Prescription Drug Abuse - Analysis of Florida Times Union Article of 010804

Review These Books & Manuals On Relapse

Prescription Drug Abuse 
Analysis of Florida Times Union Article 
August 4, 20001

On August 4, 2001 R. Michael Anderson wrote an article for the Florida Times Union <go to the original articles> about prescription drug abuse and resulting prescription medication fraud.  The article attempted to summarize the tactics used by prescription drug addicts to fraudulently obtain prescription drugs and to discuss the costs of prescription drug abuse to society.  The article was incomplete, so I decided to follow the format of the article, remove the unnecessary anecdotal examples, and present a more accurate analysis of the problem.

Prescription drug abuse is a serious problem that can destroy families, claim lives, and costs billions of dollars annually.   Until recently the war on drugs has ignored prescription drug abuse, but beginning in 2000 they began gearing up for a national offensive on prescription drug abusers.  The primary target in this front in the war on drugs medication fraud, the crime c0ommitted by prescription drug addicts when they report false information or actually forge prescriptions in order to get the medication that they are addicted to.  

Although prescription drug abuse is primarily a medical problem that should be addressed by a public health addiction policy, the DEA and other aspects of law enforcement want to bring the full force of law to bear on people addicted to prescription drugs and the physician and pharmacists who intentionally or unwittingly provide those medications.  So the war on drugs focuses upon prosecuting prescription fraud and drug law violations rather than educating the public physicians and pharmacists about the nature of prescription drug addiction, how to intervene in a positive way that will result in prescription drug addicts seeking treatment, and investing to make community based treatment resources readily available.

Prescription fraud is a crime that is usually committed by people who have become addicted to prescription medication and then have their supply cut off without being referred to treatment.  The addicts untreated addictive thinking rationalizes the exaggeration or fabrication of symptoms, seeking drugs from many doctors at the same time, and using fraudulent prescriptions, often created by altering the quantity of number of refills. 

Anderson's article focused exclusively upon the criminal aspects of prescription drug abuse while ignoring the need to identify and intervene upon the underlying addictive illness that creates the need to commit the crime. 

Most people who commit prescription medication fraud are law-abiding citizens who wouldn't commit any other crime.  They are driven into prescription fraud by an addiction which is usually unrecognized by their physicians and even if it were recognized, it is unlikely that proper treatment would be unavailable because most of the war on drugs money is going into enforcement while treatment recourses are being down-sized or eliminated.  

The most common illegal acts, arranged in the order of frequency, used to acquire prescription drugs through fraud are;

     Exaggerating or Fabricating Symptoms:  Presenting exagerrated or fabricated symptoms to a Doctor in efforts to convince them to prescribe more drugs or stronger drugs than are necessary.  (This is, by far, the most common form that prescription drug abuse takes.)

     Physician Hopping:  Seeing more than one physician at a time and asking each to prescribe the same medication.  This is often called physician hopping.

     Diversion of Legitimately Prescribed Medications:  Many addicted people will offer to buy medication from patients who are receiving legitimate prescriptions for the medication.  This often happens because many seriously ill pain patients are unemployed and in desperate need of the cash that selling their medications can provide.

     Forging Prescriptions:  Steal prescription pads from medical offices and forge doctors' signatures.

     Fraudulent Calls To Pharmacies:  Telephoning pharmacies claiming to be a physician or an assistant requesting drugs for a patient. 

     Theft:  Robbing or burgalrizing pharmacies tpo steal the drugs.

     Low Level Drug Transactions:  Some people will buy, sell, and trade prescription drugs which is a technical violation of felony drug laws.  There are few "big time" dealers involved in the prescription drug trade.

The prescription drugs that are most commonly abused are the Opiate-based drugs such as:

      Lortab

     Valium

     Xanax

     Lorocet

     Percocet

     Vicadin

     OxyContin.  

The costs that occur as the result of prescription drug addiction.  These are:

1.   The pain and sufferring of the addicted people and their families.  This includes not only the anguish caused by the addiction itself but also the harsh punishments imposed as our nation's drug warriors crack down and begin imprisoning addicted people for using and low level distribution of prescription drugs.

2.    Increased insurance Costs:  Increased insurance costs as a result of excessive doctors visits and excessive use of medication benefits that are passed on to all consumers.  No estimates were reported indicating what that cost might be

3.    Increased Crime:  Increased crime in the form of various aspects of prescription fraud including burglary, theft, and diversion of prescription drugs. 

