Megan Hali Ray

HLTH 1050

Salt Lake Community College

July 12, 2016

According to the Office of National Drug Control, drug use affects every sector of
society, straining our economy, our health care and criminal justice systems, and
endangering the futures of young people. While many challenges remain, overall drug
use in the United States has dropped substantially over the past 30 years. However,
prescription drug abuse is the Nations fastest growing drug problem and has been
classified as an epidemic by the Center for Disease Control and Prevention.
How do we combat the problem of abuse, fraud and illegal sales of a patients
prescription medications? One of the problems with prescriptions is how to monitor the
hard-copy prescriptions and the medications after they have been given to the patient.
The availability of prescription medication and over the counter medication has been
beneficial to our society by allowing us to live longer and healthier lives, but there is a
dark side.
The Substance Abuse and Mental Health Services Administrations National
Survey on Drug Use and Health indicates that approximately 7 million Americans have
abused a prescription drug within the previous month. Drug types that are more
susceptible to abuse, fraud and distribution include pain relievers, sedatives,
tranquilizers, and stimulants. This number exceeds the abuse of all illicit street drugs,
with the exception of marijuana. Unintentional poisoning, nearly all of which is attributed
to drugs, is now the second leading cause of accidental death in the United States. Utah
has the Eighth Highest Drug Overdose Mortality rate in the United States. To combat

the problem of prescription drug abuse and street sales it takes the effort of several
teams. These teams include law enforcement, from local police departments to the
DEA, prescribers, pharmacies, insurance, and citizens.
I am a nationally certified pharmacy technician, last year I was offer and
accepted a position reviewing prior authorization for prescription medication, my prior
experience had been in retail which I will touch on later, this new experience has
expanded my knowledge of so much. It is a different experience seeing the prescription
drug world from an insurance companies perspective. We review a lot of requests for
patient who are on obscene amounts of opioids per day, such as 3-4 Oxycontin ER
80mg tablets per day or request for #180 Adderall XR 30mg capsules per month. It
make me sad a lot of the times wondering is this really the patients fault, they are
receiving legit prescriptions from and their doctors are requesting their insurance pay for
way outside the quantity allowed per day. Who is really to blame? There are also
several 100 request per month that my small 10 person team review each month for
patients who have a diagnosis of opioid dependence and require Suboxone
(buprenorphine-naloxone) therapy to abstain from heroin or opioid relapse.
I was a senior pharmacy technician at Walgreens, which made me a part of the
line of defense against prescription medication abuse, fraud, and street sales. Patients
that are abusing or distributing prescription medications use many tactics to obtain their
drugs. Doctor shopping is a term used to describe a common scam that individuals use
to obtain these medication for abuse or distribution. Patients will visit several doctors in
order to obtain multiple prescriptions for the same medication. The majority of the

prescribing doctors think that they are treating a legitimate medical condition and are
unaware of the fact that the patient is visiting other prescribers.
Another problems is that fact that there are unethical pain clinics, or pill mills.
This was a big problem in 2010 in Florida, where 90 of the top 100 oxycodone
purchasing practitioners in the US were in Florida. After this incident in Florida,
Walgreens has implemented a good faith dispensing system, which includes taking a
photo id upon drop off and running the DOPL report for oxycodone, methadone, and
hydromorphone. As of October 6, 2014 hydrocodone medications were just moved from
a schedule III drug to schedule ll drug in an effort to aid in the availability of this
medication to the public to try and deter abuse and trafficking of this drug.
Almost all prescription drugs involved in abuse come from prescriptions originally.
There are instances where pharmacies are dispensing large quantities of opioids as
part of an illegal distributions schemes as well as pharmacists who fail to meet their
obligation to determine that a prescription was issued for a legitimate medical purpose.
This is a big part of the reason that Walgreens and other companies have implemented
stronger requirements and conditions that need to be met before they can dispense
medications. At the pharmacy level we verify prescriptions and report suspicious
behavior in an effort to insure that what we dispense is not being abused or trafficked to
the best of our ability. Unfortunately, there are still instances of patients who are
overusing and or selling their medications. To help fight this most states have a law that
states when the next time a patient can fill control substance prescriptions. Utah law is
that 80% of the patients previous fill by using the directions on the prescription must be
taken before the medication is to be refilled. Walgreens, and other pharmacies have

