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Doctor or Dealer: Where Do Most Drugs Come From?

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Doctor or Dealer: Where Do Most Drugs Come From?

Alcohol and marijuana are the only substances of abuse that have a higher rate of abuse than prescription drugs. The Centers for Disease Control and Prevention (CDC) called prescription drug abuse the country’s fastest-growing drug problem in 2012 and added that opioid pain medication played a role in more overdose deaths since 2003 than heroin and cocaine combined. A third of all first-time recreational users start with prescription drugs, per the Office of National Drug Control Policy, epitomizing its potential as a gateway drug, and the 2011 Drug Abuse Warning Network (DAWN) report shows that prescription and illicit substances are now responsible for an equal number of drug-related medical emergencies. Demonstrating the high rate of abuse, the National Institute on Drug Abuse (NIDA) reported for 2010 that 16 million people used prescription drugs recreationally in the past year and seven million in the past month. While the data makes it clear that prescription drug abuse is a widespread and dangerous problem, it does not, however, explain how so many people are getting their hands on medication with the intent to get high. Do people get them from doctors, dealers or both?

Drug Dealers and Prescription Medication

The Drugs: Education, Prevention, and Policy journal looked at prescription drug dealing in the 2012 article “Patterns of Prescription Medication Diversion among Drug Dealers,” and the article offers some of the best insights into how prescription drugs get into the hands of drug dealers. Utilizing data from a four-year National Institute on Drug Abuse (NIDA) study, the article made several key observations including the following:

Doctor or Dealer: Where Do Most Drugs Come From?
  • Diversion (transferring prescription drugs from lawful to unlawful channels of distribution) is a $25 billion per year business.
  • Seventy percent to 80% of street users acquire prescription drugs from a dealer, which is the primary source for obtaining controlled substances.
  • Sixty-two percent of dealers sold both illicit and pharmaceutical drugs while 38% only sold prescription medication.
  • Dealers typically fell into two classes, those who sold individual pills on the street and those who only sold full bottles at home or to street dealers.
  • Roxicodone and OxyContin were considered the most in-demand opioids while Xanax was the most popular benzodiazepine depressant.

The study also looked at how the dealers got ahold of the prescription drugs. The dealers replenished their supplies in various ways including the following:

  • Pain management clinics are the most widely used source of painkillers and depressants.
  • Dealers train individuals on what to say and provide fraudulent magnetic resonance imaging (MRI) reports giving the pain doctor.
  • Doctor shopping is the main diversion source with the average participant visiting four or five pain clinics each month.
  • Dealers also engage in a process called sponsoring in which they finance all the participants’ costs in exchange for 50% to 75% of the pills.
  • Some dealers prefer to obtain drugs from willing sellers, which tend to include veterans, crack/heroin addicts, HIV patients, and Medicaid/Medicare recipients.
  • Dealers target addicts who preferred illicit drugs and Medicaid/Medicare recipients who often needed the extra money.
  • Another drug source is a connect, a term used to describe someone at a healthcare facility with a consistent supply of medication and prescription pads.
  • In addition to stealing the connect might short or undercount dispensed medication, take samples or falsify inventory claims when shipments arrive.

Nearly all prescription drugs ultimately come from a doctor or medical facility, but dealers have many ways to build drug inventories, and they remain the primary source of illicit sales. Still, there are other ways in which doctors may contribute to prescription drug abuse through omissions or undue influence.

Prescription Drugs from the Doctor

The commerce side of prescription drugs is huge. IMS Health put the worldwide pharmaceutical industry at more than $1 trillion for 2014, and the BMJ journal reported in 2012 that manufacturers spend 19 times more on marketing and promotion than on basic research. This includes direct-to-consumer (DTC) advertising, which was essentially non-existent a few decades ago. Clinical journals and media outlets have noted several areas of concern including the following:

  • ABC News reported in 2013 that the Food and Drug Administration (FDA) says drug ads are misleading, and it sends out an estimated 100 letters per year demanding changes.
  • The Boston Globe reported in 2014 that companies pay some doctors huge sums to consult and speak publically about the benefits of their medications.
  • Medical Marketing & Media says pharmaceutical companies spent nearly $4 million on DTC marketing in 2013.
  • Current Issues and Research in Advertising in 1986 found that customers answered most true-false questions wrong in DTC advertising comprehension tests.
  • The Health Affairs journal in 2000 found that 80% of doctors think DTC advertising has negative consequences.

Doctors know the damage that addiction causes and they do not wish to make the problem worse. However, some doctors are influenced by consulting fees or pressured by patients who learned about drugs through DTC advertising. Likewise, a failure to consider non-pharmaceutical treatments (e.g., holistic and chiropractic pain therapies rather than opioid drugs) or track patient drug use can also play a role in an abuse problem. Fortunately increased access to medical records online is helping minimize doctor shopping and limit overprescribing while the Affordable Care Act (ACA) now requires more transparency from doctors who work as pharmaceutical consultants.

Prescription Drug Addiction Help

If you or a loved one struggles with prescription drug abuse, please call our toll-free helpline. Our admissions coordinators can answer questions, make recommendations, discuss treatment options and even check health insurance policies for benefits. We are available to help 24 hours a day, so please call now.

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