Collaboration is Key to Deterring Drug Diversion Without Reducing Appropriate Prescribing

LAS VEGAS—Providers and law enforcement must work closely together to prevent drug abuse while ensuring adequate treatment for patients with pain, said Stephen J. Ziegler, PhD, JD, of Indiana University-Purdue University, in Fort Wayne, Indiana, and Marc Gonzalez, PharmD, President of the NADDI of California to attendees of PAINWeek 2014.

Providers need to work with the DEA in a spirit of collaboration to foster a quid pro quo relationship of “how can we help” rather than “leave us alone,” they said. And law enforcement, in turn, needs to work to deter overprescribing, prescription drug diversion and illicit use without chilling the appropriate prescribing of medically necessary medications, they said.

Most prescribers behave reasonably and lawfully, Dr. Gonzalez was quick to note. Fewer than 2% of prescribers behave criminally. But those 2% are responsible for more than 90% of law enforcement activity on prescription drug diversion, he said. Most prescribers are “reasonable,” Drs. Ziegler and Gonzalez said. But “even the best can be duped by those with substance abuse or those motivated by profit,” they warned.

They called for new interactive approaches that encourage regulators and prescribers to collaborate on a continual basis. Part of that approach involves distinguishing between criminal and negligent prescribing. As opposed to criminal prescribers, negligent providers are those who do not profit from over-prescribing medications. These providers still contribute importantly to the drug diversion and illicit prescription painkiller use epidemics, but negligence cases are best handled administratively or civilly, Drs. Ziegler and Gonzalez said. Investigations can focus on rogue doctors or clinics, nurses, organized criminal groups, supply chains, insurance fraud, theft, doctor shopping, and unlicensed practices, Dr. Gonzalez said.

Red flags for bad actors – the very small minority of providers who run “pill mills” practices – include those who have multiple patients in each exam room, who diagnose patients in fewer than four minutes, tell patients where to fill their prescriptions (often at a nearby, small pharmacy), whose patients request specific drugs, and who perform no good-faith exams, Dr. Gonzalez reported. Another warning sign is when every patient “gets the same thing” prescribed to them, he added.

When it comes to patients, drug enforcement agencies must focus on distinguishing between people with substance abuse problems and “criminal profiteers,” concluded Dr. Gonzalez.

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