
requirements of the cited statutes and regulations. I
have no financial relationships to disclose.
LEGAL DISCLAIMER
U.S. Drug Enforcement Administration
Diversion Control Division
This presentation is for educational purposes only. This presentation may
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U.S. Drug Enforcement Administration
Diversion Control Division
§
Discuss the Public Health Epidemic.
§
Review the common drugs of abuse.
§
Discuss the relationship between
pharmaceutical controlled substances and
heroin.
Course Objectives
U.S. Drug Enforcement Administration
Diversion Control Division
§
Discuss the violence related to controlled
substance prescribing and dispensing.
§
Review key research and studies involving
the impact of indiscriminate prescribing of
controlled substances.
Course Objectives
U.S. Drug Enforcement Administration
Diversion Control Division
At the completion of this block of instruction you
will be able to answer the following questions:
1.
Which country, per million population, has
the largest amount of drug induced deaths
ages 15-64?
2.
Which state, via prescriptions, dispensed the
most oxycodone in the United States in 2016
and 2017?
Questions to Discuss
U.S. Drug Enforcement Administration
Diversion Control Division
3.
What percentage of the world's hydrocodone
production does the United States consume?
4.
What is the most misused prescription
controlled substance pain reliever in the
United States?
5.
What percent of heroin users began their
addictions with prescribed pain relievers?
Questions to Discuss
U.S. Drug Enforcement Administration
Diversion Control Division
The Problem - People Are Dying
U.S. Drug Enforcement Administration
Diversion Control Division
U.S. Drug Enforcement Administration
Diversion Control Division
The Problem - People Are Dying
The top 5 distributed scheduled controlled
substances in the United States:
1.
Hydrocodone
2.
Oxycodone
3.
Codeine
4.
Buprenorphine
5.
Morphine
Drugs of Abuse
U.S. Drug Enforcement Administration
Diversion Control Division
U.S. Drug Enforcement Administration
Office of Diversion Control
Source (2017). INCB data, International Narcotics Board: Comments on Reported Statistics on Narcotic Drugs.
United States
(Pop. 320 Mil.)
China
(Pop. 1.37 Billion)
World
(7.3 Bil)
Drug Name Percent Tons Percentage Tons Tons
Hydrocodone 99.72% 36.2 0.00% 0.001 36.3
Oxycodone 75.12% 62.5 1.08% 0.9 83.2
Morphine 48.04% 19.6 3.92% 1.6 40.8
Codeine 12.50% 35.7 2.66% 7.6 285.5
Methadone 47.11% 15.5 4.56% 1.5 32.9
Fentanyl 29.19% 0.54 0.32% 0.006 1.85
Where Does the United States
Rank In Consumption?
§
Hydrocodone / Acetaminophen (toxicity)
§
Similarities:
§
Structurally related to codeine
§
Equal to morphine in producing opiate-like
effects
§
Brand Names: Vicodin
®
, Lortab
®
, Lorcet
®
Hydrocodone
U.S. Drug Enforcement Administration
Diversion Control Division
§
October 6, 2014 moved to
SCHEDULE II
§
Street prices: $2 to $10 per tablet
depending on strength & region
Hydrocodone
U.S. Drug Enforcement Administration
Diversion Control Division
Carisoprodol
C-IV as of 1/11/2012
Benzodiazepine
Alprazolam
Muscle Relaxant
Hydrocodone
Opioid
The Trinity Cocktail
Aka: Soma
U.S. Drug Enforcement Administration
Diversion Control Division
0
500,000,000
1,000,000,000
1,500,000,000
2,000,000,000
2,500,000,000
Hydrocodone Distribution
2012-2017 U.S. Average
Schedule
Change
TOTAL
DOSAGES
Drug Enforcement Administration, Diversion Control Division, Pharmaceutical Investigations Section, Targeting and Analysis Unit
Source: ARCOS
Date Prepared: 04/19/2018
U.S. Drug Enforcement Administration
Diversion Control Division
Hydrocodone Distribution
Retail Pharmacies
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
State Ranking* - Hydrocodone
January - December 2016
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
761,524,830
12
KY
167,156,880
23
MS
93,319,730
34
MD
33,623,090
45
WY
10,264,600
2
TX
490,024,170
13
PA
164,632,230
24
OR
90,197,120
35
NJ
33,451,020
46
AK
9,277,300
3
MI
340,090,370
14
MO
160,127,350
25
WI
82,866,264
36
MA
32,595,900
47
NH
9,158,690
4
FL
291,256,130
15
NY
157,669,940
26
NV
73,346,530
37
NE
31,776,250
48
ND
8,138,030
5
IL
