Prescription Drug Diversion Use of Legal Drugs for Illegal Purposes Module 1
Welcome to the prescription drug diversion use of legal drugs for illegal purposes module 1 presentation.This presentation is the first of two 1hour modules.Prescription drug abuse has reached epidemic proportions.In 2014, 2.5 percent of the u.S.Population was taking a psychotherapeutic drug for nonmedical purposes.The financial cost of drug abuse is astounding.It is estimated that drug abuse and addiction account for more than $600 billion annually in preventable costs to taxpayers.These preventable costs include those related to health care, law enforcement, and crime.In 2010, 46.8 percent of the.
4.9 million drugrelated emergency department ed visits were the result of drug misuse or abuse.More than half of those visits were from the misuse or abuse of prescription drugs.The number of druginduced deaths exceeded the number of motor vehicle deaths in 2013.Understanding why people abuse prescription drugs is the first step in preventing drug diversion.As health care professionals, we all have a role in preventing drug diversion and putting an end to prescription drug abuse.By the end of module 1, the learner will be able to differentiate.
Between the methods of drug diversion and recognize the signs and symptoms of drug abuse.Before we focus solely on prescription drug diversion and abuse, it is important to understand how they fit in the bigger picture.Prescription drug diversion falls under the umbrella of fraud and abuse.Fraud is defined in the law regulating the medicaid program as an intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.In other words, fraud occurs when false.
Claims are submitted or medications are intentionally prescribed or dispensed when they are unnecessary.According to the u.S.Department of justice, $27.8 billion has been recovered by the health care fraud and abuse control program since 1997.In 2014, the program recovered $3.3 billion dollars, with an average return on investment of $7.70 for every dollar spent since 2012.However, improper payments for medicaid in fiscal year 2015 showed a substantial increase, $29.12 billion, nearly double the 2013 rate.There are two different types of abuse.The first kind is the abuse of prescription.
Drugs, which we will talk about throughout this presentation.The second type is abuse committed by health care professionals.According to medicaid, abuse is considered to be practices that are inconsistent with sound fiscal, business, or medical practices.These practices result in an unnecessary cost to the medicaid program or in reimbursement for services that are not medically necessary or that fail to meet professionally recognized standards for health care.This definition also includes beneficiary practices that result in unnecessary cost to the medicaid program.The chief counsel for the u.S.Department of health.
And human services, office of inspector general hhsoig testified before the u.S.House of representatives committee on ways and means in 2010 and stated that health care fraud, waste, and abuse are serious problems, and while the majority of health care professionals are honest and well intentioned, a minority of dishonest health care professionals can cost taxpayers billions of dollars.What are some common types of health care fraud and abuse fraud and abuse in the health care system frequently occur as a result of inappropriate billing, submission of false claims,.
Sharing identification id cards, accepting or giving kickbacks, and diverting prescription drugs.Inappropriate billing comes in many forms.Examples include billing for services not rendered, upcoding, filing duplicate claims, billing for a noncovered service as a covered service, and billing for a different quantity of medication than was dispensed.Submitting false claims is a specific type of fraudulent billing.Falsifying records is often used to substantiate false claims and can occur in every aspect of health care.The practice environment will determine the type of records involved.Patient medical records, pharmacy.
Dispensing records, and controlled substance logs are used in the delivery of care.Intentionally misdocumenting procedures or services provided in the patient medical record may happen in a , , or longterm care facility.Substituting a generic medication without authorization, dispensing a counterfeit medication, or diluting a medication may happen in a pharmacy.Controlled substance logs may be falsified as a result of theft in any practice setting.Billing for these services under false pretenses is fraud.Card sharing occurs when a beneficiary shares or loans his or her id card.
For medical or prescription drug coverage to a person not covered by the thirdparty payer to receive services in the beneficiary’s name.Accepting or giving gifts, money, or other incentives in exchange for a referral of services that are paid for by the federal government is a kickback.The federal antikickback statute makes it a felony for a person to knowingly and willfully solicit or receive any remuneration directly or indirectly, overtly or covertly, in cash or in kind in exchange for referring or arranging for services, goods, or property paid for by a.
Federal health care program.Diversion of prescription drugs is by definition, fraudthe intentional deception or misrepresentation made by a person with the knowledge that the deception could result in some unauthorized benefit to himself or some other person.The person diverting the drugs is intentionally deceiving someone else for personal gain.There are often other types of fraud involved with prescription drug diversion, which makes this an important topic to focus on.So, what is drug diversion drug diversion is the diversion of licit drugs for illicit purposes.It involves the diversion of drugs.
From legal and medically necessary uses towards uses that are illegal and typically not medically authorized or necessary.Drug diversion may occur at any point in the distribution process of prescription drugs and may include a variety of individuals manufacturers, wholesale distributors, s, pharmacists, nurses and other health care personnel, ancillary staff, burglars, patients, and others.People do things they are not supposed to do all the time.They steal.They lie.They do not listen to what their health care professional tells them.This is not new, and neither is.
Prescription drug diversion or abuse.So why all of the attention first, media headlines in the last few years have shed light on the problems of prescription drug abuse.Stories have included pill mills being shut down, prescriber identity theft, celebrity admissions to rehabilitation facilities, and deaths from prescription drug overdoses.According to florida’s prescription drug diversion and abuse roadmap 20122015, a pill mill is defined as a ‘s office, , or health care facility that routinely conspires in the unlawful prescribing and dispensing of controlled substances outside the scope of prevailing.
Standards of medical practice.At these s, licensed health care professionals prescribe drugs of abuse in exchange for payment without regard for diagnosis or medical necessity.According to the centers for disease control and prevention cdc, in 2007 someone died from a prescription drug overdose every 19 minutes, and in the last 10 years more people have died from opioid analgesic overdoses than heroin and cocaine combined.Now, we will take time to examine the significant health, social, legal, and financial consequences of prescription drug diversion and abuse.In 2010, there were more than 1.3 million.
