1. Pharmaceutical Drug Abuse Counterfeit Drugs

2. Current State of Affairs National drug prevalence studies indicate a sharp increase in prescription drug abuse beginning in the early to mid 1990s According to the 2005 National Drug Threat Assessment published by National Drug Intelligence Center the rate of abuse for pharmaceuticals appears to be stabilizing at high levels The availability of prescription drugs has also shown a marked increase since the early 1990s

3. The Demand for Drugs The rate of abuse for prescription drugs is relatively high compared with rates of abuse for other drug types National Survey On Drug Use and Health (NSDUH) in 2003 indicated that 6.3 % of persons aged 12 or older reported non-medical use of a prescription-type: –Pain reliever –Tranquilizer –Stimulant (including both illicit and prescription methamphetamine) –Sedative (not including over-the-counter drugs) These prescription drugs were reported second only to marijuana (10.6%) and much higher than cocaine (2.5%) and heroin (0.1%) for rates of abuse

4. Availability of Prescription Drugs Doctor Shopping Prescription Fraud Unscrupulous Physicians Pharmaceutical Theft Internet –Counterfeit drugs

5. Doctor Shopping Individuals will visit several different doctors Invent or exaggerate symptoms to receive prescriptions People will visit doctors they think more likely to write them a prescription They will have prescriptions filled at several different pharmacies to help evade detection by the pharmacist

6. Prescription Fraud Methods employed for fraud: –Forging or altering of prescriptions –Producing counterfeit prescriptions –Calling in fictitious prescriptions to pharmacies by impersonating a physician Methods of detection: –Written in unfamiliar handwriting (forged, altered or counterfeit prescriptions) Often without abbreviations –The quantities, directions, or dosages differ from normal usage –Resemble textbook examples –Appear to be photocopied

7. Unscrupulous Physicians Writing Illegal prescriptions Writing fraudulent prescriptions to obtain drugs for personal use Charging a fee to write prescriptions for patients without a legitimate need for the drugs Sometimes collaborate with unscrupulous pharmacists –Dispense drugs, known to be unnecessary, for an additional fee Doctors or pharmacists in nursing homes over order drugs from wholesalers and sell them to questionable distributors

8. Pharmaceutical Theft Pharmacies Manufactures Distributors Importers/ exporters Drug2000200120022003 Codeine 569,4251,223,205596,972622,132 Dilaudid 37,53122,64723,07241,668 Lorcet 100,548540,997126,451360,115 Lortab 686,197451,091340,325738,584 OxyContin 260,688519,597587,168464,312 Percocet 421,063127,525193,085278,581 Percodan 14,64612,7049,15134,102 Ritalin 117,408123,72074,54167,751 Valium 171,883176,280145,070146,683 Total 2,379,3893,197,7662,095,8352,753,928 Source: NDIC (DEA)

9. Internet Offer drugs without prescriptions or physician consults Recruit corrupt physicians to write fraudulent prescriptions Distribute counterfeit drugs –Occurrence in the US is increasing –Typically produced in India and China –China, Nigeria, Thailand, Cambodia, and Indonesia- as much as 60% of the drugs sold are counterfeit

10. How to Avoid Counterfeit Drugs Know your medications –Size, shape, color, texture, taste, and side effects Look at the packaging –Contact your doctor or pharmacist if there are changes/tampering in the packaging or label Buy from a safe reputable source –Check with the State Board of Pharmacy http://www.tsbp.state.tx.us/ –The National Association of Boards of Pharmacy at www.nabp.net www.nabp.net Make sure the pharmacy is properly licensed –Online pharmacies will display a seal from State or National Boards of Pharmacy –Verify the seal, don’t take the company’s word

11. Reporting Counterfeit Drugs Contact a pharmacist who will know if the color, shape, size, etc. have changed Report suspicions to the Food and Drug Administration (FDA) If you bought the drug by mail, by telephone, or in person, contact the FDA’s Medwatch program: –1-800-332-1088 –http://www.fda.gov/medwatch/http://www.fda.gov/medwatch/ If bought on the Internet, use the online form or call: –http://www.fda.gov/oc/buyonline/buyonlineform.htmhttp://www.fda.gov/oc/buyonline/buyonlineform.htm –1-800-332-1088 Seek medical attention if you have consumed a drug you think to be counterfeit

12. What’s being done to stop Pharmaceutical drug abuse? State-wide Electronic prescription monitoring programs National Electronic Prescription Monitoring Program –Proposed as the National All Schedules Prescription Electronic Reporting (NASPER) Act of 2002. –Signed by President Bush on Aug. 11, 2005 –It tracks Schedule II, III, and IV drug prescriptions –Pharmacists would report: The patient's identification number The drug, date, and quantity dispensed The prescribing physician The dispensing pharmacy. –Data entered into the NASPER system could be used to track: Patient drug use Prescribing patterns of medical practitioners Prescription rates and patterns for specific drugs Prescription patterns in specific geographic locations Prescription patterns for longtime users

13. Sources http://www.usdoj.gov/ndic/pubs11/12620/pharma.htm http://www.fda.gov/oc/initiatives/counterfeit/report02_04. htmlhttp://www.fda.gov/oc/initiatives/counterfeit/report02_04. html http://www.fraud.org/fakedrugs/ http://pubs.acs.org/cen/coverstory/8145/8145drugs.html https://nsduhweb.rti.org/ http://www.nasper.org/nasper_becomes_law.htm