Editing Drug diversion

{{Short description|Transfer of legally prescribed controlled pharmaceuticals to other individuals}}{{Worldwide-view|date=January 2023|2=US}}

'''Drug diversion''' is a medical and legal concept involving the transfer of a legally-[[medical prescription|prescribed]] [[controlled substance]] from the individual for whom it was prescribed to another person for any illicit use.<ref name="pmid22766087">{{cite journal | vauthors = Berge KH, Dillon KR, Sikkink KM, Taylor TK, Lanier WL | title = Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention | journal = Mayo Clin. Proc. | volume = 87 | issue = 7 | pages = 674–82 | year = 2012 | pmid = 22766087 | pmc = 3538481 | doi = 10.1016/j.mayocp.2012.03.013 }}</ref><ref>{{Cite web|title = Drug Diversion Defined: A Patient Safety Threat {{!}} Safe Healthcare {{!}} Blogs {{!}} CDC|url = http://blogs.cdc.gov/safehealthcare/2014/06/03/drug-diversion-defined-a-patient-safety-threat/|website = blogs.cdc.gov|access-date = 2015-07-15|url-status = dead|archive-url = https://web.archive.org/web/20150716073835/http://blogs.cdc.gov/safehealthcare/2014/06/03/drug-diversion-defined-a-patient-safety-threat/|archive-date = 2015-07-16}}</ref> The definition varies slightly among different [[jurisdiction]]s, but the transfer of a controlled substance alone usually does not constitute "diversion," since certain controlled substances that are prescribed to a child are intended to be administered by an adult, as directed by a [[medical professional]] (the prescriber). The term is named for "diverting" said drugs from their original, intended, licit [[medical indication|medical purpose]]. In some jurisdictions, [[drug diversion program]]s are available to first time offenders of diversion drug laws, which "divert" offenders from the criminal justice system to a program of education and rehabilitation.

== Imprecise, Misleading Definition of "Diversion" ==
The definition of "drug diversion" is not all-inclusive or all-encompassing, in the sense that it does not account for the potential of ''any'' substance, chemical, formulation, molecule, medication, or "drug" in the broadest sense to be diverted from one individual to another; it is not exclusive to controlled substances, as even substances that are not "scheduled" (neither "controlled" per, regulated by, nor listed in the [[Controlled Substances Act]] or related analogues and derivatives, which are regulated in the United States by the [[Federal Analogue Act]].

Even medication sold [[over-the-counter]] or [[behind the counter]] can be diverted from one individual to another for purposes of [[substance abuse]], often for [[recreational use of drugs|recreational purposes]] and/or as a means of [[self-medication|self-medicating]] that have hitherto been improperly or insufficiently treated (perhaps due to not being "taken seriously" by medical providers) or due to a patient's inability to access primary health care services due to not being insured; specific to the U.S., many Americans neither have nor qualify for [[health insurance]] coverage in any form. Perhaps most commonly, diversion serves to aid [[clandestine chemistry]] and production of [[methaqualone]], 
[[glutethimide]], [[ethinamate]], [[ethchlorvynol]], [[methyprylon]].

OTC medications that can be misused (used recreationally (depending on one's perspective) include [[diphenhydramine]], [[doxylamine]], [[chlorpheniramine]], [[dimenhydrinate]], [[propylhexedrine]], [[dextromethorphan]], [[levmetamfetamine]], [[nicotine replacement therapy]] products, oral [[caffeine]] [[dosage form]]s, vitamins, minerals, and dietary or nutritional [[dietary supplement|supplements]]. Medication containing the [[sympathomimetic amine]]s [[ephedrine]] and [[pseudoephedrine]] can be purchased without a prescription, albeit [[behind the counter]] of the pharmacy upon showing ID, signing a log and [[legal disclaimer]], and not exceeding monthly purchase limits, as defined by the [[Combat Methamphetamine Epidemic Act of 2005]].

Theoretically, prescription drugs defined as "[[controlled substance|controlled substances]]" (i.e. prescription drugs regulated or "scheduled" by the [[Controlled Substances Act]]) are the most likely to be misused or diverted.