Visits to the emergency room involving misuse or abuse of prescription drugs, an increase of 115 percent from 2004.Tracking ed visits is one method to measure the impact prescription drug abuse has on overall health.Other health effects include the physical and behavioral changes that result from abusing prescription drugs, complications from drug abuse, and even death.The adverse reactions vary with each drug and with the route of administration.Cardiac, neurologic, and gastrointestinal adverse reactions are common.It is unknown how many individuals experience an unintended reaction from the.
Misuse or abuse of a prescription drug because many will never seek treatment or may not disclose the use of illegal prescription drugs when they do seek treatment.The cdc estimates that nearly 15,000 people have died annually from prescription drug overdoses in the last 6 years.Illicit use of opioid analgesics accounted for more deaths than cocaine and heroin combined.Behavioral changes can lead to longterm medical problems, disability, and death.Individuals under the influence tend to engage in risky behaviors, such as druggeddriving, sharing needles, and unprotected sexual intercourse.
These risky behaviors put individuals at risk for contracting a sexually transmitted disease, becoming infected with a bloodborne pathogen, or being unable to prevent an avoidable car accident.In the 2014 national survey on drug use and health nsduh, 10.2 million people reported driving under the influence of illicit drugs.Illicit drugs include marijuana, cocaine, heroin, hallucinogens, and inhalants, as well as prescriptiontype pain relievers, tranquilizers, stimulants, and sedatives that are used for nonmedical purposes.Drugs of abuse have mindaltering properties.Because they affect how the brain works, these drugs may have an impact on how.
The individual abusing prescription drugs interacts with other people.Individuals who abuse drugs tend to withdraw from social activities, set bad examples for younger siblings or their children, have higher rates of absenteeism, and are alienated by their peers.Attempting to obtain a controlled substance by misrepresentation, fraud, forgery, or deception is a felony in most states and is punishable by prison terms or fines.Health care professionals involved in drug diversion activities are at risk for suspension or loss of license, restitution, recoupment, imprisonment, civil monetary penalties, and exclusion from participation in medicaid.
And other federal health care programs.Patients or other individuals involved in drug diversion face similar consequences, including loss of employment or difficulty obtaining employment and the reduced ability to get financial assistance.The legal consequences that may result from drug diversion or drug abuse encompass more than fines and prison terms.Criminal convictions can have long term implications on the individual’s career, licenses, and travel plans.Professional certifications or registrations may be denied to individuals with a criminal record.Likewise, an individual with a criminal record may be denied a job in some professions,.
Such as law enforcement, security, or business.In some cases, a criminal conviction can result in termination of employment.Individuals who like to travel abroad may not be able to obtain the proper documents, such as visas.Financial implications are more than the fines that may be imposed for participating in illegal activities.Direct and indirect costs of prescription drug diversion and abuse are paid for by everyonethe individual, his or her employer, and taxpayers.Financial consequences include employee absenteeism and lost productivity theft workers’ compensationclaims from accidents and injuries that occur while under the.
Influence of drugs law enforcement and criminal justice expenditures for arrests, investigations, and incarcerations disqualification for and immediate repayment of student loans and substance abuse treatment.The 2015 national drug threat assessment summary estimates the cost of prescription drug abuse at $70 billion annually.At this time, we’ll pause for a knowledge check.Common types of health care fraud and abuse were introduced previously in this presentation.Five major types were highlighted, which include inappropriate billing, submission of false claims, sharing id cards, accepting or giving kickbacks, and diverting prescription drugs.
Consider the following question.Inappropriate billing may include all of the following except services not rendered quantity discrepancies properly coded diagnoses duplicate claims.The correct answer is properly coded diagnoses.This is not considered inappropriate billing.The other three are clearly inappropriate billing practices.At this time, we will take a look at methods of drug diversion.Individuals use many methods to obtain prescription drugs for nonmedical purposes.The most common methods of drug diversion are shopping, theft, forgery, illicit prescribing, illegal prescription drug sales, and counterfeiting.Prevention strategies can be implemented.
To protect you from falling victim to one of these methods by your patients, coworkers, or employees.We will discuss each of these methods in more detail on the next couple of slides and discuss prevention strategies later in the presentation. shopping occurs when a patient seeks medical services from multiple prescribers to obtain prescriptions.Individuals who shop are most likely pharmacy shopping as well to prevent being detected or reported to the prescriber.Individuals who shop may provide a vague description of their symptoms, exaggerate symptoms of an existing medical condition,.
Or make up symptoms to obtain a prescription for their drug of abuse.To avoid being detected in a pharmacy, individuals may avoid using their insurance card to pay for a prescription and instead pay for it with cash.In fiscal years 2006 and 2007, shopping resulted in about $63 million in medicaid payments related to prescription drugs.This amount does not include the cost of the office visit.More recently, a 2008 government accountability office gao study showed that 170,000 medicare part d beneficiaries received prescriptions for frequently abused prescription drugs from five.
Or more prescribers at a cost of $148 million.One beneficiary received prescriptions from 87 different prescribers.On the positive side, florida’s recently enacted pdmp has helped reduce shopping multiple provider episodes by 65 percent since its launch.The 1970 controlled substances act requires the attorney general to set production quotas for schedule ii controlled substances each year.Quantities are to be sufficient enough to meet the medical, scientific, research, and industrial needs of the united states to meet lawful export requirements and to establish and maintain reserve stocks.When demand exceeds the projected production.