263,273,500
16
OK
137,166,930
27
KS
69,862,710
38
NM
31,223,910
49
DE
5,938,440
6
IN
200,457,150
17
LA
126,294,860
28
IA
57,332,210
39
MT
20,872,990
50
VT
5,030,470
7
OH
200,405,880
18
WA
123,108,310
29
CO
56,365,150
40
CT
19,790,230
51
DC
1,400,090
8
TN
200,348,680
19
SC
117,214,080
30
WV
53,773,800
41
ME
17,946,020
52
PR
532,450
9
GA
196,802,830
20
AR
103,551,640
31
MN
50,004,380
42
HI
14,385,450
53
VI
290,920
10
AL
192,898,540
21
VA
101,240,330
32
UT
48,752,040
43
SD
13,094,290
54
GU
141,700
11
NC
168,661,440
22
AZ
95,911,090
33
ID
44,712,660
44
RI
11,447,000
55
AS
0
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
676,242,530
12
NC
147,357,930
23
MS
80,970,420
34
MD
28,581,330
45
WY
8,763,100
2
TX
446,172,550
13
MO
143,001,770
24
OR
78,111,160
35
NE
28,112,150
46
AK
7,863,730
3
MI
302,709,000
14
PA
135,619,580
25
WI
70,555,870
36
MA
27,569,860
47
NH
7,799,380
4
FL
270,315,920
15
NY
135,009,060
26
NV
66,160,610
37
NJ
27,163,110
48
ND
6,908,450
5
IL
238,409,740
16
OK
126,275,040
27
KS
63,847,710
38
NM
26,501,730
49
DE
4,998,310
6
IN
180,150,420
17
LA
112,484,390
28
IA
50,454,090
39
MT
18,698,410
50
VT
4,045,920
7
GA
178,851,440
18
WA
109,072,900
29
CO
50,350,810
40
CT
16,419,880
51
DC
1,150,600
8
TN
176,844,330
19
SC
103,974,530
30
WV
44,821,360
41
ME
14,686,680
52
PR
280,960
9
AL
169,886,520
20
AR
95,818,050
31
UT
43,698,580
42
HI
12,780,000
53
VI
237,400
10
OH
169,479,340
21
VA
83,110,820
32
MN
42,806,000
43
SD
11,457,270
54
GU
102,800
11
KY
152,420,500
22
AZ
82,588,230
33
ID
40,971,880
44
RI
9,333,410
55
AS
0
State Ranking* - Hydrocodone
January - December 2017
Source: ARCOS
Date Prepared: 04/13//2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Hydrocodone Distribution
Practitioner's Office
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Practitioners
State Ranking* - Hydrocodone
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
3,703,028
12
MO
403,080
23
CT
184,360
34
SC
72,080
45
MS
26,580
2
IL
1,674,177
13
AZ
386,846
24
MN
181,996
35
KS
69,640
46
RI
24,000
3
GA
1,396,600
14
NY
369,100
25
NC
172,180
36
ND
65,960
47
SD
15,820
4
FL
800,460
15
TN
343,510
26
OR
147,182
37
WV
57,300
48
DE
10,000
5
VA
683,410
16
HI
331,230
27
IN
146,555
38
NE
56,640
49
VT
9,600
6
AL
568,292
17
CO
309,550
28
KY
140,280
39
AK
53,400
50
NH
6,200
7
MD
545,964
18
WA
305,385
29
IA
123,365
40
AR
42,150
51
DC
4,800
8
MI
509,320
19
NJ
255,760
30
LA
109,842
41
WY
37,200
52
GU
3,400
9
TX
489,150
20
OH
229,340
31
ID
103,810
42
MT
33,400
53
VI
200
10
OK
461,270
21
WI
208,431
32
MA
100,520
43
NM
33,318
54
AS
0
11
PA
446,850
22
NV
188,870
33
UT
75,680
44
ME
28,130
55
PR
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Practitioners
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
2,723,452
12
MO
354,760
23
NC
172,210
34
NE
70,050
45
RI
23,700
2
IL
1,063,795
13
AZ
346,895
24
MN
169,730
35
SC
65,660
46
MS
21,106
3
GA
992,335
14
PA
328,200
25
OR
166,920
36
KS
58,450
47
SD
14,300
4
FL
876,750
15
WA
308,970
26
KY
158,630
37
ND
55,390
48
DE
13,100
5
VA
503,700
16
CO
305,620
27
IN
156,430
38
WY
53,508
49
VT
9,800
6
TX
466,140
17
TN
294,490
28
CT
135,455
39
WV
47,100
50
DC
4,000
7
MD
446,822
18
OK
268,960
29
MA
123,790
40
AR
43,350
51
GU
4,000
8
MI
403,666
19
NJ
256,028
30
IA
119,135
41
MT
42,790
52
NH
4,000
9
NY
366,975
20
OH
219,570
31
LA
114,280
42
AK
40,480
53
VI
1,400
10
HI
363,900
21
NV
204,108
32
ID
92,240
43
ME
28,500
54
AS
0
11
AL
356,450
22
WI
181,930
33
UT
81,400
44
NM
26,990
55
PR
0
State Ranking* - Hydrocodone
January - December 2017
Source: ARCOS
Date Prepared: 04/13//2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
The
1990s
OxyContin®
U.S. Drug Enforcement Administration
Diversion Control Division
OxyContin®
§
OxyContin® controlled release formulation of
Schedule II oxycodone:
§
The controlled release method of delivery
allowed for a longer duration of drug action
and contained much larger doses of
oxycodone.
§
Abusers easily compromised the controlled
release formulation by crushing the tablets for
a powerful morphine-like high.
§
10, 20, 40, 80mg available.
U.S. Drug Enforcement Administration
Diversion Control Division
§
Effects:
§
Similar to morphine in effects and
potential for abuse/dependence.