4.    Increased Cost Of Enforcement:  As the DEA is cracking down on prescription drug abuse large amounts of money are spent in investigative work with known prescription drug abusers, pharmacies, and physicians.  These investigations are typically targeted on the addicted users who are often small time dealers supporting their personal addiction.  

5.    Lost Productivity Due To Criminal Justice Actions:  Most prescription drug abusers are employed.  When arrested for prescription drug abuse many are terminated from their jobs and have difficulty finding new employment.  

6.    Costs of Incarceration & Criminal Justice Monitoring:   Many prescription drug abusers are arrested, prosecuted, and sentenced for drug crimes surrounding their prescription  drug addiction.  Some enter court diversion programs and receive treatment in the community while being supervised by drug courts and/or probation departments.  Others are incarcerated in jails and prisons.  

 The costs involved in increased enforcement, lost productivity due to criminal justice actions, and the costs of incarceration and criminal justice monitoring could easily exceed all other cost factors involved in prescription drug abuse.  

Clay County Florida provides atypical example of how law enforcement is organizing to combat prescription drug abuse.  To crack down on the problem, the sheriff's office has:

1.    Assigned an investigator full time to prescription drug abuse cases

2.    Initiated a drug court to keep offenders out of jail but under close supervision while they go through a one-year program that involves counseling, frequent drug testing and regular court appearances.

3.    Launched intensive investigations to identify prescription drug addicts and the physicians and pharmacies that provide them with their drugs.  this has involved having investigators visit each individual pharmacy and attempting to enlist the pharmacist as informants about people who might be abusing prescription drugs.

4.    Asking pharmacists to require photo identification from everyone with a prescription

5.    Asking pharmacists to keep doctors' signatures on file to compare with signatures on prescriptions

6.    Calling physicians to verify prescriptions

7.    Securely dispose of all paperwork containing patient information

8.    Calling police if they think someone has submitted a phony prescription.

So, what is a pharmacist supposed to do if they suspect someone of prescription drug abuse.

Step 1:  Call the physician's office to verify the prescription

Step 2:  If the prescription cannot be verified, don't fill it

Step 3:  Explain the problem to the customer and ask them to talk with their physician.

Should a pharmacist call the police?  If the pharmacist is not in danger and the amount is obviously for personal use, I'd say no.  

Ideally pharmacists and physicians should be trained in medical interventions that could use the identification of an attempt to get a prescription refilled too soon or to get a fraudulent prescription filled as an opportunity to get the addicted person into treatment for their addiction.

As things stand it's up to the individual pharmacist whether to send the person asking for the prescription on his way or try to stall him and call police.

Other Articles About Prescription Drug Abuse

About the Author

Terence T. Gorski is internationally recognized for his contributions to Relapse Prevention Therapy. The scope of his work, however, extends far beyond this. A skilled cognitive behavioral therapist with extensive training in experiential therapies, Gorski has broad-based experience and expertise in the chemical dependency, behavioral health, and criminal justice fields.

To make his ideas and methods more available, Gorski opened The CENAPS Corporation, a private training and consultation firm of founded in 1982.  CENAPS is committed to providing the most advanced training and consultation in the chemical dependency and behavioral health fields.

Gorski has also developed skills training workshops and a series of low-cost book, workbooks, pamphlets, audio and videotapes. He also works with a team of trainers and consultants who can assist individuals and programs to utilize his ideas and methods.
Terry Gorski is available for personal and program consultation, lecturing, and clinical skills training workshops. He also routinely schedules workshops, executive briefings, and personal growth experiences for clinicians, program managers, and policymakers.

Mr. Gorski holds a B.A. degree in psychology and sociology from Northeastern Illinois University and an M.A. degree from Webster's College in St. Louis, Missouri.  He is a Senior Certified Addiction Counselor In Illinois.  He is a prolific author who has published numerous books, pamphlets and articles.  Mr. Gorski routinely makes himself available for interviews, public presentations, and consultant.  He has presented lectures and conducted workshops in the U.S., Canada, and Europe.  

For books, audio, and video tapes written and recommended by Terry Gorski contact: Herald House - Independence Press, P.O. Box 390 Independence, MO 64055.  Telephone: 816-521-3015 0r 1-800-767-8181.  His publication website is www.relapse.org.

Original Article From The Florida Time Union

ANOTHER SIDE OF DRUG WAR

Prescription Fraud Costly For Society

The term "war on drugs" evokes images of scruffy lowlifes on dark 
street corners selling crack cocaine, heroin or marijuana, and drug 
task forces periodically sweeping neighborhoods to get rid of them.