==Commonly diverted drugs==
[[File:Zolpidem.svg|thumb|Chemical structure of zolpidem, a [[Nonbenzodiazepine|Z-drug]]]]

[[Chemical class]]es of commonly diverted controlled substances include:<ref name="Diverted drug types">{{cite journal | vauthors = McCabe SE, Teter CJ, Boyd CJ | title = Medical use, illicit use, and diversion of abusable prescription drugs | journal = J Am Coll Health | volume = 54 | issue = 5 | pages = 269–78 | year = 2006 | pmid = 16539219 | pmc = 1876754 | doi = 10.3200/JACH.54.5.269-278 }}</ref>
===Central Nervous System (CNS) Depressants===
*[[Benzodiazepines]], including [[diazepam]] and [[clonazepam]] are often prescribed to treat [[social anxiety]], [[generalized anxiety]], [[akathisia]], and [[anxiety]] related to, or stemming from, [[obsessive-compulsive disorder]] (OCD) (such as [[compulsive decluttering]]); [[lorazepam]] and [[alprazolam]] are often utilized to treat symptoms of [[social anxiety]] and [[panic disorder]], acute [[panic attack]]s, and [[akathisia]]; [[temazepam]], [[flurazepam]], [[triazolam]], and sodium [[clorazepate]] are utilized for the [[treatment of insomnia|treatment of]] [even "[[treatment-resistant insomnia|treatment-resistant]]"] [[insomnia]] by virtue of their status as [[sedative-hypnotic]], calming, and [[soporific]] (sleep-inducing) agents; and [[midazolam]] is frequently utilized for [[muscle relaxant|muscle relaxation]] and [[antispasmodic|easing of muscle spasms]]).

*[[Opioid|Opioids]] ([[analgesic]]s for relief of chronic, severe pain in cases of broken bones and cancers), including [[codeine]], [[morphine]], [[hydrocodone]], [[oxycodone]], [[tapentadol]], [[hydromorphone]], and [[fentanyl]].
*[[Z-drug]]s, including [[zolpidem]] (Ambien) and [[eszopiclone]] (Lunesta) &nbsp;– prescription [[sleep aid|sleep medications]]
*[[Stimulant]]s (CNS stimulants, psychostimulants, "uppers") including [[amphetamine]]s, [[methylphenidate]] &nbsp;– prescribed to treat [[ADHD]], [[narcolepsy]], and [[anorectic|obesity]].

According to the [[United States Department of Justice]], "Most pharmaceuticals abused in the United States are diverted by doctor shopping, forged prescriptions, theft and, increasingly, via the Internet."<ref name="US Department of Justice web site">{{Cite web |url=http://www.usdoj.gov/ndic/pubs11/11449/diversion.htm |title=US Department of Justice web site |access-date=2009-07-01 |archive-date=2009-07-25 |archive-url=https://web.archive.org/web/20090725112638/http://www.usdoj.gov/ndic/pubs11/11449/diversion.htm |url-status=dead }}</ref> To reduce the occurrence of pharmaceutical diversion by doctor shopping and prescription fraud, almost all states have established [[Prescription monitoring program|prescription monitoring programs (PMPs)]] that facilitate the collection, analysis, and reporting of information regarding pharmaceutical drug prescriptions.<ref>{{Cite web|url=https://www.cdc.gov/drugoverdose/pdmp/index.html|title=Prescription Drug Monitoring Programs (PDMPs)|website=www.cdc.gov|access-date=2016-05-04}}</ref>

== Registration of drug suppliers ==
21 U.S.C. § 823 of the [[Controlled Substances Act]] provides for registration of manufacturers and distributors of controlled substances. The criteria for registering manufacturers of Schedule I and II drugs are particularly strict and call for "limiting the importation and bulk manufacture of such controlled substances to a number of establishments which can produce an adequate and uninterrupted supply of these substances under adequately competitive conditions for legitimate medical, scientific, research, and industrial purposes." The [[United States Attorney General|Attorney General]] must make a positive determination that the registration would be "consistent with the public interest."{{citation needed|date=July 2015}}

For manufacturers of other drugs, and for drug distributors, the regulations are substantially less strict: "The Attorney General shall register an applicant… unless he determines that the issuance of such registration is inconsistent with the public interest." The criteria for both manufacture and distribution is somewhat biased in favor of established industries, favoring "past experience" and a record of compliance with drug laws {{citation needed|date=July 2015}} The Controlled Substances Act also provides for the registration of medical practitioners (i.e., physicians, dentists, veterinarians, etc.), pharmacies and hospitals that prescribe, administer, or dispense controlled substances directly to patients, as well as individuals conducting approved research involving controlled substances.  This category also includes narcotic treatment programs that administer and dispense primarily [[methadone]] for narcotic addiction treatment.{{medical citation needed|date=July 2015}}

=== Examples ===
This activity can occur in many venues:

