two separate sites, one governmental and the other illicit (Dart et al., 2016). Table 3: Example of a StreetRx Display for Adderall Pricing Prices for Adderall - USA □ Include products with the same active ingredient $5 Jun 16, 2019 Adderall, 5mg pill New Jersey Rate: $$$$$$ $5 Jun 16, 2019 Adderall, 10mg pill Houston, Texas Rate: $$$$$$ $25 Jun 16, 2019 Adderall, 15mg pill Los Angeles, California Rate: $$$$$$ $4 Jun 16, 2019 Adderall, 20mg pill Missouri Rate: $$$$$$ $10 Jun 16, 2019 Adderall, 20mg pill Kentucky Rate: $$$ $$$ $5 Jun 16, 2019 Adderall, 30mg pill North Dakota Rate: $ $$$$$ $15 Jun 16, 2019 Adderall, 30mg pill Meridianville, Alabama Rate: $$$$$ $ $10 Jun 16, 2019 Adderall, 30mg pill Ohio Rate: $$$ $$$ $10 Jun 16, 2019 Adderall, 10mg pill Poughkeepsie, New York Rate: $$$$$ $ The economic impact of opioid abuse has also been studied. In 2005, White and colleagues examined the medical and pharmacy claims of 16 self-insured employer health plans from 1998 to 2002. Their study included data from more than 2 million people; their findings concluded that: Opioid abusers, compared with nonabusers, had significantly higher prevalence rates for a number of specific comorbidities, including nonopioid drug poisoning, hepatitis (A, B, or C), psychiatric illnesses, and pancreatitis, which were approximately 78, 36, 9, and 21 (p < 0.01) times higher, respectively, compared with nonabusers (White et al., 2005). These higher prevalence rates translated into increased hospital costs to treat these patients; treatment costs for opioid abusers were 12 times higher than for those who had no abuse activity for the same drug (White et al., 2005). One cost of prescription drug abuse that has come under increasing scrutiny is the role of prescription drugs as gateway drugs to heroin abuse. For people who have become addicted to prescription opioids and now find that they are difficult to access or too expensive, heroin may become the alternative (CDC, 2014; Muhuri et al., 2013; NIDA, 2018g; Sacco et al., 2018). As the U.S. epidemic of prescription drug abuse expands, so do its estimated societal costs. Until the root of the cause is sufficiently addressed, these costs will continue to escalate, placing a huge burden on our nation’s future (Birnbaum et al., 2011). with a beverage right out in the open – in “public.” Their drug use produces no smoke, no residual smell, requires no needles or “paraphernalia” – just some liquid to help those abusers who cannot “dry swallow” the pill(s) that were likely taken from or given to them by a friend or family member. Raiding an elderly relative’s medicine cabinet is far safer than meeting a drug dealer on a street corner.
who engages in the act of “doctor shopping” – going from doctor to doctor, complete with expensive diagnostic tests and emergency room visits, for the purpose of acquiring prescription drugs – costs an insurer from $10,000 to $15,000 annually (CAIF, 2007; Hansen et al., 2011). According to the Pew Charitable Trusts (2017), annual costs of prescription opioid misuse, overdose, and dependence include $28.9 billion in health care costs (with patients with an OUD incurring annual additional costs of approximately $18,000). Society pays another $7.6 billion in criminal justice costs (with 96% of these costs falling on state and local governments). The estimated annual cost of lost productivity is $41.8 billion with 7 in 10 employers experiencing “issues associated with prescription drug misuse, such as employee absenteeism, decreased job performance, and injury.” The remarks of an addict, posting under the pseudonym punkin0201 in reaction to the CNNMoney article, are troubling: I am a recovering addict (from prescription pain pills) and I currently have 2 years clean. What I still say to this day is that it is sad that not only are these prescriptions given out like candy (I was being prescribed 360 Percocet [pills] a month), but insurance companies will only charge you the copay to get them. So pretty much for $5, my copay for generic, I was getting all of those pills. But the truly sad part is that when I needed to go to rehab to try to arrest my addiction, that same insurance that let me pay $5, would only pay for and allow me to stay in rehab for 8 days, when it was recommended that I stay 45 days (O’Toole, 2012). The CAIF report compared the 2007 retail price and street value of several prescription drugs known to be most commonly abused. The report noted that retail prices were supplied by Walgreens.com, whereas street values were obtained from a group of sources (including information gathered from police representatives; the Office of the Attorney General of Kentucky; and the Warren County, Ohio, Drug Task Force). According to this report, several drugs – including: oxycodone 40mg, Ritalin, Adderall, Vicodin, hydrocodone/APAP (with acetaminophen), Valium, diazepam, Adipex, Xanax 2mg, and alprazolam – could be bought on the streets for less than $10 a pill (CAIF, 2007). A CNN Money report of 2011 revealed that prices had not changed substantially (Kavilanz, 2011). The website StreetRx.com uses crowdsourcing to identify and track the street value of prescription as well as illicit drugs. The site shows current prices for each drug in various parts of the country (StreetRx.com, n.d.). Table 3 shows an example of a StreetRx display for Adderall. For comparison, as of late June 2019, one website was showing that a single 30 mg Adderall capsule, sold in a bottle of 60, was selling in pharmacies around the country for approximately $7.50. A 10 mg capsule in a bottle of 7 was being sold for approximately $8.50 (PharmacyChecker. com, n.d.). StreetRx users can anonymously post, view, and rate submissions. This site offers an inside look at the black market. By providing invaluable information about the preferences of users, health communication specialists can adapt outreach efforts to the needs of their communities (StreetRx.com, n.d.). As of 2016, the prices reported on this site had been validated by Prescription drug acceptability Use of illicit or street drugs conjures up images of abandoned houses in questionable neighborhoods, violent crimes, police raids, assorted weaponry, and unsavory characters lurking in dark alleys. In contrast, abuse of prescription drugs often occurs in an entirely different world. Prescription medicines are perceived to be high in benefit and low in risk (Slovic et al., 2007). As a part of this thought process, abusers will note that these drugs are FDA-approved, prescribed by a licensed doctor, and dispensed by pharmacists. Although some abusers choose to inject or crush their prescription drug of choice, many can simply wash it down
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