But there is another, less-publicized battlefield in the same war 
that also destroys families, claims lives and costs billions of 
dollars annually: prescription medication fraud.

It's a crime committed by many people who have come to depend on 
drugs to feed an addiction to legal pills.

"Many of them are law-abiding citizens who wouldn't commit a crime, 
but they're driven to a desperate act by an addiction," said Lt. 
Larry Thompson, head of the narcotics and vice squad in the Clay 
County Sheriff's Office.

Some offenders steal prescription pads from medical offices and forge 
doctors' signatures. Some telephone pharmacies claiming to be a 
physician or an assistant requesting drugs for a patient. Some simply 
break into a pharmacy and loot the drug cabinets.

"Doctor-hopping is probably the biggest problem," said Thompson, 
referring to patients who often go to dozens of doctors getting a 
prescription from each one.

Opiate-based drugs such as Lortab, Valium, Xanax, Lorocet, Percocet 
and Vicadin are high on the list of pills commonly sought by people 
who lie, cheat or steal to get their fix. Another drug gaining in 
popularity among addicts is Oxycontin, a pain medication often 
prescribed for cancer patients but in the wrong hands "is killing 
people all over the country," Thompson said.

It's not just the addicts and their families who suffer. Society is 
victimized as well.

"We all pay in increased insurance costs," Thompson said. "Not 
everybody knows somebody who's addicted to heroin or crack cocaine, 
but just about everybody knows somebody who's been addicted to 
prescribed medication."

Another social cost is increased burglaries and thefts.

A man broke into the Walgreen drug store at 1320 Blanding Blvd. in 
June and fled with an undisclosed quantity of Oxycontin. A 
22-year-old woman was arrested in May after she tried to rob a 
Walgreen at 42 Blanding Blvd. of drugs.

During 1999 and 2000, the sheriff's office investigated 26 cases of 
prescription drug fraud and made 16 arrests in Clay County. Since 
October, 45 cases have been investigated and 22 arrests made.

To crack down on the problem, the sheriff's office has assigned an 
investigator full time to the cases. Also, the county initiated a 
drug court a few months ago to keep offenders out of jail but under 
close supervision while they go through a one-year program that 
involves counseling, frequent drug testing and regular court 
appearances.

Detective Theresa Murray, the chief prescription drug fraud 
investigator, agreed that doctor-hopping is a major problem. She said 
she recently received a notice from an insurance company about an 
individual who had gone to about 80 physicians in Northeast Florida 
over 30 months to obtain controlled substances.

"That's a clear-cut case of fraud," Thompson said. Investigating that 
kind of case, however, takes a lot of time because physicians and 
insurance companies don't have a central computer system to tell if 
an individual has been to other doctors or pharmacies.

"I have to go to each individual pharmacy," Murray said. "Hand in 
hand, we can make a difference. Pharmacists are my front line of 
defense. They're my eyes and ears."

The sheriff's office has asked pharmacists to require photo 
identification from everyone with a prescription, keep doctors' 
signatures on file to compare with signatures on prescriptions, call 
physicians to verify prescriptions, securely dispose of all paperwork 
containing patient information, and call police if they think someone 
has submitted a phony prescription.

One pharmacy victimized about a dozen times this year is Walgreen 
drug store on Blanding Boulevard at Knight Boxx Road, the same store 
struck by the Oxycontin thief in June.

Pharmacist Bret McBride said drug fraud is a problem everywhere.

"We had a wave of them for a couple of months earlier this year, but 
then it started dying out," he said.

In trying to assess whether a prescription is valid, McBride said 
pharmacists look closely at a person's demeanor and whether they 
appear nervous or jittery.

"A lot of it is just intuition," he said. "If we suspect something, 
we call the physician's office to verify the prescription."

If the prescription cannot be verified, it is not filled, he said. 
It's up to the individual pharmacist whether to send the person 
asking for the prescription on his way or try to stall him and call 
police.

"It's a professional judgment call," McBride said. "There are safety 
considerations."

Home - What's New - Site Map - Search Gorski's Site - Articles - Book Reviews

Mission & Vision - Training & Consultation Services - Publications - Links

Daily News Review  -  Addiction Databases  - Leading Addiction Websites

GORSKI-CENAPS Clinical Model --- Research-Based Best Practice Principles

Terry Gorski and Other Members of the GORSKI-CENAPS Team are Available To Train & Consult On Areas Related To Recovery, Relapse Prevention, & Relapse Early Intervention