Guidance for state medical boards and HCPs in office-based OUD treatment is available. The FSMB Model Policy on DATA 2000 and Treatment of Opioid Addiction in the Medical Office may be downloaded
from the following link: http://legalsideofpain.com/ uploads/FSMB-2013_model_policy_treatment_opioid_ addiction.pdf.
DIVERSION
Diversion of CS a significant public health problem that contributes to harm in the form of increased fatal and nonfatal overdoses, criminal activity, ED visits, and SUD development. The economic burden of opioid misuse reaches $78.5 billion a year in healthcare, lost productivity, addiction treatment, and criminal justice costs. 87 Diversion occurs any time a prescribed,
controlled medication is deflected from its intended medical source to an unintended purpose and can occur at any point along the supply chain. Common types of diversion are shown in Table 6. 25 Diversion and misuse create a loop that leads to more overdoses deaths and widespread development of SUDs. 17
Table 6. Common Types of Drug Diversion
Method Definition Selling Prescription Drugs Patients and non-patients sell prescription drugs that were obtained illegally “Doctor Shopping” Soliciting multiple prescribers under false pretenses to obtain CS prescriptions Illegal Internet Pharmacies Rogue websites under the guise of legitimate pharmacies provide CS to people without prescriptions, evading state licensing requirements, operating across state and international borders Theft May occur at any step of the supply chain (examples: manufacturers, patients, patient’s relatives or friends, HCPs, pharmacists) Prescription Pad Theft and Forgery Printing or stealing prescription pads to write fraudulent prescriptions, altering existing prescriptions to obtain unauthorized quantity Illicit Prescribing Providing unnecessary prescriptions or larger quantities than medically necessary (i.e., “pill mills”)
CS = Controlled substances HCPs = Health care providers
Most misused opioids are obtained through diversion. Year after year, the National Survey on Drug Use and Health, conducted annually by SAMHSA, reports that most people who misuse prescription opioids either bought them, were given them, or took them without asking from family members or friends. 88 About a third of people who misuse opioids get them by prescription from one doctor. 88 Leftover pills from acute pain prescriptions are a chief source of diverted and misused opioids. One systematic review found that 42% to 71% of opioids obtained by surgical patients went unused. 89 Leftover CS in medicine cabinets can then become a significant source for diversion. Patients should be counseled never to share opioids or other CS with any other person and to store opioids
in a locked area away from other family members and visitors. 44 Certain medications are highly sought for diversion as identified by the DEA and NIDA and shown in Table 7. 25 Some prescription drugs sell on the street for as much as $50 a pill and, unfortunately, some patients sell the drugs prescribed to them as a way of earning money to pay expenses or to finance their desire to buy street drugs. 17 To be clear, most patients who take opioids for pain do not misuse or divert their pills. 88 However, HCPs should understand that some people who visit a medical facility for pain are actually seeking opioids to divert or misuse and take relevant precautions to prevent diversion as required by the DEA. Some patients may have the disease of OUD and should be managed accordingly.
Book Code: TN24CME
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