Pharmaceutical Drug Abuse

Counterfeit Drugs

Current State of Affairs

• National drug prevalence studies indicate a sharp increase in prescription drug abuse beginning in the early to mid 1990s

• According to the 2005 National Drug Threat Assessment published by National Drug Intelligence Center the rate of abuse for pharmaceuticals appears to be stabilizing at high levels

• The availability of prescription drugs has also shown a marked increase since the early 1990s

The Demand for Drugs

• The rate of abuse for prescription drugs is relatively high compared with rates of abuse for other drug types

• National Survey On Drug Use and Health (NSDUH) in 2003 indicated that 6.3 % of persons aged 12 or older reported non-medical use of a prescription-type:– Pain reliever– Tranquilizer– Stimulant (including both illicit and prescription

methamphetamine)– Sedative (not including over-the-counter drugs)

• These prescription drugs were reported second only to marijuana (10.6%) and much higher than cocaine (2.5%) and heroin (0.1%) for rates of abuse

Availability of Prescription Drugs

• Doctor Shopping

• Prescription Fraud

• Unscrupulous Physicians

• Pharmaceutical Theft

• Internet– Counterfeit drugs

Doctor Shopping

• Individuals will visit several different doctors

• Invent or exaggerate symptoms to receive prescriptions

• People will visit doctors they think more likely to write them a prescription

• They will have prescriptions filled at several different pharmacies to help evade detection by the pharmacist

Prescription Fraud

• Methods employed for fraud:– Forging or altering of prescriptions– Producing counterfeit prescriptions– Calling in fictitious prescriptions to pharmacies by

impersonating a physician

• Methods of detection:– Written in unfamiliar handwriting (forged, altered or

counterfeit prescriptions)• Often without abbreviations

– The quantities, directions, or dosages differ from normal usage

– Resemble textbook examples– Appear to be photocopied

Unscrupulous Physicians

• Writing Illegal prescriptions

• Writing fraudulent prescriptions to obtain drugs for personal use

• Charging a fee to write prescriptions for patients without a legitimate need for the drugs

• Sometimes collaborate with unscrupulous pharmacists– Dispense drugs, known to be unnecessary, for an

additional fee

• Doctors or pharmacists in nursing homes over order drugs from wholesalers and sell them to questionable distributors

Pharmaceutical Theft

• Pharmacies

• Manufactures

• Distributors

• Importers/

exporters

Drug 2000 2001 2002 2003

Codeine 569,425 1,223,205 596,972 622,132

Dilaudid 37,531 22,647 23,072 41,668

Lorcet 100,548 540,997 126,451 360,115

Lortab 686,197 451,091 340,325 738,584

OxyContin 260,688 519,597 587,168 464,312

Percocet 421,063 127,525 193,085 278,581

Percodan 14,646 12,704 9,151 34,102

Ritalin 117,408 123,720 74,541 67,751

Valium 171,883 176,280 145,070 146,683

Total 2,379,389 3,197,766 2,095,835 2,753,928

Source: NDIC (DEA)

Internet

• Offer drugs without prescriptions or physician consults

• Recruit corrupt physicians to write fraudulent prescriptions

• Distribute counterfeit drugs– Occurrence in the US is increasing– Typically produced in India and China– China, Nigeria, Thailand, Cambodia, and

Indonesia- as much as 60% of the drugs sold are counterfeit

How to Avoid Counterfeit Drugs

• Know your medications– Size, shape, color, texture, taste, and side effects

• Look at the packaging– Contact your doctor or pharmacist if there are

changes/tampering in the packaging or label

• Buy from a safe reputable source– Check with the State Board of Pharmacy

http://www.tsbp.state.tx.us/– The National Association of Boards of Pharmacy at

www.nabp.net

• Make sure the pharmacy is properly licensed– Online pharmacies will display a seal from State or

National Boards of Pharmacy– Verify the seal, don’t take the company’s word

Reporting Counterfeit Drugs

• Contact a pharmacist who will know if the color, shape, size, etc. have changed

• Report suspicions to the Food and Drug Administration (FDA)

• If you bought the drug by mail, by telephone, or in person, contact the FDA’s Medwatch program:– 1-800-332-1088 – http://www.fda.gov/medwatch/

• If bought on the Internet, use the online form or call: – http://www.fda.gov/oc/buyonline/buyonlineform.htm– 1-800-332-1088

• Seek medical attention if you have consumed a drug you think to be counterfeit

What’s being done to stop Pharmaceutical drug abuse?

• State-wide Electronic prescription monitoring programs

• National Electronic Prescription Monitoring Program– Proposed as the National All Schedules Prescription Electronic

Reporting (NASPER) Act of 2002. – Signed by President Bush on Aug. 11, 2005 – It tracks Schedule II, III, and IV drug prescriptions– Pharmacists would report:

• The patient's identification number• The drug, date, and quantity dispensed• The prescribing physician• The dispensing pharmacy.

– Data entered into the NASPER system could be used to track:• Patient drug use• Prescribing patterns of medical practitioners• Prescription rates and patterns for specific drugs• Prescription patterns in specific geographic locations• Prescription patterns for longtime users

Sources

• http://www.usdoj.gov/ndic/pubs11/12620/pharma.htm• http://www.fda.gov/oc/initiatives/counterfeit/

report02_04.html• http://www.fraud.org/fakedrugs/• http://pubs.acs.org/cen/coverstory/8145/8145drugs.html• https://nsduhweb.rti.org/• http://www.nasper.org/nasper_becomes_law.htm