''[[The Cincinnati Post]]'' has reported on its frequency. John Burke, an expert on the issue, was quoted as saying, "Pharmaceutical diversion is kind of funny because it's going on in every community, but it appears not to exist unless you go after it purposely."<ref>{{cite news|url=http://www.cincypost.com/2005/01/18/pharm011805.html|title=Police target prescription abuse|first=Shelly|last=Whitehead|work=[[The Cincinnati Post]]|publisher=[[E. W. Scripps Company]]|date=2005-01-18|archive-url=https://web.archive.org/web/20050312065853/http://www.cincypost.com/2005/01/18/pharm011805.html|archive-date=2005-03-12}}</ref>

==DEA investigation into oxycodone diversion==
According to the US Justice Department, in 2011 CVS pharmacies in [[Sanford, Florida]], ordered enough painkillers to supply a population eight times its size. Sanford has a population of 53,000 but the supply would support 400,000.<ref>{{cite news| url=https://www.bloomberg.com/news/2012-02-29/cardinal-health-blocked-from-shipping-painkiller-in-florida-1-.html | work=Bloomberg | first=Tom | last=Schoenberg | title=Cardinal Health Blocked From Shipping Painkiller in Florida | date=2012-02-29}}</ref> According to the [[Drug Enforcement Administration]] (DEA), in 2010 a single CVS pharmacy in Sanford ordered 1.8 million oxycodone pills, an average of 137,994 pills a month. Other pharmacy customers in [[Florida]] averaged 5,364 oxycodone pills a month. DEA investigators serving a warrant to a CVS pharmacy in Sanford on October 18, 2011 noted that "approximately every third car that came through the drive-thru lane had prescriptions for oxycodone or hydrocodone."

According to the DEA, a pharmacist at that location stated to investigators that "her customers often requested certain brands of oxycodone using street slang," an indicator that the drugs were being diverted and not used for legitimate pain management. In response, CVS in a statement issued February 17 in response to opioid trafficking questions from ''[[USA Today]]'' said the company is committed to working with the DEA and had taken "significant actions to ensure appropriate dispensing of painkillers in Florida."<ref>{{cite news| url=https://www.usatoday.com/news/nation/story/2012-02-27/painkiller-abuse-DEA/53275844/1 | work=USA Today | title=Most Popular E-mail Newsletter | date=2012-02-27}}</ref>

In February 2012, Joseph Rannazzisi, chief of the [[Drug Enforcement Administration]]’s Office of Diversion Control, issued immediate suspension orders against [[Cardinal Health]]'s supply of [[oxycodone]] to suspected pill mills.<ref name=WashPo16>{{cite news|last1=Lenny Bernstein|last2=Scott Higham|author2-link=Scott Higham|title=Investigation: The DEA slowed enforcement while the opioid epidemic grew out of control|url=https://www.washingtonpost.com/investigations/the-dea-slowed-enforcement-while-the-opioid-epidemic-grew-out-of-control/2016/10/22/aea2bf8e-7f71-11e6-8d13-d7c704ef9fd9_story.html|access-date=17 March 2017|newspaper=[[The Washington Post]]|date=22 October 2016}}</ref>  Deputy Attorney General [[James M. Cole]] then called Rannazzisi to a meeting at Justice Department headquarters where Cole warned him “it made good sense to listen to what Cardinal had to say”.<ref name=WashPo16/>  Rannazzisi was fired from the drug diversion office in August 2015.<ref name=WashPo16/>  Cardinal was never fined.<ref name=WashPo16/>

Cardinal, alongside [[McKesson Corporation]] and [[AmerisourceBergen]], spent $13 million lobbying Congress to pass Congressman [[Tom Marino]]'s "Ensuring Patient Access and Effective Drug Enforcement Act".<ref name=WashPo16/>  The bill, which increases the burden of proof enforcers need to show against drug distributors, was signed into law by President [[Barack Obama]] in April 2016.<ref>{{USBill|114|S.|483}}, 114th Cong. (2015).</ref>

==See also==
* [[Diversion (disambiguation)]]
* [[Unused drug]]
* [[Oxycodone]]
* [[Pharmaceuticals in India]]
* [[Steroids]]

==References==
{{Reflist}}

==External links==
{{Wiktionary|diversion}}
*[https://web.archive.org/web/20060720080603/http://www.usdoj.gov/dea/agency/csa.htm Controlled Substances Act – U.S. Drug Enforcement Administration]

{{DEFAULTSORT:Drug Diversion}}
[[Category:Illegal drug trade]]
[[Category:Drug control law]]
[[Category:United States criminal law]]
[[Category:Medical law]]