§
Sold in "Cocktails" such as:
§
Oxycodone, Soma ® and Xanax®
§
Street price: Approx. $80 per 80mg tablet
OxyContin®
U.S. Drug Enforcement Administration
Diversion Control Division
0
200,000,000
400,000,000
600,000,000
800,000,000
1,000,000,000
1,200,000,000
1,400,000,000
Hydrocodone
Schedule
Change
Oxycodone Distribution
2012-2017 U.S. Average
TOTAL
DOSAGES
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Oxycodone Distribution
Retail Pharmacies
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
State Ranking* - Oxycodone
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
FL
327,396,960
12
MD
125,735,760
23
KY
82,392,630
34
MS
37,881,860
45
MT
14,987,850
2
PA
289,615,310
13
VA
125,223,670
24
AL
81,599,660
35
NM
37,587,670
46
PR
12,343,940
3
CA
283,323,420
14
MO
110,174,930
25
MN
72,078,260
36
WV
34,522,500
47
AK
11,106,040
4
NY
274,724,480
15
MA
109,525,870
26
OK
70,780,960
37
ME
24,677,180
48
WY
9,734,720
5
OH
240,022,630
16
MI
97,933,810
27
LA
67,844,460
38
NH
24,281,880
49
VT
8,974,030
6
NC
236,168,260
17
WI
94,207,800
28
CT
62,070,650
39
IA
24,180,470
50
SD
7,231,450
7
NJ
174,379,890
18
IN
91,166,180
29
NV
60,054,648
40
DE
24,126,160
51
DC
6,682,270
8
AZ
168,119,440
19
OR
90,591,450
30
UT
59,277,520
41
ID
21,551,870
52
ND
6,175,330
9
TN
166,650,300
20
SC
90,410,270
31
IL
53,048,100
42
NE
17,785,620
53
GU
442,000
10
GA
150,552,720
21
CO
85,984,060
32
AR
47,225,630
43
RI
16,602,080
54
VI
328,320
11
WA
135,572,910
22
TX
84,794,340
33
KS
44,555,870
44
HI
15,466,860
55
AS
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Pharmacies
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
FL
329,461,680
12
MD
114,361,790
23
CO
78,169,210
34
MS
36,635,450
45
MT
13,427,080
2
CA
261,549,628
13
VA
107,748,430
24
AL
77,140,750
35
NM
32,068,120
46
AK
10,185,200
3
PA
253,252,920
14
MO
101,345,360
25
OK
69,022,730
36
WV
28,936,880
47
WY
8,963,820
4
NY
241,791,409
15
MA
94,783,430
26
MN
64,133,340
37
IA
22,162,430
48
PR
7,957,520
5
NC
213,722,718
16
MI
90,536,160
27
LA
63,814,980
38
DE
21,864,430
49
VT
7,852,910
6
OH
212,322,630
17
TX
87,319,170
28
NV
56,910,004
39
ID
21,243,380
50
SD
6,312,160
7
TN
157,546,900
18
IN
83,911,860
29
UT
55,264,620
40
NH
21,171,060
51
DC
5,914,480
8
NJ
150,664,960
19
SC
83,287,870
30
CT
53,910,840
41
ME
19,988,670
52
ND
5,434,750
9
AZ
150,356,340
20
OR
80,083,810
31
IL
50,154,100
42
NE
16,531,480
53
GU
358,700
10
GA
148,367,190
21
KY
78,914,340
32
AR
44,957,930
43
HI
14,251,920
54
VI
256,400
11
WA
124,475,080
22
WI
78,771,970
33
KS
42,893,960
44
RI
13,956,870
55
AS
0
State Ranking* - Oxycodone
January - December 2017
Source: ARCOS
Date Prepared: 04/19/2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Oxycodone Distribution
Practitioner's Office
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Practitioners
State Ranking* - Oxycodone
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
GA
402,510
12
PA
89,455
23
MO
43,760
34
NM
14,100
45
DC
1,800
2
MD
356,390
13
TN
80,350
24
MI
39,190
35
NE
14,000
46
RI
1,200
3
CT
230,051
14
OK
78,610
25
KS
36,180
36
MA
11,535
47
WY
1,080
4
AL
171,025
15
VA
78,320
26
IA
35,400
37
LA
9,750
48
MT
800
5
HI
165,900
16
AZ
74,000
27
OR
33,880
38
MS
7,320
49
VT
800
6
CO
165,760
17
MN
71,360
28
TX
21,460
39
KY
7,300
50
DE
520
7
CA
152,772
18
IL
70,145
29
SD
17,860
40
AR
6,400
51
WV
200
8
WI
151,030
19
SC
58,440
30
WA
17,800
41
UT
5,700
52
AS
0
9
NV
147,440
20
NC
53,160
31
IN
16,500
42
ME
4,000
53
GU
0
10
FL
141,586
21
NJ
45,460
32
AK
16,270
43
NH
3,300
54
PR
0
11
NY
135,680
22
OH
44,600
33
ID
14,830
44
ND
2,910
55
VI
0
Source: ARCOS
Date Prepared: 04/19/2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Practitioners
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
MD
344,330
12
TN
79,985
23
SC
25,882
34
ND
7,260
45
KY
2,000
2
GA
319,335
13
VA
61,150
24
OH
22,879
35
MA
7,120
46
MT
1,300
3
HI
208,250
14
AZ
59,160
25
ID
22,765
36
AR
6,500
47
RI
900
4
NV
185,725
15
MN
53,860
26
NC
19,377
37
UT
6,035
48
VT
400
5
CT
170,864
16
PA
48,811
27
NE
18,820
38
MS
5,440
49
DE
300
6
CO
156,965
17
IL
47,750
28
MO
18,315
39
LA
4,900
50
NH
200
7
CA
152,927
18
MI
43,710
29
WA
17,730
40
NM
4,700
51
WV
200
8
AL
120,325
19
OK
39,282
30
KS
17,485
41
ME
2,800
52
AS
0
9
WI
118,930
20
NJ
37,530
31
TX
16,952
42
SD
2,700
53
GU
0
10
