Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications
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Diversion of prescription opioids is a widespread problem in the USA. While “doctor shopping” and pill brokering are well-described types of medication diversion, we sought to understand the social dynamic of diversion of prescription opioids and identify other diversion methods. Using qualitative data collected as part of a 12-week Rapid Assessment and Response study of prescription opioid overdose and abuse (the RARx Study) conducted in three communities in two New England states, we reviewed and thematically coded 195 interviews. Diversion took many forms: doctor shopping, pill brokering, and, most commonly, siphoning from the family medicine chest. Partnering—of patients with other “patients,” of patients with “caregivers”— to obtain prescription opioids was also described. Motivations for partnering indicated doing so out of fear of violence, for financial benefit, or in exchange for transportation or other services. Partnering for prescription opioids exhibited a range of power differentials, from collaboration to coercion, and tended to involve vulnerable populations such as the elderly, disabled, or destitute. Increased awareness among health providers of the ease of access and diversion of prescription opioids is needed to promote patient safety and prevent interpersonal violence.
- Hall AJ, Logan JE, Toblin RL, et al. Patterns of abuse among unintentional pharmaceutical overdose fatalities. JAMA. 2008; 300: 2613–2620. CrossRef
- Paulozzi LJ. Opioid analgesic involvement in drug abuse deaths in American metropolitan areas. Am J Public Health. 2006; 96(10): 1755–1757. CrossRef
- Paulozzi LJ, Ballesteros MF, Stevens JA. Recent trends in mortality from unintentional injury in the United States. J Safety Res. 2006; 37(3): 277–283. CrossRef
- Paulozzi LJ, Budnitz DS, Xi Y. Increasing deaths from opioid analgesics in the United States. Pharmacoepidemiol Drug Saf. 2006; 15(9): 618–627. CrossRef
- Paulozzi LJ, Ryan GW. Opioid analgesics and rates of fatal drug poisoning in the United States. Am J Prev Med. 2006; 31(6): 506–511. CrossRef
- Diversion Prevention and Control, Uniform Controlled Substances Act. In: on NCoC, Laws US, eds. Chicago, Il1994.
- Davis WR, Johnson BD. Prescription opioid use, misuse, and diversion among street drug users in New York City. Drug Alcohol Depend. 2008; 92(1–3): 267–276. CrossRef
- Rosenblum A, Parrino M, Schnoll SH, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug Alcohol Depend. 2007; 90(1): 64–71. CrossRef
- Inciardi JA, Surratt HL, Kurtz SP, Burke JJ. The diversion of prescription drugs by health care workers in Cincinnati, Ohio. Subst Use Misuse. 2006; 41(2): 255–264. CrossRef
- Inciardi JA, Surratt HL, Kurtz SP, Cicero TJ. Mechanisms of prescription drug diversion among drug-involved club- and street-based populations. Pain Med. 2007; 8(2): 171–183. CrossRef
- Inciardi JA, Surratt HL, Cicero TJ, Kurtz SP, Martin SS, Parrino MW. The "black box" of prescription drug diversion. J Addict Dis. 2009; 28(4): 332–347. CrossRef
- Inciardi JA, Surratt HL, Cicero TJ, Beard RA. Prescription opioid abuse and diversion in an urban community: the results of an ultrarapid assessment. Pain Med. 2009; 10(3): 537–548. CrossRef
- Lankenau SE, Teti M, Silva K, Jackson Bloom J, Harocopos A, Treese M. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012; 23(1): 37–44. CrossRef
- Green TC, Grau LE, Carver HW, Kinzly M, Heimer R. Epidemiologic trends and geographic patterns of fatal opioid intoxications in Connecticut, USA: 1997–2007. Drug Alcohol Depend. 2011; 115(3): 221–8. CrossRef
- SAMHSA. Area profiles of drug-related mortality, 2008. Rockville, MD2010.
- Advameb, Inc., City-Data. updated July 1, 2012. http://www.city-data.com. Accessed 14 Aug 2012.
- RADARS System."OxyContin". StreetRx. Updated August 10, 2012. http://www.streetrx.com. Accessed 10 Aug 2012.
- Cicero TJ, Inciardi JA, Surratt H. Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States. Drug Alcohol Depend. 2007; 91(2–3): 115–120. CrossRef
- Paulozzi LJ, Xi Y. Recent changes in drug poisoning mortality in the United States by urban–rural status and by drug type. Pharmacoepidemiol Drug Saf. 2008; 17(10): 997–1005. CrossRef
- Cicero TJ, Surratt H, Inciardi JA, Munoz A. Relationship between therapeutic use and abuse of opioid analgesics in rural, suburban, and urban locations in the United States. Pharmacoepidemiol Drug Saf. 2007; 16(8): 827–840. CrossRef
- Jones DL, Irwin KL, Inciardi J, et al. The high-risk sexual practices of crack-smoking sex workers recruited from the streets of three American cities. The Multicenter Crack Cocaine and HIV Infection Study Team. Sex Transm Dis. 1998; 25(4): 187–193. CrossRef
- Weatherby NL, Shultz JM, Chitwood DD, et al. Crack cocaine use and sexual activity in Miami, Florida. J Psychoactive Drugs. 1992; 24(4): 373–380. CrossRef
- Green TC, Mann MR, Bowman SE, et al. How does use of a prescription monitoring program change medical practice? Pain Med. 2012; 13(10): 1314–23. CrossRef
- O’Campo P, Kirst M, Tsamis C, Chambers C, Ahmad F. Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review. Soc Sci Med. 2011; 72(6): 855–866. CrossRef
- Ramsay J, Richardson J, Carter YH, Davidson LL, Feder G. Should health professionals screen women for domestic violence? Systematic review. BMJ. 2002; 325(7359): 314. CrossRef
- McCaw B, Berman WH, Syme SL, Hunkeler EF. Beyond screening for domestic violence: a systems model approach in a managed care setting. Am J Prev Med. 2001; 21(3): 170–176. CrossRef
- Potter M, Schafer S, Gonzalez-Mendez E, et al. Opioids for chronic nonmalignant pain. Attitudes and practices of primary care physicians in the UCSF/Stanford Collaborative Research Network. University of California, San Francisco. J Fam Pract. 2001; 50(2): 145–151.
- Fishman SM, Papazian JS, Gonzalez S, Riches PS, Gilson A. Regulating opioid prescribing through prescription monitoring programs: balancing drug diversion and treatment of pain. Pain Med. 2004; 5(3): 309–324. CrossRef
- Richard M, Reisman PJS, Adam J, Atherly, