Drug Diversion and Abuse: The Future of Analgesic Drugs

John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at linkEmail('burke','choice.net');, via the Web site www.rxdiversion.com, or by phone at 513-336-0070.

Undoubtedly, a huge spike in theprescribing and dispensing ofprescription pain products hasoccurred over the past few years in theUnited States. Certainly the issues andeducation surrounding legitimate painmanagement have helped to increaseprescribing, offering pain relief to thousandswho were very likely undertreatedor not treated at all for pain.

A good example of this comes frommy own family. My mother-in-law is atrue chronic pain patient and probablyhas been one for several decades, eventhough she was not identified as oneuntil fairly recently. She has had countlesssurgeries on her leg since she was ayoung girl, and it is now essentially fusedtogether and cannot be bent. She sufferswith pain constantly and only gauges agood day by the reduction in pain, notthe elimination of pain.

Until just a few years ago, she receivednothing from her physician for pain. Shehad been told 40 years ago by her physicianbefore he died, "Never take anythingstronger than aspirin, or you will becomean addict." So, of course she never did,and the pain became excruciating. Wewere eventually able to get her to a painspecialist, and he started prescribingneeded heavy-duty medication that hassince improved the quality of her life bya substantial amount.

The truth also remains that if theprescribing of a controlled substanceanalgesic increases, so does drug diversion—it is simply a matter of numbers. Ifeel it also is true that if a pharmaceuticalproduct is a great pain reliever, it also isa great drug to achieve the high soughtby addicts and recreational users worldwide.The pharmaceutical company orcompanies that can make a great prescriptionpain reliever, while significantlyreducing the instances of diversion, willtruly make enormous strides in treatingchronic pain and reducing abuse.

This is obviously not an easy process,but it is one in which some major pharmaceuticalcompanies are investing millions,if not billions, of research dollars.I am sure it would be easy to make adrug virtually diversion-proof, but alsomaking it effective is the balance thatthese companies are striving to accomplish.I am sure it could be encased in ahardened steel ball, making it impossibleto abuse but also ineffective as a painreliever.

As pharmacists, over the next fewyears, you are likely to see several newprescription pain products that will beavailable in your arsenal to treat bothacute and chronic pain. These productswill have had extensive research, andthe companies will have developed amandated risk management plan—manyof those plans being elaborate attemptsto cover all of the bases and provide thebest product they can.

I applaud all of these companies becausethe road to approval is long andsometimes rocky, to say the least. Then,after approval and an expensive riskmanagement program, it is possible thatan individual who was not even prescribedthe drug will take a couple handfulsof the pain reliever, overdose, anddie, as has happened in the past—then,lawsuits fly.

The best reason for these companiesto develop these products is that if theyare effective, it will reduce drug diversion,which will better ensure that legitimatepain patients receive the propermedication and achieve a better qualityof life. That is hopefully something weare all striving for in the end.