Rx Abuse and Diversion 2013

Collaboration will be critical in the upcoming year.

As I have stated many times before in this column, I am the president of the National Association of Drug Diversion Investigators (NADDI), a nonprofit organization made up of individuals involved in the problem of prescription drug abuse. We recently concluded our 2012 annual conference in Nashville, Tennessee, and it made me think about the upcoming year and our challenges.

One of the questions we get from different entities is “What is the stance of NADDI on abuse-resistant opiates?” A few years ago when this question first came up, I thought just for a second that maybe it was some kind of trick question! This not only gets asked by multiple entities in different facets of industry, but also by the press.

The answer is, of course, that we are in favor of abuse-resistant formulations of controlled substances—and not just in opioids, but any controlled substance, as long as the efficacy is not compromised. And if that happens, the product won’t be on the market for long anyway. NADDI has testified and sent written positions to the FDA on this topic on several occasions. We can’t imagine why anyone would oppose making drugs that are being abused less abused!

Several pharmaceutical companies have drugs in the pipeline that hopefully will be abuse-resistant. This is on the heels of what has been a success with OxyContin and its reformulation and launch in August 2010. I measure success on this topic by ultimate street price and mere demand for the drug, both of which have taken a considerable plunge since the launch.

NADDI’s board meetings and conference also revealed a new project of hosting webinars in 2013 on the abuse of prescription drugs. These webinars hopefully will start in January 2013, with the first one being available to anyone who wants to sign on at no cost. After that, there will be no charge to attend the webinars, but you will need to be a NADDI member at a cost of $50 per year—and all pharmacists are eligible. Of course, there is much more value for your membership than just the webinars, and all of that can be perused at www.naddi.org.

The theme of this year’s conference was collaboration. Collaboration toward the goal of reducing prescription drug abuse has always been mandatory in my opinion. This means that law enforcement can’t arrest its way out of the problem, and neither can education and rehabilitation entities stay huddled in their own arenas, and expect the problem to be significantly reduced. It requires the 3 groups—enforcement, education, and rehabilitation—to come together and find solutions and programs that work. Hopefully, the enforcement regiments are also working on some educational programs, or are at least supporting them in one way or the other. One of the ways law enforcement can support education is through their asset forfeiture accounts.

These are accounts that have funds legally procured from criminals as the result of their illegal activities, often drug trafficking. Asset forfeiture accounts can be used for many things that further the prosecution of drug offenses. The education of the officers or general public about drug issues can certainly be one of them. For example, an agency can buy bullet-proof vests for its officers and with the same money help to support Red Ribbon Week at its local schools.

One of the problems anyone working in one of these 3 areas knows is that the 3 groups do not always collaborate well, causing the efforts of each of them individually to be less than effective. NADDI has always attempted to combat this by encouraging a diverse membership that doesn’t just put the emphasis on enforcement.

I see 2013 as once again being an interesting year, with the continued push for more abuse-resistant formulations of controlled substances, especially opiates. I think those approving the formularies from the payer standpoint are going to have to consider whether paying more for a drug that is abuse-resistant will ultimately cause a reduction in diversion and its costs.

As more of these products come to market—and if they are successful in reducing abuse—this hard choice of paying more now to pay much less in the long run will have to be addressed by insurance groups of all kinds, both public and private. I realize that these decisions will not be easy in 2013, but a lot is at stake.

Cmdr Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.