FL
112,307
21
IA
31,420
32
IN
8,740
43
WY
2,040
54
PR
0
11
NY
94,790
22
OR
31,190
33
AK
8,490
44
DC
2,000
55
VI
0
State Ranking* - Oxycodone
January - December 2017
Source: ARCOS
Date Prepared: 04/19/2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
160,000,000
180,000,000
200,000,000
Codeine Distribution
2012-2017 U.S. Average
TOTAL
DOSAGES
Hydrocodone
Schedule
Change
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Codeine Distribution
Retail Pharmacies
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
State Ranking* - Codeine
January - December 2016
Source: ARCOS
Date Prepared: 04/19/2018
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
TX
145,413,320
12
SC
11,648,710
23
KY
7,847,140
34
CO
3,629,700
45
MT
1,429,950
2
CA
75,550,040
13
OK
11,302,780
24
NC
7,726,310
35
IA
3,368,310
46
NH
1,360,470
3
MI
36,087,230
14
MO
10,959,250
25
AL
7,300,710
36
NM
2,667,270
47
RI
1,266,300
4
IL
26,863,020
15
AZ
10,685,640
26
MN
6,714,870
37
UT
2,358,370
48
SD
1,156,440
5
FL
25,045,710
16
AR
10,151,350
27
LA
6,295,160
38
PR
2,132,610
49
ND
807,910
6
NY
24,208,400
17
MD
9,867,790
28
OR
5,424,730
39
NE
2,043,030
50
AK
790,600
7
PA
22,796,838
18
WA
9,355,780
29
KS
4,356,640
40
ID
2,020,160
51
WY
642,850
8
OH
16,846,030
19
VA
9,124,810
30
WV
4,332,620
41
DC
1,921,640
52
VT
593,170
9
TN
15,622,570
20
WI
8,631,680
31
CT
4,206,600
42
ME
1,916,500
53
GU
178,450
10
GA
15,209,500
21
IN
8,522,327
32
MS
4,039,460
43
HI
1,858,350
54
VI
108,750
11
NJ
13,344,450
22
MA
7,955,420
33
NV
4,015,790
44
DE
1,699,330
55
AS
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Pharmacies
State Ranking* - Codeine
January - December 2017
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
TX
140,549,520
12
NJ
11,695,290
23
AL
6,994,970
34
CO
3,341,860
45
MT
1,286,740
2
CA
66,917,310
13
OK
11,200,330
24
KY
6,977,190
35
IA
3,132,620
46
NH
1,160,800
3
MI
33,561,880
14
MO
10,102,450
25
MA
6,886,800
36
NM
2,445,390
47
RI
1,092,250
4
IL
24,941,980
15
AZ
10,010,270
26
LA
5,968,350
37
UT
2,163,250
48
SD
1,037,230
5
FL
24,490,360
16
AR
9,526,020
27
MN
5,883,620
38
PR
2,071,250
49
ND
741,930
6
NY
20,408,340
17
MD
8,604,850
28
OR
4,904,040
39
ID
1,801,120
50
AK
734,350
7
PA
19,629,293
18
WA
8,603,170
29
WV
4,207,020
40
NE
1,766,620
51
WY
568,000
8
GA
15,047,710
19
VA
8,019,790
30
KS
4,044,640
41
HI
1,710,400
52
VT
520,250
9
OH
14,752,550
20
WI
7,402,680
31
MS
3,902,790
42
DC
1,687,620
53
GU
157,600
10
TN
12,652,630
21
IN
7,342,940
32
CT
3,637,210
43
ME
1,573,450
54
VI
119,000
11
SC
11,967,085
22
NC
7,209,860
33
NV
3,626,610
44
DE
1,426,260
55
AS
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Codeine Distribution
Practitioner's Office
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Practitioners
State Ranking* - Codeine
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
1,723,088
12
AL
115,012
23
IN
23,790
34
SC
10,030
45
WV
2,800
2
MD
357,835
13
OR
99,050
24
KS
23,640
35
IA
10,000
46
NH
2,150
3
VA
258,110
14
MI
92,986
25
NV
23,440
36
CT
8,615
47
DC
2,100
4
PA
204,270
15
OK
84,247
26
WI
22,995
37
ME
7,900
48
GU
1,900
5
WA
195,300
16
MO
62,110
27
AR
22,610
38
ND
7,060
49
MS
1,500
6
NJ
192,140
17
TN
59,610
28
KY
18,280
39
UT
6,600
50
NM
800
7
AZ
168,950
18
FL
52,360
29
LA
18,150
40
MT
4,900
51
VT
350
8
IL
157,865
19
CO
39,370
30
OH
16,840
41
SD
4,200
52
VI
300
9
GA
146,060
20
ID
35,310
31
MN
16,120
42
WY
4,170
53
RI
100
10
NY
141,280
21
MA
29,320
32
NC
13,128
43
DE
3,760
54
AS
0
11
TX
131,720
22
NE
25,250
33
HI
12,490
44
AK
2,915
55
PR
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Practitioners
State Ranking* - Codeine
January - December 2017
Source: ARCOS
Date Prepared: 04/19/2018
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
1,322,930
12
NJ
111,515
23
KS
32,820
34
SC
8,680
45
SD
3,200
2
MD
326,320
13
TN
95,300
24
MA
29,900
35
CT
8,510
46
AK
2,940
3
WA
263,930
14
MI
89,320
25
WI
21,465
36
MT
6,960
47
DC
2,000
4
VA
207,510
15
MO
74,690
26
AR
21,070
37
WY
6,790
48
NM
1,630
5
NY
170,490
16
AL
73,280
27
KY
18,700
38
UT
6,000
49
GU
700
6
PA
162,865
17
ID
65,270
28
HI
16,528
39
ND
5,795
50
NH
510
7
AZ
155,590
18
OK
61,350
29
IN
15,525
40
NC
5,695
51
VT
350
8
IL
148,825
19
FL
51,710
30
LA
14,380
41
ME
5,400
52
VI
200
9
GA
147,960
20
CO
44,020
31
OH
11,860
42
DE
3,760
53
AS
0
10
TX
145,420