Quota, drug shortages may result.Such shortages may prompt patients with legitimate needs to pharmacy shop in an attempt to find their medication elsewhere.Theft is another method of drug diversion and it can occur at any point in the distribution process.In 2010, thieves broke in to an eli lilly warehouse in enfield, connecticut, and stole psychiatric and cancer drugs worth an estimated $80 million.Pharmacy robberies in maine increased from 2 in 2008 to 56 in 2012, but had dropped to 6 midway through 2013.In minnesota, reported drug thefts from.
Health care facilities increased by more than 50 percent in 5 years.Between 2011 and 2014, the fbi office in michigan and other enforcement agencies dismantled a criminal enterprise of 26 pharmacies run by one man, which involved 38 other individuals.All but one individual, who is believed to have fled the country, have been convicted and sentenced, and the ringleader was ordered to pay $19 million in restitution.Patients may also be the victims of drug theft.Approximately 14.6 percent of individuals who abuse prescription pain relievers either steal or buy them from a friend or relative.
In a 2013 iowa home invasion, victims reported that two men kicked in the door of their des moines home and demanded prescription drugs at knife point.Requests for early prescription refills because medications were stolen are also common.The u.S.Drug enforcement administration dea should be notified of all thefts or losses of controlled substances.An electronic reporting form form 106 is available by visiting the dea office of diversion control website.Forgery can be the result of writing prescriptions from stolen or fake prescription pads, altering a legitimate prescription, or posing as a licensed prescriber.
And calling in a prescription to a pharmacy.In 2009, five collegeage individuals were arrested in california for illegally obtaining prescription drugs using stolen identities.Using dea and medical license numbers stolen from a physician from san diego, the ringleader ordered five blank prescription pads.Using these prescription pads, the group was able to obtain thousands of tablets of oxycontin, xanax, percocet, adderall, and hydrocodoneacetaminophen.One of the men was earning $31,000 a week by selling the illegally obtained drugs.Illicit prescribing is essentially the act of prescribing prescription medication for nonmedical or illegitimate purposes.
pill mills are probably the most notable form of illicit prescribing.Many pill mills operate as pain or stress s.Florida used to be known as the nation’s epicenter for pill mills, with seven floridians dying every day from prescription drug abuse.In 2011, laws were passed banning the dispensing of schedule ii and iii controlled substances by physicians.Florida went from having 98 of the top 100 physicians who bought and prescribed oxycodone to having none of them.The cost to the florida medicaid program for oxycodone prescribed at pill mills.
Was $27 million in 2010 and 2011.Prescription drugs are illegally sold by and purchased from drug dealers, friends or relatives, and illegal internet pharmacies.Little is known about how drug dealers obtain prescription drugs to sell however, some of their supplies may be obtained through diversion methods we have already discussed.Illegal internet pharmacies are rogue websites that operate under the guise of legitimate pharmacies providing controlled substances or other medications to individuals without a valid prescription.According to a report released by the national association of boards of pharmacy.
Nabp, only 3 percent of the more than 10,000 websites reviewed comply with u.S.Pharmacy laws.Reasons for noncompliance include affiliation with a network that obtains a drug from questionable sources, offering foreign or nonu.S.Food and drug administration fda approved drugs, failing to require a valid prescription, being physically located outside the u.S., and having its server located in a foreign country.Distributing counterfeit medications is not only illegal, but may also cause harm to the end user.Counterfeit medications may contain the wrong active ingredient, the wrong amount of the active ingredient,.
Or no active ingredient.In one case, a pharmacist in texas was convicted for conspiracy to introduce counterfeit and misbranded drugs into u.S.Commerce.He purchased counterfeit cialis and viagra from china for 30 cents per tablet.Wholesale prices for the legitimate drugs were $9.55 for cialis and $13.55 for viagra.The pharmacist profited from the drugs and exposed his customers to the risk of potentially dangerous medications.He was sentenced to 2 years in federal prison.Before we discuss the drugs that are being diverted, it is important to understand.
Why people divert or abuse prescription drugs.Some of the most common reasons people may divert or abuse prescription drugs are dependence and addiction, selfmedication, treatment or prevention of withdrawal symptoms, and monetary gain.So that we are all on the same page, physical dependence on a drug occurs because of normal adaptations to chronic exposure to a drug.Individuals that are dependent on a drug of abuse will develop tolerance, requiring more of the drug to achieve a certain effect and will experience physical or mental withdrawal symptoms with abrupt.
Discontinuation or a rapid reduction in dose.Addiction is characterized by drugseeking behavior, which will be discussed in detail later in the presentation.Addiction involves compulsive drug use despite harmful consequences characterized by an inability to stop using a drug and failure to meet work, social, or family obligations.Dependence is not addiction however, addiction may include dependence.There are primarily two reasons people become addicted to prescription drugs using medications for legitimate purposes or abusing medications for recreational use.Prolonged use of controlled substances for medical reasons may result in addiction.
Patients become dependent on the medications over time.As tolerance develops, prescribers increase the dosages.Eventually, these patients need to continue taking the medications just to feel normal.Some patients who are addicted to controlled substances may resort to shopping or other methods to obtain their medications.There is a perception that because the fda approves these prescription drugs, they are safe.In reality, they are generally safe when used as prescribed and by the person for whom they were prescribed.Recreational use of prescription drugs often starts as an experiment..
The individual tries the drug at a party or sees it in a medicine cabinet and decides to take one and see what happens.After they try the drug, they find they crave it and are unable to stop using it.The feelings they exhibit are dependent on the drug that was used.Patients may choose to selfmedicate by increasing their medication dose without the knowledge, direction, or supervision of their physician or pharmacist.This is actually misuse, not abuse.The treatment of pain is a common ailment for selfmedicating.Using leftover opioids from a procedure.
