Prescription Drug Abuse Trends, Part II: Class 4

Pharmacy Times, Volume 0, 0

Many people think that Class 3 drugs are the most abused pharmaceuticals. However, Class 4 drugs, especially the benzodiazepines, represent a very significant part of the prescription drug abuse problem.

A few months ago, Florida Governor Jeb Bush?s daughter attempted to call in a phony prescription for alprazolam. For the first time, many Americans may have become aware that alprazolam can be a drug of abuse sought after by those diverting pharmaceuticals.

In traveling extensively across the United States and communicating with law enforcement and healthcare professionals, I have found that alprazolam seems to have emerged as the number 1 benzodiazepine of abuse. I have been told that alprazolam has the ability to get into the bloodstream faster than other drugs of its type?a sensation that drug seekers often crave.

In Warren County, OH, where I became the commander of the drug task force in 1999, the most common prescription drug that we purchased through illegal trafficking in 2001 was alprazolam. Street values of $2 to $4 a pill, depending on strength, are commonplace across the United States.

Diazepam, a drug that has long been thought of as the most abused benzodiazepine, certainly continues to be popular among those diverting pharmaceuticals. We had a case years ago in which a drug seeker was seeing multiple veterinarians for his dog, Dolly. He would indicate that Dolly had a lot of anxiety, and what took care of her problem was Valium. He would see 5 veterinarians every month, who had no knowledge that Dolly was receiving some very high doses of diazepam. If Dolly did have anxiety, she never received any of the drugs for her problem. A very sharp pharmacist discovered this scam and notified our office. The street value of diazepam is usually slightly lower than that of alprazolam, often $1 to $3 a dose, depending on strength.

Addiction to benzodiazepines can reach some very high levels?20 to 30 pills a day or higher. As most of you know, a cold-turkey approach to those at this stage of addiction to benzodiazepines can be fatal. Benzodiazepines also seem to be the drugs of choice for poly substance abusers. These drugs are often consumed in conjunction with many other substances, including alcohol and a variety of prescription pain relievers.

Propoxyphene, although not thought of as a heavy-duty pain reliever, has a small, dedicated following in the abuse world. Many physicians and pharmacists may not be as wary of a drug seeker when he or she is requesting propoxyphene instead of hydrocodone or oxy-codone. However, propoxyphene may very well be a particular drug seeker?s prescription drug of choice. Years ago we arrested a police officer who was ?doctor shopping? for propoxyphene. He was swallowing 15 to 20 Darvocet?N 100s a day.

Although the diversion of butor-phanol tartrate has subsided some since it became a Class 4 drug in 1997, it still remains a drug that can cause considerable problems for those prone to abuse prescription drugs. Some people became very dependent on this substance in a fairly short time. One woman obtained more than $30,000 worth of this drug in about a year. She accomplished this by soaking prescriptions in acetone to remove the ballpoint-pen ink, and then she wrote prescriptions for herself for Stadol Nasal Spray.

Class 3 and Class 4 drugs account for a significant amount of the abuse of prescription drugs in this country. Noncontrolled prescription drugs can also be heavily sought after and abused. Next month we will examine some of those drugs that most people may think are not a problem with prescription drug seekers.

John Burke, director of the Warren County, OH, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad, is a 32-year veteran of law enforcement.

For information, he can be reached by e-mail at

, by phone at 513-336-0070, or via the web site www.