homes, but securing prescription drugs may be a less obvious necessity (Dittmann Tracey, 2014). People who are seeking drugs do their best to blend in by dressing in businesslike attire, asking questions that make them appear interested, and displaying typical behaviors – like asking to use the bathroom. While in the bathroom unsupervised, they raid the medicine cabinet of prescription drugs. Such criminals can have very busy and productive days moving from one open house to another. Homeowners who have laborers working on projects in their homes have also reported drugs being stolen from medicine cabinets. Another unsuspecting target is the grocery shopper who picks up a prescription at the in-store pharmacy and proceeds with grocery shopping. The burglar patiently waits for the shopper to be distracted from his or her cart and then moves in to steal the medication. Like homeowners, shoppers may be accustomed to safeguarding their wallets, but it may not occur to them that their prescription drugs are equally vulnerable targets of theft. Prevention groups have launched programs that include flyers and pamphlets aimed at customers, homeowners, and real estate agencies that suggest picking up prescriptions as the last stop when shopping and safeguarding them at home by keeping them in a secure location (see Figures 1 and 2).
employees, not only from pharmacies but also from hospitals, senior-living facilities, veterinary clinics, and dental offices (California State Board of Pharmacy, 2013; Muha, 2017). Drug- seekers have traditionally forged prescriptions by using acetone to dissolve ink on paper prescriptions (North Carolina Board of Pharmacy, 2017). However, now that the Centers for Medicare and Medicaid Services (CMS) mandates electronic prescribing for patients with Medicare Part D plans, electronic prescriptions are more common (CMS, 2014). The major impetus behind “e-prescribing” was greater accuracy and safety. However, the new technology is also being seen as a way to prevent forgery of prescriptions for controlled substances and of tracking such prescriptions (Lucas, 2016; Myers-O’Shea, 2016). New and less-anticipated methods of gaining prescription drug access have recently come to light. Preventing Prescription Abuse in the Workplace, a project funded by the Substance Abuse and Mental Health Services Administration (SAMHSA), has called attention to some of the less than obvious sources of illegally obtained prescription drugs (RTI International, 2018). These sources include prescription drugs stolen from homeowners during open houses and from people shopping in grocery stores. Unsuspecting homeowners may know to secure cash and checkbooks before allowing strangers into their
Figure 1: Open House Flyer
Figure 2: Grocery Cart Theft Flyer
Common prescribing practices Diversion of prescription drugs cannot be fully discussed without noting some striking statistics related to access to prescription drugs. It is well documented that access to prescription drugs is quite easy for many. This situation is further exacerbated by current prescribing practices that provide patients with quantities of prescribed drugs in excess of those needed to treat their health-related issues. Little has been written linking the prescribing of CNS depressants and stimulants to prescription drug abuse (Ahmed & Virani, 2017; Lembke et al., 2018). In contrast, prescribing practices involving opioids have come under greater scrutiny as the epidemic of prescription drug abuse is more closely examined and prevention measures are put into action. Organizations such as the NIH, NIDA, the American Dental Association (ADA), and the American Medical Association (AMA) have been watchfully surveying this topic. Between 1991 and 2009 more than 200 million opioid prescriptions were written – a staggering number that reflects a near threefold increase during that time period (NIDA, 2011a). According to the American Society of Addiction Medicine (2016), in the United States in 2012, approximately 259 million opioid prescriptions were written, enough for one bottle of pills for every U.S. adult. Some literature on this topic is focused on younger patients because they have been identified as a population at greater risk for addictive behaviors. One NIDA study that drew data from more
than 35,000 U.S. pharmacies showed that in 2009 nearly 12% of all opioids prescribed were written for young patients between 10 and 29 years of age (NIDA, 2011a). Of this group, dentists were identified as the main prescribers for patients who were between 10 and 19 years of age. The frequency of prescribing practices for opioids was also examined. The findings suggest that 56% of the opioid analgesic prescriptions were offered to patients who had previously received prescriptions for pain in the past 30 days, some of which came from the same provider (Volkow et al., 2011). A 2011 study at the University of Utah Health Sciences Center reported that more than two-thirds of patients who underwent a urological surgical procedure had leftover pain medication and more than 90% of those patients decided to keep the prescription drugs in their medicine cabinets (Bates et al., 2011). A nationwide survey conducted by the University of Pittsburgh School of Dental Medicine found that although oral surgeons reported prescribing, on average, 20 tablets of an opioid pain reliever (e.g., Vicodin or Percocet) after third molar extraction surgeries, only 8 to 12 tablets may be required to alleviate the postoperative pain associated with the procedure (Oakley et al., 2011). A study of approximately 2.7 million Medicaid patients who had undergone surgical tooth extractions between the years 2000 and 2012 found wide variations in the amount of opioids prescribed, although there did appear to have been a pattern of
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