To treat an undiagnosed injury, headache, or other pain is just another example of selfmedicating.Individuals may also borrow medication from a friend or family member to treat an undiagnosed problem.Attentiondeficithyperactivity disorder adhd medications also may be used to selfmedicate.Individuals may fake symptoms to obtain a prescription in order to improve concentration when studying or taking an exam, or to simply gain additional accommodations for school work.Underlying mental issues may also lead to selfmedication and pseudo addiction.The misuse of prescription drugs may lead to substance abuse and dependence.
Patients who have become dependent on controlled substances will experience withdrawal symptoms when they abruptly stop taking the medication or rapidly reduce the dose.The withdrawal symptoms people experience can be so unpleasant that individuals trying to stop abusing prescription drugs relapse before they become completely clean.Prescription drug diversion can be a lucrative business.Convictions against pill mills have shown how lucrative it can be.The largest pill mill operation in the u.S.Was shut down in 2011.The s writing the prescriptions were paid $75 to $100 for each opioid.
Prescription they wrote.Many of the physicians would see around 100 patients a day, taking home about $37,500 a week or $1.95 million a year.A june 2011 article on cnn money’s website put into perspective the rapid rise in the street market for prescription pain killers.Oxycontin was selling for more than 10 times its retail value.Hydrocodone, oxycodone, percocet, and vicodin were going for at least twice their value and in some cases, more than 15 times their retail value.The website streetrx provides current estimates on the street value.
Of various drugs.The values are anonymously reported by individuals selling drugs on the black market.Now that we have an understanding of why drugs are being diverted, let’s take a look at which prescription drugs are diverted.The u.S.Dea has identified five classes of drugs of abuse opioids, central nervous system cnsdepressants, stimulants, anabolic steroids, and over thecounter otc medications, specifically dextromethorphan dxm.Other prescription drugs that have been reported to be diverted or abused are gabapentin, antipsychotics, antiretrovirals, and human growth hormone.The term narcotic originates from the.
Greek word for stupor or numbness because the substances relieved pain and dulled the senses.Opioid has become synonymous with narcotic and is the more current term for the drug class that contains opium, opium derivatives, and their semisynthetic substitutes.Opioids can induce euphoria by increasing dopamine levels in the brain.The route of administration can affect the response to the drug.Reduced tension, anxiety, and aggression are expected when the drugs are taken as intended.However, the euphoric feelings can be intensified when the drugs are snorted, injected, or smoked.The unintended routes.
Of administration also increase the risk of respiratory depression, coma, and addiction.The unintended routes of administration are not isolated to tablets or oral liquids being used inappropriately.Deaths related to fentanyl have been reported from chewing the patch or withdrawing the drug from the patch and injecting, ingesting, or smoking it.Methadone has been used for years to treat opioid addiction.It is also used to treat severe pain when longterm, continuous opioid treatment is needed.Methadone use for severe pain has increased, bringing a subsequent increase in methadonerelated deaths.
According to the cdc, 30 percent of deaths from painkillers involve methadone.Suboxone is a combination opioid agonist and antagonist approved for the maintenance treatment of opioid dependence.The drug addiction treatment act of 2000 allows physicians who meet certain qualifications to obtain a waiver so they can prescribe fdaapproved medications for the treatment of opioid addiction on an outpatient basis.Suboxone buprenorphine and naloxone, subutex buprenorphine, and embeda morphine and naltrexone are the only drugs approved at this time.Unfortunately, in the last few years suboxone has become a drug of abuse.Suboxone.
Was designed so that when taken sublingually the naloxone component has no al effect however, when injected the naloxone component blocks the euphoric effects of the opioid component and precipitates withdrawal.Individuals have figured out how to separate out the naloxone so they can inject or inhale the drug to get a quick high.The cns depressants include barbiturates, benzodiazepines, sedativehypnotics, and skeletal muscle relaxants.Most depressants enhance gammaaminobutyric acid gaba activity, which slows brain activity to produce a drowsy or calming effect.Similar to opioids, individuals who abuse depressants experience euphoria.
Depressants also may be used to intensify the high of another drug or to prevent the side effects of other drugs.Individuals abuse depressants by taking the drug orally, crushing the tablet or capsule and snorting it, or injecting the liquid formulation.An overdose may result in respiratory distress, hypotension, dilated pupils, and coma.With the exception of the barbiturates, cns depressant overdoses are rarely fatal however, when combined with alcohol or other drugs, an overdose can be fatal.Stimulants, such as methamphetamine, methylphenidate, amphetamine, and all of their derivatives, increase cns activity.
The otc products ephedrine and pseudoephedrine are also stimulants.Stimulants enhance the effects of norepinephrine and dopamine in the brain, causing a euphoric effect similar to the opioids and cns depressants when they are taken for nonmedical purposes.Caffeine and tobacco are also stimulants, but they are very mild in comparison to prescription stimulants.Stimulants can produce a sudden sensation known as a rush or a flash when they are snorted, injected, or smoked.An overdose may result in death because of its effects on thermoregulation and the cardiovascular system.Stimulants also.
Have been abused to enhance performance and promote weight loss.It is estimated that 15 to 40 percent of students who attend schools with high academic standards take stimulants to improve cognition.In 2008, the utilization rate for stimulant medications was 3.5 percent.The overall use of stimulant medications by people ages 10 to 19 has increased by 26 percent since 2007, and high school seniors are more likely to use them than sophomores or eighth graders.However, there seems to be a slight downward trend in the use of illicit.
Drugs, cigarettes, and alcohol among teens.Anabolic steroids are synthetic derivatives of testosterone.They are frequently abused to improve athletic performance and promote muscle growth.Individuals who abuse anabolic steroids often take multiple products in a cyclic manner.They believe by doing this they will improve the effectiveness of the steroid and minimize adverse reactions.Mood and behavioral changes are common with steroid abuse.Individuals who inject steroids place themselves at risk for complications from unsterile injections, such as an infection.Infections may be the result of poor aseptic technique or a.