implemented a 90% rule, which means that 90% of the medication per the instructions
must be gone before dispensing. Insurance companies are also helping with this with
refills too soon rejects, where they will not pay for the medication until a certain amount
of the medication must be gone before it is filled, however there are patients who are
uninsured or choose to pay cash.
There are 49 states that have established or are developing prescription drug
monitoring programs (PMPs) to track prescriptions for controlled substances. It allows
healthcare professionals to check the database to see if a patient has recently obtained
prescriptions from another prescriber. Law enforcement officials, under special
circumstances, can obtain permission to check to the database as part of an
investigation.
Theft is a major problem with prescription medications and it occurs at almost all
levels. Patients steal prescriber's prescription pads to forge their own prescriptions or
are counterfeiting them. They are robberies that occur at the pharmacy usually for
controlled substances, such as oxycodone and Percocet.
A lot of us have known or do know someone who has been greatly impacted by
the abuse, fraud, and illegal trade of prescription medications. One of my best friends
from high school has had problems with abusing her prescription medication. It started
like a lot of prescription abuse cases. She was diagnosed with lupus and part of her
treatment was pain management for which she was prescribed oxycodone. At first she
seemed to be responsible with her medication, but then as time went on she began to
abuse it. She was taking too many tablets a day and even began smoking her
medication to try to enhance the effect. She was unable to keep a job and she blamed

the disease but the abuse of this pain killer was not working in her favor. She started
selling her pills to earn money but then towards the end of the month when she almost
or completely out of medication she would then buy it off the streets. Her abuse of this
opiate was showing in her appearance, she picked at her face and skin and has now
lost all of her teeth, she is 25.
The majority of Americans have at one point in time been on some type of
prescription medication. Why are some patients more likely to abuse these medication?
Financial incentives have a massive impact on street sales of controlled substances.
We need to continue to assess and strengthen how we combat the problems associated
with abuse and distribution of prescription medication. We all need to remember to only
take prescriptions that are prescribed to us and not share with others. We can all be
warriors against prescription drug abuse and trafficking by reporting any misuse or
distribution, taking our unwanted and expired medications to proper disposal sites, most
police stations have a collection box, and always taking our own prescription and otc
medications as directed. Remember they are instructions not suggestions.

Work Cited
"Combating Pharmacy Theft." Rx Safety Matters. Web. 18 Jun. 2016.
<http://www.rxsafetymatters.org/law-enforcement-and-government/combating-pharma
cy-theft/>.
"Drug Abuse Surveillance." Rx Safety Matters. Web. 17 Jun. 2016.
<http://www.rxsafetymatters.org/law-enforcement-and-government/drug-abuse-surveill
ance/>.
"Journal of American Pharmacists Association | Article." Journal of American Pharmacists
Association | Article. Web. 17 Jun. 2016. <http://japha.org/article.aspx?
articleid=1043655>
"Office of National Drug Control Policy." The White House. The White House. Web. 1 Jul. 2016.
<http://www.whitehouse.gov/ondcp>.
"Prescription Monitoring Programs." Rx Safety Matters. Web. 17 Jun. 2016.
<http://www.rxsafetymatters.org/law-enforcement-and-government/prescription-monito
ring-programs/>.
"Utah Department of Administrative Services Division of Administrative Rules." UT Admin Code
R156-37. Utah Controlled Substances Act Rule. Web. 1 Jul. 2016.
<http://www.rules.utah.gov/publicat/code/r156/r156-37.htm>.