Pharmaceuticals

Pharmaceutical controlled substances, which include narcotics, depressants, and stimulants, are a growing drug threat to the country. Pharmaceutical controlled substances are commonly diverted through fraudulent prescriptions, unscrupulous physicians and pharmacists, and theft. The number of armed robberies of pharmacies has increased substantially over the past 2 years. These robberies have particularly targeted the Schedule II narcotic OxyContin, which commands a very high street value.

Diverted narcotics such as hydrocodone, oxycodone, and codeine are available in drug markets throughout the country, and this availability may be increasing. The overall demand for diverted narcotics is high and increasing, as are the consequences associated with their abuse.

Depressants, including benzodiazepines and barbiturates, are available and abused throughout the country to varying degrees. The abuse of depressants appears to be increasing, and abuse of the benzodiazepine Xanax in particular has increased notably in some eastern states.

The availability of diverted stimulants is increasing in most areas of the country, largely because of sharp increases in stimulant prescriptions since 1990. And while reporting from law enforcement agencies indicates a rise in stimulant abuse, data from drug consequence studies show declines in ED mentions for stimulants.

NDTS data show that 2.7 percent of state and local law enforcement agencies nationwide identify diverted pharmaceuticals as their greatest drug threat. Regionally, more state and local law enforcement agencies in the Florida/Caribbean (6.9%), Mid-Atlantic (4.3%), Southeast (4.1%), Great Lakes (3.7%), and New England regions (2.8%) identify diverted pharmaceuticals as the greatest drug threat than do their counterparts in the New York/New Jersey (1.8%), Pacific (1.4%), Southwest (0.6%), and West Central regions (0.0%).

NDTS data further reveal that 70.0 percent of state and local law enforcement agencies nationwide identify the availability of diverted pharmaceuticals as high or medium, while 20.2 percent indicate availability is low. Just 7.1 percent of state and local law enforcement agencies nationwide report that diverted pharmaceuticals are not available in their jurisdictions.

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Narcotics

Pharmaceutical narcotics are diverted and abused for the euphoric effects they produce. Narcotics such as hydrocodone, oxycodone, hydromorphone, and codeine are available throughout the country, and law enforcement reports indicate that availability is increasing.

Hydrocodone is the most available and abused of the pharmaceutical narcotics. A semisynthetic opioid structurally related to codeine, hydrocodone produces opiate-like effects similar to those of morphine. DEA reports that the diversion and abuse of hydrocodone drugs increased sharply since 1990, and DEA Field Divisions in Atlanta, Chicago, Dallas, Houston, Los Angeles, New Orleans, and San Francisco report that Vicodin, Lorcet, and Lortab are the most commonly encountered hydrocodone drugs in their areas. Moreover, data from the National Association of State Controlled Substance Authorities (NASCSA) 2001 Survey indicate that, overall, hydrocodone--particularly Vicodin--is the most abused and diverted pharmaceutical in the 34 states surveyed.

The availability of diverted oxycodone drugs such as OxyContin, Percocet, and Percodan is rising. Reporting from most DEA Field Divisions, HIDTAs, and sources in Pulse Check sites indicates that the availability and abuse of oxycodone drugs, particularly OxyContin, are increasing in their areas. According to NASCSA, oxycodone is the second most abused and diverted pharmaceutical.

The abuse of OxyContin, a central nervous system depressant with heroin-like effects, is most prevalent in eastern states, particularly in the Mid-Atlantic and New England regions. Over the past year, however, abuse has spread to every region of the country. In many areas where increasing abuse of OxyContin has been reported, law enforcement agencies also have noted increased pharmacy thefts. Moreover, reporting from some HIDTAs and local law enforcement agencies in areas where OxyContin abuse emerged, such as western Pennsylvania and Maine, suggests that recent increases in heroin abuse may be due to OxyContin abusers switching to heroin. Not only is heroin less expensive but efforts to control the diversion of OxyContin may be reducing the availability of OxyContin in some areas. The use of heroin as a substitute for OxyContin has been reported in 12 of 20 Pulse Check sites.

Hydromorphone (Dilaudid) and codeine also are commonly diverted throughout the country, but they generally are abused less frequently than hydrocodone and oxycodone drugs. Six DEA Field Divisions (Dallas, Houston, Los Angeles, New York, San Francisco, and Seattle) and four HIDTAs (Atlanta, Houston, Milwaukee, and Washington/Baltimore) report the availability and abuse of codeine in their areas. The DEA Houston Field Division identifies increases specifically in the abuse of codeine cough syrups.