Bloodborne pathogen, such as hepatitis b or human immunodeficiency virus hiv.Bacterial infections related to steroid use may lead to endocarditis.Dextromethorphan dxm is found in some prescription cough medications, but it is most frequently obtained without a prescription due to its otc status.Dxm is found in more than 120 otc cold medicines, so it is fairly easy to obtain.At high doses, dxm causes euphoria and visual and auditory hallucinations.In very high doses, dxm acts on the glutamate receptors like phencyclidine pcp and ketamine do, causing similar dissociative or outofbody experiences.
Traditionally, individuals who abuse dxm would drink large amounts of otc cough syrup.Newer tablet and capsule preparations have become popular because they are more palatable, easier to consume, and easily transported and concealed.Overdoses of dxm usually do not result in severe medical consequences or death.Most deaths related to dxm use are caused by ingestion of dxm in combination with another drug or as a result of accidents that occur while under the influence of dxm.At this time, we’ll pause for another knowledge check.Earlier in the presentation the terms.
Addiction and dependence were defined.The most common reasons individuals become addicted to prescription drugs were also discussed.For this knowledge check, read the following phrases.Decide if the phrase is an indication of addiction or dependence.Compulsive drug use despite harmful consequences.This is an indication of addiction.Normal adaptation to chronic exposure to a drug.This is an indication of dependence.Failure to meet work, family, or social obligations.This is an indication of addiction.Now we will take a look at who is diverting prescription drugs.Drugs can be diverted in many ways.
And through a variety of people, including individuals, health care professionals, manufacturers and wholesale distributors, and illegal internet pharmacies.We will take a closer look at each of these.When referring to individuals, we are really talking about patients and consumers.A patient is someone who is under medical care not every person who abuses drugs is under the care of a health care professionalnor is every person who diverts prescription drugs.Those individuals who are not under medical care are consumers.Individuals divert drugs in a variety of ways.Of the methods we discussed previously,.
shopping, theft, forgery, and illegal purchasing are the most likely to involve individuals. shopping is one of the most common methods individuals use to obtain prescription drugs.According to the 2014 nsduh, 3.1 percent of individuals who used pain relievers for nonmedical purposes obtained them from more than one .Drug theft can occur at any step of the supply chain.Pharmacy robberies have increased and reports of robberies of manufacturers and distributors have grabbed headlines.According to the 2014 nsduh, 4.4 percent of those who used pain relievers.
For nonmedical use stole medications from friends or relatives.Forgery is another common method of drug diversion.Forgery can occur by altering an existing prescription or by writing a fake prescription on stolen or illegally printed prescription pads.Prescribers should take extra steps to secure prescription pads and protect electronic prescribing identification information.Individuals may also phone in a fake prescription to the pharmacy.Pharmacy personnel should take extra precautions, such as documenting who called in the prescription, the date and time the call was received, a call back number, and required information, such as a dea.
Number for controlled substances.A call back number that does not match your records or caller hesitation when providing a dea number may be reason to proceed with caution.A prescriber may hesitate when asked for detailed patient information such as a birth date, address, or telephone number, and an imposter may hesitate or hang up when asked for a dea or other license number.If there is anything suspicious or unusual about the phone call, do not be afraid to call the prescriber to verify the information.Individuals may obtain prescription.
Drugs by illegally purchasing them from friends or relatives, drug dealers, or pill mills.While a cash transaction may not take place, obtaining prescription drugs from a friend or family member is still illegal.Sharing medications with friends and family members is a form of drug diversion and can be just as harmful as buying medications on the black market or stealing prescription pads to obtain drugs illegally.Health care professionals include physicians, pharmacists, nurses, physician assistants, nurse practitioners, respiratory therapists, and any other medical personnel that may have access to.
Prescription drugs or a patient’s medical record.Health care professionals may be knowingly or unknowingly involved in drug diversion activities.Theft, forgery, illicit prescribing, illegal sales, and counterfeiting are ways health care professionals may divert prescription drugs.Health care professionals often have access to controlled substances and other medications with street value.Theft may go undetected for prolonged periods, especially if the quantities are small, removed from stock infrequently, and controlled substance logs are altered to match inventory.Facilities, such as nursing homes and other longterm care facilities with low staffing levels,.
With incoherent patients, or without automated dispensing machines are at greater risk to have controlled substances stolen by a staff member.Submitting false claims is also a form of theft.Health care professionals who bill for medications that were not administered or dispensed, for more medication than was administered or dispensed, or bill under another beneficiary’s medicaid or insurance benefit are stealing.Not only are they stealing from the individual or health plan paying for the medication, they may also be stealing the medication that was not administered or dispensed.Forgery is not typically a method associated.
With health care professionals however, a health care professional may forge a prescription to make it appear it was written by another health care professional.Illicit prescribing has gained attention in the medical community because of all of the pill mills.Health care professionals who knowingly prescribe unnecessary prescriptions or larger quantities of medication than are medically necessary are contributing to the drug abuse epidemic and are assisting in the diversion of prescription drugs.Falsifying records and credentials are also part of illicit prescribing.Illegal sales are frequently associated with purchases.
Made on the black market.Health care professionals involved in drug diversion who are interested in financial gain may illegally purchase medications to administer or dispense to increase their profits.The most basic form of counterfeiting can happen in any health care setting, including s, s, pharmacies, and longterm care facilities.Diluting medications is counterfeiting.The medication being administered or dispensed is not what it is supposed to be.The health care professional has either made it less potent or failed to provide the correct medication.Health care professionals may also.
