John Burke, commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 40-year veteran of law enforcement. Cmdr Burke also is the current president of the National Association of Drug Diversion Investigators. For information, he can be reached by e-mail at , via the Web site www.rxdiversion.com, or by phone at 513-336-0070.
Undoubtedly, a huge spike in the prescribing and dispensing of prescription pain products has occurred over the past few years in the United States. Certainly the issues and education surrounding legitimate pain management have helped to increase prescribing, offering pain relief to thousands who were very likely undertreated or not treated at all for pain.
A good example of this comes from my own family. My mother-in-law is a true chronic pain patient and probably has been one for several decades, even though she was not identified as one until fairly recently. She has had countless surgeries on her leg since she was a young girl, and it is now essentially fused together and cannot be bent. She suffers with pain constantly and only gauges a good day by the reduction in pain, not the elimination of pain.
Until just a few years ago, she received nothing from her physician for pain. She had been told 40 years ago by her physician before he died, "Never take anything stronger than aspirin, or you will become an addict." So, of course she never did, and the pain became excruciating. We were eventually able to get her to a pain specialist, and he started prescribing needed heavy-duty medication that has since improved the quality of her life by a substantial amount.
The truth also remains that if the prescribing of a controlled substance analgesic increases, so does drug diversion—it is simply a matter of numbers. I feel it also is true that if a pharmaceutical product is a great pain reliever, it also is a great drug to achieve the high sought by addicts and recreational users worldwide. The pharmaceutical company or companies that can make a great prescription pain reliever, while significantly reducing the instances of diversion, will truly make enormous strides in treating chronic pain and reducing abuse.
This is obviously not an easy process, but it is one in which some major pharmaceutical companies are investing millions, if not billions, of research dollars. I am sure it would be easy to make a drug virtually diversion-proof, but also making it effective is the balance that these companies are striving to accomplish. I am sure it could be encased in a hardened steel ball, making it impossible to abuse but also ineffective as a pain reliever.
As pharmacists, over the next few years, you are likely to see several new prescription pain products that will be available in your arsenal to treat both acute and chronic pain. These products will have had extensive research, and the companies will have developed a mandated risk management plan—many of those plans being elaborate attempts to cover all of the bases and provide the best product they can.
I applaud all of these companies because the road to approval is long and sometimes rocky, to say the least. Then, after approval and an expensive risk management program, it is possible that an individual who was not even prescribed the drug will take a couple handfuls of the pain reliever, overdose, and die, as has happened in the past—then, lawsuits fly.
The best reason for these companies to develop these products is that if they are effective, it will reduce drug diversion, which will better ensure that legitimate pain patients receive the proper medication and achieve a better quality of life. That is hopefully something we are all striving for in the end.
The Oncology Care Pharmacist in Health-System Pharmacy
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