21
NE
40,050
32
IA
11,390
43
WV
3,600
54
PR
0
11
OR
129,765
22
MN
37,900
33
NV
8,950
44
MS
3,200
55
RI
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
0
20,000,000
40,000,000
60,000,000
80,000,000
100,000,000
120,000,000
140,000,000
Buprenorphine Distribution
2012-2017 U.S. Average
TOTAL
DOSAGES
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Hydrocodone
Schedule
Change
Buprenorphine Distribution
Retail Pharmacies
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
State Ranking* - Buprenorphine
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
PA
28,632,630
12
NC
12,666,510
23
OK
5,028,870
34
CO
3,449,388
45
DC
948,058
2
NY
26,334,358
13
MD
11,198,506
24
UT
4,798,024
35
MN
3,128,264
46
AK
939,668
3
OH
23,863,496
14
AL
10,798,187
25
MS
4,709,566
36
NM
3,072,006
47
MT
800,302
4
FL
22,418,290
15
VA
9,784,675
26
SC
4,704,158
37
AR
2,479,442
48
IA
678,446
5
CA
20,000,798
16
WA
8,625,526
27
WI
4,644,726
38
VT
2,322,104
49
NE
608,378
6
MA
19,450,268
17
LA
8,192,852
28
AZ
4,471,392
39
NV
1,647,162
50
WY
537,876
7
KY
16,316,338
18
IN
8,149,080
29
OR
4,437,130
40
ID
1,566,592
51
ND
407,022
8
TN
16,195,006
19
GA
7,601,450
30
MO
4,380,400
41
KS
1,246,834
52
SD
200,018
9
TX
13,816,536
20
CT
7,171,048
31
ME
4,172,150
42
HI
1,221,196
53
VI
11,694
10
NJ
13,725,036
21
WV
6,927,694
32
NH
3,722,984
43
PR
1,202,522
54
GU
530
11
MI
13,360,490
22
IL
6,690,938
33
RI
3,512,246
44
DE
1,164,006
55
AS
0
Source: ARCOS
Date Prepared: 04/19/2018
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Pharmacies
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
PA
31,897,154
12
NJ
14,400,630
23
OK
5,808,752
34
RI
3,802,198
45
PR
1,198,536
2
NY
28,764,435
13
MD
12,398,238
24
OR
5,359,120
35
CO
3,764,922
46
AK
1,142,032
3
OH
26,158,834
14
AL
12,176,008
25
SC
5,304,810
36
NM
3,551,104
47
MT
1,088,812
4
FL
24,177,806
15
IN
10,318,702
26
UT
5,276,228
37
AR
3,079,406
48
IA
778,188
5
CA
22,395,194
16
VA
10,116,024
27
WI
5,127,856
38
VT
2,728,532
49
NE
679,226
6
MA
21,142,180
17
WA
10,093,418
28
MO
5,088,882
39
ID
1,854,894
50
WY
637,180
7
TN
17,800,288
18
LA
9,763,600
29
MS
5,028,064
40
NV
1,838,896
51
ND
450,332
8
KY
17,661,612
19
GA
8,291,451
30
AZ
5,018,492
41
DE
1,444,186
52
SD
235,578
9
NC
15,506,116
20
IL
7,924,872
31
ME
5,004,694
42
KS
1,356,664
53
VI
7,850
10
MI
14,961,338
21
CT
7,765,608
32
NH
4,219,292
43
HI
1,330,424
54
GU
480
11
TX
14,517,894
22
WV
7,391,406
33
MN
3,855,608
44
DC
1,205,572
55
AS
0
State Ranking* - Buprenorphine
January - December 2017
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Buprenorphine Distribution
Practitioner's Office
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Practitioners
State Ranking* - Buprenorphine
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
MD
113,340
12
AZ
13,140
23
VT
2,100
34
DE
60
45
ID
0
2
FL
111,030
13
OH
13,080
24
AK
1,830
35
ME
60
46
KS
0
3
CA
105,420
14
WA
7,380
25
CT
1,770
36
MS
60
47
KY
0
4
TX
87,250
15
WI
6,106
26
NC
750
37
UT
30
48
MT
0
5
PA
57,450
16
CO
5,400
27
WV
684
38
WY
30
49
ND
0
6
RI
54,060
17
MA
4,410
28
MN
540
39
AR
0
50
NE
0
7
MI
52,950
18
AL
3,660
29
VA
484
40
AS
0
51
NH
0
8
NJ
35,400
19
IL
2,940
30
MO
420
41
DC
0
52
NM
0
9
NV
35,340
20
SC
2,640
31
LA
288
42
GU
0
53
PR
0
10
OR
18,660
21
OK
2,370
32
TN
270
43
HI
0
54
SD
0
11
NY
14,220
22
GA
2,190
33
IN
90
44
IA
0
55
VI
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Practitioners
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
PA
241,624
12
WI
13,576
23
NC
1,650
34
WV
90
45
DC
0
2
MD
110,416
13
WA
13,266
24
IL
1,448
35
CT
83
46
GU
0
3
CA
89,656
14
AZ
6,844
25
IN
1,298
36
MS
64
47
HI
0
4
TX
89,578
15
GA
5,280
26
MN
1,020
37
DE
60
48
IA
0
5
MI
87,680
16
SC
4,620
27
KY
972
38
NM
60
49
ID
0
6
FL
48,800
17
AL
3,398
28
AK
934
39
RI
50
50
MT
0
7
NV
45,750
18
MO
3,150
29
NH
424
40
UT
44
51
NE
0
8
NJ
45,684
19
KS
2,700
30
MA
404
41
ME
34
52
SD
0
9
OR
21,300
20
TN
2,262
31
VA
346
42
PR
4
53
VI
0
10
NY
17,962
21
CO
2,250
32
ND
270
43
AR
0
54
VT
0
11
OH
16,928
22
OK
1,950
33
LA
244
44
AS
0
55
WY
0
State Ranking* - Buprenorphine
January - December 2017
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
0
50,000,000
100,000,000
150,000,000
200,000,000
250,000,000
Morphine Distribution
2012-2017 U.S. Average
TOTAL
DOSAGES