Initiate schemes that divert prescription drugs.A physician allegedly prescribed oxycodone to patients who then resold the drugs to third parties.In turn, those third parties distributed more than 11,000 oxycodone pills in a scheme resulting in a $1 million expense to the medicaid program.It may be difficult to detect suppliers diverting drugs.The methods of diversion that suppliers may use include illegal sales and counterfeiting.The fda oversees the drug supply chain.Illegally purchased drugs may be adulterated, expired, diluted, or illegally imported.Counterfeit drugs may be more or less potent than.
The authentic drug or may contain no drug or a different drug.All of these may compromise the supply chain and place patients at risk.In one scheme, secondary wholesalers were used to funnel millions of dollars worth of illegally obtained prescription drugs to primary wholesalers and then to pharmacies.Illegal internet pharmacies are rogue websites that operate under the guise of legitimate pharmacies and may provide controlled substances or other medications to individuals without a prescription.These pharmacies evade state licensing requirements and standards by operating across state and international borders.
According to the fda, nearly one out of every four internet consumers people who shop on the internet for anything, not just prescription drugs have purchased a prescription drug from an internet pharmacy.Since less than 3 percent of internet pharmacies meet federal and state laws, the risk of purchasing from an uncontrolled source is high.Unapproved internet pharmacies may sell you drugs without a prescription from your sell drugs for extremely discounted prices send unsolicited emails selling cheap drugs be located outside of the united states and not be licensed in the united states.
To raise public awareness about the prevalence of fraudulent internet pharmacies and to help consumers make safe purchases, the fda launched a national campaign, besaferx know your online pharmacy, in september 2012.The besaferx campaign on the fda website provides information to consumers and health care professionals on what to look for on an internet pharmacy website, the potential dangers of purchasing medications online from rogue websites, and how to report a suspicious internet pharmacy.The dea office of diversion control also has an online reporting system for suspected unlawful sales of drugs.
The reporting system is available at the dea office of diversion control website.At this time, we will pause for a knowledge check.Each method of diversion forgery, shopping, illicit prescribing, illegal purchasing, counterfeiting, and theft is defined previously in the presentation.We also discussed information about who is responsible for diverting prescription drugs.We have also looked at examples of diversion methods most commonly associated with these individuals and entities.In the examples on this slide and the next one, a short case study is presented.Determine if the case study is an example.
Of forgery, shopping, illicit prescribing, illegal purchasing, counterfeiting, or theft.Case study 1 a male patient at a rehabilitation facility has progressed quite well over the last month, but has started to complain of severe pain with physical therapy pt in the last week.The patient’s chart states he has an order for oxycodone 10 mg 30 minutes prior to pt.The medication administration record mar shows he has been receiving the medication.Upon review, you notice that the dates of the pt notes when the patient has complained of severe pain are the same days a.
New nurse has been administering the medication.When you examine the patient, he asks why he is not getting the pain medicine anymore before pt.The correct answer is theft, which can occur at any point in the supply chain.Medications can be stolen from friends, relatives, manufacturers, and distributors.Case study 2 a pharmaceutical sales representative notices a discrepancy between the amount of the cancer drug a local pharmacist bought and the amount he sold.He mentions the matter to a nurse in the office of an oncologist who contracts.
With the pharmacy for oncology medications.The oncologist has the medication supplied by the pharmacist tested.The results show the prescriptions were diluted.The correct answer is counterfeiting.This method can happen in any health care setting, including s, s, pharmacies, and longterm care facilities.We will now turn the discussion to the detection of prescription drug diversion and abuse.Detecting drug diversion and drug abuse is challenging for all health care professionals.As health care professionals, we must be vigilant and attentive.Many individuals who participate in drug diversion do not look any different.
Than you or i do.We need to pay attention to what is going on around us, listen for what is and is not being said, and ask questions to get more information.Eventually, most individuals who are participating in illegal activities or using prescription drugs for nonmedical purposes will slip and give themselves away.The individual may be your patient, your coworker, or your family member.Regardless of the person’s relationship with you, he or she needs help.Detecting the activity or behavior is the first step in getting the.
Person help.The detection of drug diversion and abuse requires us to be able to recognize drugseeking behavior, substance abuse, and provider identity theft.We also need to recognize red flags and question those things that just do not feel right.At this time, we’ll look at each of these areas in greater detail.Being able to recognize drugseeking behavior is critical to detect and prevent prescription drug diversion and abuse.Drugseeking activity refers to a pattern of behavior characteristics of persons trying to obtain drugs through fraudulent means.Individuals trying to obtain prescription.
Drugs for nonmedical purposes may use several tactics to get the medications they want.Classic drugseeking behaviors that individuals use include complaining of headache, back pain, or dental pain and stating that pain is 10 or greater than 10 on a 10point scale requesting medications by name, specifically narcotics, benzodiazepines, and muscle relaxants requesting parenteral administration of the medication stating they ran out of medication or requesting a refill of a narcotic, benzodiazepine, or muscle relaxant and reporting their medication or prescription was stolen.Pain is the most common complaint of patients visiting an ed.
Identifying patients who are exaggerating or faking pain is not an easy task.Pain is subjective.Scans and laboratory tests cannot diagnose pain.Individuals trying to fraudulently obtain prescription drugs may request specific medications or a specific route of administration.They may say the prescribed drug does not work or they are allergic to it.Drugseeking individuals have stated they are allergic to nonnarcotic drugs so that they are prescribed a narcotic.Requesting a medication refill is a normal behavior, especially by patients who are compliant with their medications.Requests for narcotic, benzodiazepine,.
Or muscle relaxant refills may be cause for concern, especially if the normal course of the injury or disease process should no longer require treatment or as intense of treatment.Individuals may use unsuspecting methods to obtain more medication by simply stating they ran out or need a refill.They may also ask for a larger quantity so they do not have to refill the medication as often or request to have more refills written on the prescription so they do not have to bother you so often.New patients may state they are visiting.