The demand for narcotics is high and appears to be increasing overall. The NHSDA reports that nearly 8.4 million people abused narcotics (pain relievers) in 2001--more than the number who abused cocaine or heroin. Among individuals aged 12 and older the rate of past year nonmedical use of pain relievers increased significantly between 2000 and 2001 (2.9% to 3.7%), and in both years, the rates were higher than those for any other drug except marijuana. NHSDA data further show that the number of lifetime nonmedical OxyContin users escalated from 221,000 in 1999, to 399,000 in 2000, to 957,000 in 2001. According to MTF data, past year use of narcotics other than heroin increased significantly among young adults (19-28) from 4.1 percent in 2000 to 5.0 percent in 2001. In 2002 the MTF questioned students regarding use of Vicodin and OxyContin; because this is the first year such data were collected, there are no trend data. In 2002, 2.5 percent of eighth graders, 6.9 percent of tenth graders, and 9.6 percent of twelfth graders reported past year use of Vicodin, while 1.3, 3.0, and 4.0 percent of eight, tenth, and twelfth graders, respectively, reported past year use of OxyContin.

The consequences associated with the abuse of narcotics are increasing as well. DAWN data show that between 2000 and 2001 the estimated number of ED mentions for hydrocodone drugs rose from 20,098 to 21,567, while those for oxycodone drugs increased significantly from 10,825 to 18,409 over the same period. DAWN data for hydromorphone were incomplete in both 2000 and 2001, while ED mentions for codeine declined during those years from 1,155 to 930.

According to TEDS data, admissions to publicly funded treatment facilities for abuse of narcotics other than heroin increased 41 percent from 1994 (15,436) to 1999 (21,758), when they accounted for 1 percent of all TEDS admissions. Much of this increase likely is due to an increase in the number of individuals seeking treatment for OxyContin abuse. The American Methadone Treatment Association reports an increase in the number of patients admitted to methadone treatment for OxyContin abuse. Moreover, treatment programs in Kentucky, Pennsylvania, and Virginia report that 50 to 90 percent of newly admitted patients in 2001 identified OxyContin as their primary drug of abuse.

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Depressants

Pharmaceutical depressants--the most frequently prescribed of which are benzodiazepines and barbiturates--cause relaxation and reduced anxiety; thus, they often are used to treat anxiety and sleep disorders. Depressants are diverted and abused throughout the country to varying degrees. Law enforcement reporting indicates that while benzodiazepines such as alprazolam (Xanax) and diazepam (Valium) are widely available and abused in every region, the availability and abuse of barbiturates such as pentobarbital (Nembutal) and secobarbital (Seconal) are rarely reported. DEA Field Divisions and HIDTAs report that the availability and abuse of benzodiazepines, Xanax in particular, have increased in several areas of the country but primarily in eastern states and particularly in Florida. No DEA Field Division or HIDTA reports significant availability or abuse of barbiturates.

The consequences of depressant abuse generally are rising. According to DAWN, the estimated number of ED mentions increased significantly for both benzodiazepines (91,078 to 103,972) and barbiturates (7,102 to 9,506) between 2000 and 2001. DAWN data show significant increases in ED mentions for alprazolam between 2000 and 2001 (+16.0%), 1999 and 2001 (+25.2%), and 1994 and 2001 (+49.4%). Likewise, TEDS data show the number of admissions to publicly funded treatment for abuse of benzodiazepines increased from 3,693 to 4,153, while the number of admissions for abuse of barbiturates decreased from 1,118 to 1,030 between 1998 and 1999.

Stimulants

Pharmaceutical stimulants increase alertness and energy and improve concentration; consequently, they are prescribed largely to treat attention deficit disorder (ADD), attention deficit hyperactivity disorder (ADHD), obesity, and narcolepsy. The availability of diverted pharmaceutical stimulants such as dextroamphetamine (Adderall and Dexedrine) and methylphenidate (Concerta, Metadate, Methyline, and Ritalin) is increasing in most areas of the country. DEA and HIDTA reporting indicates that the diversion and abuse of stimulants--Ritalin and Adderall in particular--are increasing. Law enforcement reporting identifies college students as the most common abusers of stimulants, although others abuse stimulants as well. Adolescents, for example, often are identified as abusers of Ritalin.

A sharp rise in the number of prescriptions for Ritalin and Adderall appears to be contributing to the increased availability of these drugs. According to DEA, approximately 2,000 prescriptions per year were written for methylphenidate (usually for Ritalin) before 1991. By 2000, this number had increased to approximately 11 million per year. The number of amphetamine prescriptions (usually for Adderall) also increased from approximately 1.3 million in 1996 to approximately 6 million in 1999.

Despite reports of increased availability, the abuse of stimulants and the consequences of that abuse appear to be declining. MTF data indicate that between 2001 and 2002 use of Ritalin declined for eighth (2.9% to 2.8%) and twelfth graders (5.1% to 4.0%) and held steady at 4.8 percent for tenth graders. According to DAWN data, ED mentions for methylphenidate declined between 2000 (1,487) and 2001 (1,279), continuing a general decrease since 1997.

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