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Hydrocodone
Schedule
Change
Morphine Distribution
Retail Pharmacies
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Pharmacies
State Ranking* - Morphine
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
68,601,930
12
GA
16,099,780
23
AL
10,727,912
34
CT
5,127,272
45
AK
1,630,378
2
FL
55,582,900
13
OR
14,580,040
24
MA
10,026,080
35
IA
5,064,134
46
RI
1,609,786
3
PA
30,379,134
14
OK
14,366,990
25
NV
9,955,602
36
ID
4,485,694
47
VT
1,570,988
4
TX
28,690,088
15
IL
14,129,610
26
SC
9,463,078
37
NM
4,481,724
48
SD
1,292,984
5
AZ
27,982,976
16
WI
14,025,740
27
LA
7,891,570
38
WV
3,325,732
49
WY
1,241,460
6
MI
27,562,106
17
IN
13,291,792
28
MN
7,809,498
39
DE
3,232,100
50
ND
918,578
7
TN
24,461,684
18
MO
13,203,956
29
UT
7,582,980
40
ME
3,028,304
51
DC
462,860
8
NY
22,274,440
19
MD
13,091,098
30
AR
7,448,044
41
MT
2,982,682
52
PR
232,070
9
WA
19,818,762
20
VA
11,782,100
31
KY
7,004,708
42
HI
2,866,190
53
GU
101,600
10
NC
19,205,796
21
NJ
11,588,070
32
KS
6,221,092
43
NH
2,826,318
54
VI
16,400
11
OH
18,324,462
22
CO
11,062,854
33
MS
5,174,414
44
NE
2,703,984
55
AS
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Pharmacies
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
CA
60,913,914
12
GA
15,355,060
23
AL
9,511,142
34
CT
4,567,002
45
AK
1,473,762
2
FL
52,506,746
13
IL
13,192,538
24
NV
9,043,506
35
IA
4,521,494
46
RI
1,436,700
3
PA
27,696,706
14
OK
13,168,648
25
SC
9,000,106
36
ID
4,260,124
47
VT
1,366,218
4
TX
27,030,444
15
OR
12,086,298
26
MA
8,973,426
37
NM
3,614,402
48
WY
1,155,140
5
MI
24,389,222
16
MO
12,005,800
27
UT
7,079,132
38
DE
3,138,174
49
SD
1,118,600
6
AZ
24,289,066
17
WI
11,892,570
28
LA
7,064,228
39
WV
2,748,100
50
ND
793,054
7
TN
21,307,364
18
MD
11,696,950
29
MN
7,026,794
40
NH
2,646,192
51
DC
395,986
8
NY
19,588,310
19
IN
11,488,818
30
AR
6,816,812
41
NE
2,614,002
52
PR
144,200
9
NC
17,324,028
20
NJ
10,597,684
31
KY
6,319,422
42
ME
2,537,514
53
GU
86,000
10
WA
17,261,578
21
VA
10,505,418
32
KS
5,733,764
43
MT
2,528,222
54
VI
16,800
11
OH
16,478,018
22
CO
9,988,810
33
MS
4,708,468
44
HI
2,510,052
55
AS
0
State Ranking* - Morphine
January - December 2017
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Morphine Distribution
Practitioner's Office
U.S. Drug Enforcement Administration
Diversion Control Division
* Business Activity - Retail Practitioners
State Ranking* - Morphine
January - December 2016
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
GA
72,380
12
AZ
18,560
23
TN
4,566
34
NE
900
45
IA
0
2
CA
65,332
13
HI
17,160
24
ID
4,500
35
KY
800
46
LA
0
3
MD
57,180
14
OH
17,060
25
MN
3,180
36
MT
600
47
ME
0
4
OK
51,360
15
SC
16,878
26
WA
2,801
37
OR
400
48
MS
0
5
FL
47,885
16
MO
16,660
27
CO
2,780
38
NJ
200
49
ND
0
6
CT
34,710
17
SD
16,660
28
IL
2,633
39
AK
100
50
NH
0
7
NC
34,520
18
VA
15,450
29
TX
2,000
40
AR
100
51
PR
0
8
AL
29,456
19
WI
11,720
30
WY
1,900
41
DE
1
52
RI
0
9
PA
19,893
20
NY
7,800
31
MI
1,560
42
AS
0
53
VI
0
10
IN
19,360
21
KS
5,520
32
MA
1,033
43
DC
0
54
VT
0
11
NV
18,930
22
NM
4,800
33
UT
1,000
44
GU
0
55
WV
0
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
* Business Activity - Retail Practitioners
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
RANK
STATE
TOTAL
1
MD
56,180
12
NY
5,900
23
TX
1,300
34
MT
400
45
LA
0
2
GA
38,943
13
MI
5,406
24
TN
1,233
35
MN
320
46
ME
0
3
OK
35,204
14
CO
4,433
25
OH
1,133
36
IA
300
47
MS
0
4
AL
26,117
15
ID
3,333
26
AR
1,000
37
WY
300
48
NH
0
5
NV
21,513
16
AZ
2,638
27
SC
900
38
OR
200
49
ND
0
6
HI
19,710
17
UT
2,551
28
KY
700
39
DE
120
50
PR
0
7
CT
19,280
18
WA
2,520
29
MA
700
40
NE
100
51
RI
0
8
FL
14,345
19
PA
1,900
30
IL
500
41
NM
100
52
SD
0
9
CA
11,093
20
KS
1,733
31
IN
500
42
AS
0
53
VT
0
10
WI
8,970
21
MO
1,333
32
NJ
500
43
DC
0
54
VI
0
11
VA
8,286
22
NC
1,333
33
AK
450
44
GU
0
55
WV
0
State Ranking* - Morphine
January - December 2017
U.S. Drug Enforcement Administration
Diversion Control Division
Source: Drug Enforcement Administration, Office of Diversion Control,
Pharmaceutical Investigations Section, Targeting and Analysis Unit
Most current ARCOS information as of 08/27/2016
Drug Trends
U.S. Drug Enforcement Administration
Diversion Control Division
Heroin and Fentanyl
U.S. Drug Enforcement Administration
Diversion Control Division
Heroin
.
