The Other Victim of Drug Diversion and Abuse: The Legitimate Patient with Pain

I have been in law enforcement for almost 48 years, a portion of which—especially the past 25 years—has been primarily devoted to fighting illegal drug trafficking. I include prescription drugs in this work because when they are diverted, they essentially become illegal drugs.

The prescription drug work is somewhat different than combating the distribution of common street drugs, because with the diversion and abuse of prescription drugs, there are 2 victims. Collateral damage is widespread regarding all illegal drugs, but with prescription drugs, there is another victim: legitimate patients with pain. These victims basically stay hidden in our society, mostly because they are physically and financially unable to protest, and have little ability to organize with a united voice. Severe pain mandates paying undivided attention to these victims.

The closest ally legitimate patients with pain'have is often the pharma industry, although it is often regarded as a group of money-hungry corporations that are only in business to increase their bottom line. When pharma does help individuals, much of the public considers it an unintentional consequence! On the contrary, the hundreds of individuals I have met in pharma have seldom given me the impression that money is more important than the patients.

The negative stereotype of pharma is typically fueled by the media and by politicians trying to further their careers.

Yet these same politicians likely take medications—perhaps even regularly to control cholesterol and manage heart problems—developed by the same pharma companies they villainize. Because patients with pain have little political power and the general public is outraged with the drug problem, politicians react accordingly, with no apparent understanding of pain management issues.

In my experience, the general public does not know much about pain medication or chronic pain, but considers pain medications, and those who take them, one of our top societal problems. Without question, drug abuse of all kinds is a considerable problem that costs us lives and more money than most individuals know. Therefore, it is understandable that our society, which hears little about the positive impact of pharmaceuticals on patients, has negative impressions of the drugs and, ultimately, those who use them.

Law enforcement may be the biggest violator of the problem, as it typically sees only one side of the situation: those who are violating the law with medications. We seldom consider patients with chronic pain when dealing with individuals illegally trafficking or possessing prescription drugs. Law enforcement officers might not like to admit it, but their experiences with drug-related crime, without having a close friend or family member who is a legitimate patient with pain, can cause them to develop a negative view of pain medications.

Pharmacists are the ones most involved with prescription drugs. Without question, you see a significant amount of drug diversion and abuse via the scams and excuses that you likely deal with on a weekly basis. You have every reason to be vigilant against diversion and abuse: not only is it the right thing to do, but it is also necessary for keeping your job and license because of the legal mandate of corresponding responsibility.

Pharmacists also see the other side of the prescription drug diversion and abuse problem: legitimate patients with pain. They come to your counter with debilitating physical problems that are only controlled with medications—some- times strong opiates. When these drugs are for acute pain, however, you may never see the affected patients again. You see other patients for the rest of their lives as they struggle to do daily tasks others take for granted.

My message is that we must never forget about legitimate patients with pain, who are still the consumers of most pain medications. They suffer enough with their physical ailments, so it is important that they do not become collateral damage in the pursuit of reducing prescription drug diversion and abuse. Let’s also remember that any of us could become a legitimate patient with pain someday.

Cmdr Burke is a 40-year veteran of law enforcement and the past president of the National Association of Drug Diversion Investigators. He can be reached by e-mail at burke@rxdiversion.com or via the website www.rxdiversion.com.