From outoftown, need to establish care, or are changing providers.Lost or stolen medications or prescriptions can be legitimate or an excuse to get more medication or a new prescription.Frequent requests for a refill because the medication or prescription was lost or stolen should provide reason for caution.Other behaviors to be aware of include requesting early refills, demanding to be seen immediately, threatening staff, refusing tests or consultations, volunteering to pay cash for services or medications, failing to schedule or attend followup appointments, appearing to be in a hurry, and.
Providing a vague medical history.Drugseeking behaviors that health care professionals may exhibit may include the behaviors used by individuals that we just discussed.As coworkers, however, we probably will never witness many of them.Behaviors that may be more characteristic of a health care professional or a coworker trying to obtain prescription drugs for nonmedical purposes include volunteering to administer controlled substances forgetting to have a witness when wasting controlled substances pocketing or hiding excess drug that needs to be wasted overexaggerating patient symptoms and complaints spending excess time by the drug room.
Or automated dispensing machine requesting prescriptions from prescribers they work with writing illegibly in or falsifying patient records or drug log books keeping blank prescription pads in their pocket and prescribing drugs of abuse for family members.Most nurses do not like to administer controlled substances because of the documentation that accompanies such prescriptions.Most s, s, and longterm care facilities require a witness to obtain a controlled substance for administration and to waste the excess drug.In a busy practice environment, it is not always easy to find someone to help.
Health care professionals with access to the medications may also forget to have a witness sign off on the medication at the time the drug is obtained, administered, or wasted, and ask you later to sign the witness documentation even though you are not actually witnessing the act.Health care professionals also may make it appear that they are disposing of the excess drug when they are really disposing of an imposter and have pocketed the real thing.Technology has made it more difficult to obtain drugs from the facility’s supply,.
But drugseeking health care professionals have found ways to circumvent the technology.They may steal another health care professional’s identification or credentials to log in to the drug cabinet or dispensing machine and remove more drug than is necessary.Health care professionals who tend to linger around the drug areas may be trying to memorize your information or catch you with your guard down, such as forgetting to log yourself off.Everyone has physical complaints from time to time and may appreciate the professional courtesy extended by a coworker who is willing to provide a.
curbside consult.Prescribers need to be cautious of coworkers who abuse the courtesy by frequently asking for a prescription to treat their latest ailment, especially if they request a drug that may be abused or diverted.Refer prescription requests for chronic medications to their primary care physician.Illegible handwriting and false documentation are ways health care professionals try to conceal drug theft.The shift to electronic health records should minimize discrepancies or at least make them easier to discover and link to the health care professional.Handwritten prescriptions are becoming a thing of the past however,.
Many prescribers still have blank prescription pads in their offices or other practice environments.Health care professionals without prescribing privileges have little need to have blank prescription pads readily available and doing so places the prescribers at risk for identity theft and becoming a victim of forgery.Prescription pads should be stored in a secure location, and access should be limited to those with prescriptive authority.Writing prescriptions for yourself or family members is not unusual when it comes to treating an infection or the common cold however, prescribers that are writing controlled.
Substance prescriptions for themselves or a family member is cause for alarm.The american medical association ama code of medical ethics states, except in emergencies, it is not appropriate for physicians to write prescriptions for controlled substances for themselves or immediate family members.Signs and symptoms of drug abuse and drugseeking behavior go handinhand.Individuals who abuse drugs tend to do whatever it takes to get their hands on their drugs of choice.However, not all individuals who seek drugs abuse them, so it is important to be able to differentiate them.
Signs and symptoms of drug abuse include exhibiting unusual behavior as if they are under the influence of drugs or alcohol or having severe mood swings seeming distracted or disinterested in finding the cause of the medical problem telling unrealistic stories providing unreliable medical history showing physical signs of drug abuse, such as track marks or related scars, or wearing clothing to hide them, such as long sleeves in the summer appearing overdressed or underdressed for where they came from or are going to and failing to groom.Individuals trying to obtain prescription.
Drugs may be doing so to prevent or treat withdrawal symptoms.Withdrawal symptoms and the severity of them vary with the drug being abused and the length of time it has been abused.Withdrawal symptoms are usually neurologic, cardiac, and gastrointestinal gi.Symptoms of opioid withdrawal include insomnia, agitation, muscle aches, abdominal pain, nausea and vomiting, sweating, fever, tachycardia, hypertension, and tachypnea.Withdrawal symptoms from opioids are not considered to be lifethreatening.Benzodiazepine withdrawal causes symptoms similar to opioid withdrawal however, benzodiazepine withdrawal may also cause delirium tremens and lifethreatening seizures.
Withdrawal symptoms associated with stimulants include depression, fatigue, apathy, and disrupted sleep patterns.Withdrawal from anabolic steroids is associated with depression, headache, and muscle and joint pain.Dextromethorphan withdrawal causes gi symptoms similar to opioid and benzodiazepine withdrawal.It also can cause depression, cognitive problems, muscle and bone aches, and chills.What are some things you can watch for in detecting abuse one of the strategies for detection is to be alert and watch for red flags.Do this by being observant, taking extra time to do a thorough history and complete exam, reviewing past medical.
And prescription records, and verifying information that is not clear or is incomplete or inconsistent.Be on the lookout for these warning signs during the exam persistently abnormal vital signs, multiple injection marks, abscesses, jaundice, scratching associated with formication syndrome, pinpoint or dilated pupils, nystagmus, nasal ulcerations or perforations, or tachycardia.Questions you may ask yourself to make sure you are not overlooking something obvious include is the patient picking up narcotics prescribed by multiple health care professionals is the patient consistently requesting to pay cash for the prescription rather than submit it to his or her insurance.