Heroin comes from the poppy flower.
.
It comes from outside of the U.S. - Asia,
Pakistan, Afghanistan.
.
Brought in through different drug routes -
Mexico.
.
Heroin use has increased in the last 5 years.
U.S. Drug Enforcement Administration
Diversion Control Division
U.S. Drug Enforcement Administration
Diversion Control Division
Fentanyl
§
Fentanyl is a synthetic opioid.
§
Fentanyl is very powerful (50-100 times more potent
than heroin).
§
Dealers are combining Fentanyl with Heroin, pills,
marijuana, counterfeit pills, etc.
§
Carfentanil (100 times more potent than Fentanyl).
§
Is stolen or diverted from legitimate channels.
§
Be cautious when inventorying personal items in ED
or the hospital.
§
Be cautious when touching patients.
§
Be cautions when going through a patient's personal
items.
§
Don't ever take back a patient's medications.
Fentanyl Dangers to
Practitioners
U.S. Drug Enforcement Administration
Diversion Control Division
From Pills to Heroin
U.S. Drug Enforcement Administration
Diversion Control Division
§
75% of heroin users switched after first
using controlled substance prescription
pain relievers.
§
Heroin is much cheaper than prescription
drugs.
§
Deck: 1 small bag of heroin ($8 to $10)
§
Bundle: 10 bags of heroin
From Pills to Heroin
U.S. Drug Enforcement Administration
Diversion Control Division
Prescription Drug Abuse Trends
U.S. Drug Enforcement Administration
Diversion Control Division
U.S. Drug Enforcement Administration
Diversion Control Division
Prescription Drug Abuse
Is Driven By-
Indiscriminate Prescribing And
Criminal Activity
Hydrocodone
, 41%
Oxycodone
, 23%
Codeine, 16%
Tramadol,
10%
Buprenorphine,
4%
Morphine, 3%
Methadone, 2%
Fentanyl, 1%
Prescription Pain Reliever Misuse
(Age 12 and Older)(2016)
Source: National Survey On Drug Use and Health (2016)
Total past year
abusers: 11,517,000
Doctor,
36%
Friend
or
Relative,
54%
Drug
Dealer,
Stranger,
5%
Other,
5%
Where Do They Come From?
U.S. Drug Enforcement Administration
Office of Diversion Control
Source: Department of Health and Human Services
Many Patients Share Prescribed
Controlled Substances
University of Pennsylvania Dental School Study:
§
*More than half of the narcotics prescribed for
wisdom teeth removal go unused...findings
suggest that more than 100 million pills
prescribed go unused... leaving the door open
for possible misuse or abuse.
Source: https://www.pennmedicine.org/news/news-
releases/2016/september/100-million-prescription-opioid
https://www.nlm.nih.gov/medlineplus/news/fullstory_159336.html
U.S. Drug Enforcement Administration
Diversion Control Division
John Hopkins Study:
§
+60% had leftover opioids they hung on for
"future use"
§
20% shared their medications
§
8% likely will share w/ friend
§
14% likely will share w/ relative
§
>10% securely lock their medication
Source: https://www.pennmedicine.org/news/news-
releases/2016/september/100-million-prescription-opioid
https://www.nlm.nih.gov/medlineplus/news/fullstory_159336.html
U.S. Drug Enforcement Administration
Diversion Control Division
Many Patients Share Prescribed
Controlled Substances
John Hopkins Study:
§
The study further explored adult
attitudes towards controlled substances
and found:
§
73 percent of adults agreed that children
can overdose on opioids more easily than
adults.
Source: https://www.pennmedicine.org/news/news-
releases/2016/september/100-million-prescription-opioid
https://www.nlm.nih.gov/medlineplus/news/fullstory_159336.html
U.S. Drug Enforcement Administration
Diversion Control Division
Many Patients Share Prescribed
Controlled Substances
John Hopkins Study:
§
Yet found that 13% of the respondents
"worry" about their children accessing their
opioid medications.
§
With parents of older children reporting
that they were significantly less likely to
worry about children accessing medications
than parents of younger children.
