Drug Diversion and Abuse: DEA Allows Rx Returns

Pharmacy Times, November 2014 Cough & Cold, Volume 80, Issue 11

Recently, US Attorney General Eric Holder announced a new Drug Enforcement Administration (DEA) regulation that allows hospitals, pharmacies, clinics, and other authorized entities to provide drop-off locations for outdated or unused prescription drugs. Nursing homes will also be allowed to collect medications turned in by their residents, and the general public will have the option of mailing in their medications to authorized collection companies. Holder and the DEA feel that this new regulation, which went into effect in October 2014, will help to curb the rising prescription drug problem in America.

It’s interesting, no matter what you think of this move by the DEA, that it has is being done well after the peak of the prescription drug epidemic in the United States. I’m not saying that there still isn’t a huge problem, but our federal government always seems to be 1 or 2 steps behind the times!

The launch of abuse-deterrent formulation (ADF) OxyContin in August 2010 started the decline in the street prices and the diversion of this pharmaceutical. This was followed by ADFs for other prescription drugs, and now the 2 biggest extended-release hydrocodone products being marketed by Purdue Pharma and Zogenix seem to be on a path for approval and marketing in late 2014 and early 2015. These new formulations are a good thing, of course, and will ultimately help legitimate pain patients get their needed medications while diversion issues stay in check.

Unfortunately, the cartels took notice of OxyContin’s new formulation and began marketing cheap heroin to try to take its place. Today, much of the country suffers from heroin addiction and a spike in overdose deaths. With these new ADFs, I don’t see heroin going away any time soon. Blaming the pharmaceutical companies for the heroin outbreak seems ludicrous, but some individuals are doing just that.

I always felt there was good reason for the DEA’s ban on patients returning their medications to a pharmacy. The ability to return medications could create significant problems by allowing drug-dependent or addicted employees to access the medications for their own pleasure or by tempting independent pharmacies to recirculate returned drugs to increase revenue. This new regulation has come even though DEA take-backs have been successful twice a year and Rx drop boxes have sprung up all over the country (www.rxdrugdropbox.org) and are available 24/7 in some locales.

I realize that the vast majority of pharmacy employees and independent pharmacies will not abuse this new regulation, but those that do will be thrust into the media limelight. They won’t represent the norm, but the media attention will make the abuse appear to be commonplace.

Before this new regulation, long-term care facility medication returns and discontinuations were a potential target of abuse by nursing personnel. I am concerned that pharmaceutical returns by long-term care facility residents will be an added temptation for facility staff with addiction problems.

Although I am somewhat skeptical, I hope this new regulation helps to continue to curb prescription drug abuse in America. However, sometimes we forget why regulations are in place, and in good faith they are changed, resulting in a bigger problem.

In the meantime, let’s encourage the public to get outdated and unused pharmaceuticals out of their medicine cabinets and into the hands of responsible parties that will ensure proper disposal. This, coupled with patients properly securing the medications they do need, can help reduce drug diversion and abuse.

Go to www.guardyourmeds.org for information from the National Association of Drug Diversion Investigators on how to safely deal with patients’ medications.

Cmdr Burke is commander of the Warren County, Ohio, drug task force and retired commander of the Cincinnati Police Pharmaceutical Diversion Squad.