Is this a new behavior, or is the patient starting to show a pattern is this the first time the patient has been seen for this problem is this the first time the patient has reported a prescription lost or stolen why did the patient choose to change providers has the patient missed followup appointments is the prescriber writing prescriptions for frequently abused medications for his or her own family members question and clarify or verify anything that sends up a red flag before the drug is prescribed or dispensed.A phone call to verify a prescription.
Or validate a story does not harm anyone.It just takes time, and the extra effort to check into something that does not seem quite right may even save a life.At this time, we’ll take a moment for a knowledge check.The previous section of the presentation reviewed detection.Classic drugseeking behaviors observed in patients and health care professionals are identified.In addition, examples of neurological, cardiac, and gastrointestinal withdrawal symptoms are presented.Observable signs and symptoms of drug abuse that are often considered red flags are described.Review the following bullets.
Decide if each one is an example of physical signs, drug abuse behavior, or al withdrawal symptoms.Complaining of pain greater than 10 out of 10 and requesting larger quantities of controlled substances these are examples of drug abuse behavior red or glassy eyes and slowed reflexes these are examples of physical signs and delirium tremens and hyperhidrosis these are examples of al withdrawal symptoms.In this module, we have discussed the who, what, and why of prescription drug diversion and abuse and how to detect it.What can we do to prevent it from.
Happening in the first place continue on to module 2 of this presentation to learn how to evaluate a prescription for tamperresistant features, for recommendations to improve the usefulness of a prescription drug monitoring program pdmp, and for tips on how to formulate a drug diversion prevention plan for your practice.This presentation was current at the time it was published or uploaded onto the web.Medicaid and medicare policies change frequently so links to the source documents have been provided within the document for your reference.This presentation was prepared as a service to the public.
NIDA scientist Ruben Baler talks about the dangers and consequences of steroid abuse English
Male speaker steroid abuse, take one.Ruben baler working out to stay in shape is a great feeling.Grunts but knowing you’re doing it the right way is even better.Anabolic steroids are artificial substances similar to the male sex hormone testosterone.They stimulate tissue growth, and they help build up muscle.Some people take steroids to improve their performance or appearance, but there are very good reasons why steroids are banned from sports.Steroids can weaken your body’s ability to defend against germs and diseases.And steroids can tell your bones to stop growing.
Grunts the scary thing though steroids can affect your brain.Steroids can mess with the part of your brain that controls mood, learning, and memory.I’m sure you’ve heard of roid rage.The fact is that, after awhile, people on steroids can become aggressive or even depressed.But that’s not all.If you’re a guy, steroids can lower your testosterone levels, reduce your sperm count, and even shrink your testicles.Oh, did i mention your hair falling out oh, my god! and if you’re a girl using steroids, you could lose.
Steroids Will Kill You
Steroids will kill you,Bodybuilder bodies are often destroyed from steroids and hgh which cause extreme transformations the before and after photos are unreal subscribe for new. Truth about anabolic steroid side effects,Sfacebookpeterubish1. Epic 1 year steroid transformation,4 days on 1 day off program.
Full report inside the uks illegal steroid laboratories,Senior correspondent alex rossi visits a blackmarket lab in the west midlands where anabolic steroids are being produced and speaks to two steroid users. 10 worst side effects of steroid abuse,Top 10 worst things that can happen to bodybuilders when they overuse steroids subscribe to our channel 9cwqhg other tutorials you might like. Hack live on body obsession steroids,Despite the known health risks and legal consequences steroids are still a big part of the conversation when it comes to bulking up we find out why on hack.
Illegal steroids health effects,Maintaining an active lifestyle and and balanced diet all contribute to leading a healthy life however how far do people go to reach their ideal body image.
Nida scientist ruben baler talks about the dangers and consequences of steroid abuse english,Nida scientist ruben baler talks about the dangers and consequences of steroid abuse this tutorial can also be viewed at. Steroids disguised as supplements,In an update of the early eye investigation into anabolic steroids that are disguised as dietary supplements kelly cobiella reports on how they work the effects.
How to get ripped why you shouldnt use anabolic steroids,Gainmusclebuildmuscle how to get ripped why you shouldnt use anabolic steroids yes anabolic steroids can increase muscle mass. Bigger stronger faster trailer is it still cheating if everyones doing it,The documentary examines the steroid use of the director christopher bell and his two brothers who all grew up idolizing arnold schwarzenegger hulk hogan.
3 testosterone side effects you need to see before you take steroids,See how to bulk up and gain mass quicklyweightgainmethodviewyt3c steroids are no joke and they should be treated like a very serious.
Steroids sold illegally via facebook,Summary of news on steroids sold illegally via facebook sourcebbcnewsukengland35403285 dealers offering illegal. Learn about the steroid truth at worldclassbodybuilding,A very good attempt to get to the bottom of the steroid is very bad myth yes its a myth discussion can be made at. Students and steroids college health guru,Many a professional athlete has turned to anabolic steroids in the hopes of getting big fast check out more at collegehealthguruyt.
Dorian yates effects of steroids health london real,Dorian yates is a professional bodybuilder 6 time mr olympia full episode slondonrealacademyepisodesdorianyatesintotheshadow. Top 10 disturbing results of steroid abuse,Top 10 disturbing results of steroid abuse results of steroid. Understanding ptsd part 11 7keto dhea involved in important hormone production,Dr michael borkin nmd is a pioneer in hormone and electrolyte research he specializes in hormone and electrolyte testing and balancing to see his tutorials.
Understanding ptsd part 59 fingernails toenails tongue show health or disease,Dr michael borkin nmd is a pioneer in hormone and electrolyte research he specializes in hormone and electrolyte testing and balancing to see his tutorials. Understanding ptsd part 43 digestive problems are hidden cause of adrenal exhaustion,Dr michael borkin nmd is a pioneer in hormone and electrolyte research he specializes in hormone and electrolyte testing and balancing to see his tutorials.