Source: https://www.pennmedicine.org/news/news-
releases/2016/september/100-million-prescription-opioid
https://www.nlm.nih.gov/medlineplus/news/fullstory_159336.html
U.S. Drug Enforcement Administration
Diversion Control Division
Many Patients Share Prescribed
Controlled Substances
Violence
U.S. Drug Enforcement Administration
Diversion Control Division
Violence Associated
With Opiates
Communities undergo:
§
Drug related crimes
a. Robberies
b. Burglaries/break ins
c. Drug thefts
§
Abuse and neglect of children
§
Domestic violence in the home
§
Increase of arrests
U.S. Drug Enforcement Administration
Diversion Control Division
50.0%
36.0%
7.7%
4.3%
Drug Enforcement Administration, Diversion Control Division, Pharmaceutical Investigations Section, Targeting and Analysis Unit
Source: DTL
Date Prepared: 04/19/2018
Lost in Transit
341 Incidents
Reported
Night Break-In
615 Incidents
Reported
Nationwide Practitioner Thefts
January 1, 2009 - December 31, 2017
Other
3,973 Incidents
Reported
Employee
Pilferage
2,860 Incidents
Reported
Customer Theft
136 Incidents Reported -
1.7%
Armed Robbery
21 Incidents Reported -
0.3%
45.7%
37.6%
9.6%
5.7%
Drug Enforcement Administration, Diversion Control Division, Pharmaceutical Investigations Section, Targeting and Analysis Unit
Source: DTL
Date Prepared: 04/19/2018
Lost in Transit
31 Incidents
Reported
Night Break-In
52 Incidents
Reported
Florida Practitioner Thefts
January 1, 2009 - December 31, 2017
Other
247 Incidents
Reported
Employee
Pilferage
203 Incidents
Reported
Customer Theft
5 Incidents Reported - 1.7%
Armed Robbery
2 Incidents Reported -
0.3%
CDC Guidelines
Prescribing Opioids for Chronic Pain
Clinical Reminders:
§
Opioids are not first-line or routine therapy for
chronic pain.
§
Establish and measure goals for pain and
function.
§
Discuss benefits, risks and availability of non
opioid therapies with patients.
Source: CDC Morbidity & Mortality Weekly Report CDC
Guideline for Prescribing Opioids for Chronic Pain -
United States, 2016, March 15, 2016
www.cdc.gov/drugoverdose/prescribing/guideline.html
U.S. Drug Enforcement Administration
Diversion Control Division
Clinical Reminders:
§
Use immediate-release opioids when starting.
§
Start low and go slow.
§
When opioids are needed for acute pain,
prescribe no more than needed.
U.S. Drug Enforcement Administration
Diversion Control Division
CDC Guidelines
Prescribing Opioids for Chronic Pain
Source: CDC Morbidity & Mortality Weekly Report CDC
Guideline for Prescribing Opioids for Chronic Pain -
United States, 2016, March 15, 2016
www.cdc.gov/drugoverdose/prescribing/guideline.html
Clinical Reminders:
§
Do not prescribe ER/LA opioids for acute pain.
§
Follow-up and re-evaluate risk of harm; reduce
dose or taper and discontinue if needed.
§
Evaluate risk factors for opioid-related harms.
U.S. Drug Enforcement Administration
Diversion Control Division
CDC Guidelines
Prescribing Opioids for Chronic Pain
Source: CDC Morbidity & Mortality Weekly Report CDC
Guideline for Prescribing Opioids for Chronic Pain -
United States, 2016, March 15, 2016
www.cdc.gov/drugoverdose/prescribing/guideline.html
Clinical Reminders:
§
Check PDMP for higher dosages and prescriptions from
other providers.
§
Use urine drug testing to identify prescribed substances
and undisclosed use.
§
Avoid concurrent benzodiazepine and opioid prescribing.
§
Arrange treatment for opioid use disorder if needed.
U.S. Drug Enforcement Administration
Diversion Control Division
CDC Guidelines
Prescribing Opioids for Chronic Pain
Source: CDC Morbidity & Mortality Weekly Report CDC
Guideline for Prescribing Opioids for Chronic Pain -
United States, 2016, March 15, 2016
www.cdc.gov/drugoverdose/prescribing/guideline.html
Survey of Long-Term
Painkiller Users
§
Majority say their doctor talked about possibility
of addiction or dependence - 61% say there was no
discussion about plan to get them off.
§
Majority say they used the drugs to relieve pain.
Other major reasons for taking them:
§
20% - 'for fun or get high"
§
14% - "to deal with day-to-day stress"
§
10% - "to relax or relieve tension"
Source: Washington Post/Kaiser Family Foundation
Survey of Long-Term Prescription Painkiller Users and
Their Household Members, December 2016
U.S. Drug Enforcement Administration
Diversion Control Division
Survey of Long-Term
Painkiller Users
§
Other Findings:
§
34% admit being dependent or addicted.
§
17% have taken painkillers that were not
specifically prescribed for them.
§
14% have given their painkillers to a family
member or friend.
§
20% know or suspect someone was using, taking
or selling their painkillers.
Source: Washington Post/Kaiser Family Foundation
Survey of Long-Term Prescription Painkiller Users and
Their Household Members, December 2016
U.S. Drug Enforcement Administration
Diversion Control Division
1.
Which country, per million population, has
the largest amount of drug induced deaths
ages 15-64?
A.
Sweden
B.
Germany
C.
United States
D.
Russia
E.
China
Post Questions
U.S. Drug Enforcement Administration
Diversion Control Division
2.
Which state, via prescriptions, dispensed
the most oxycodone in the United States in
2016 and 2017?
A.
California
B.
Florida
C.
Texas
D.
Ohio
E.
New York
Post Questions
U.S. Drug Enforcement Administration
Diversion Control Division
3.
What percentage of the world's
hydrocodone production does the United
States consume?
A.
Less than 10%
B.
34%
C.
50%
D.
More than 70%
Post Questions
U.S. Drug Enforcement Administration
Diversion Control Division
4.
What is the most misused prescription
controlled substance pain reliever in the
United States?
A.
Oxycodone
B.
Morphine
C.
Hydrocodone
D.
Codeine
Post Questions
U.S. Drug Enforcement Administration
Diversion Control Division
5.
What percent of heroin users began their
addictions with prescribed pain relievers?
A.
15%
B.
40%
C.
75%
D.
90%
E.
99%
Post Questions
U.S. Drug Enforcement Administration
Diversion Control Division
Thank-you for your time
and attention !
U.S. Drug Enforcement Administration
Diversion Control Division
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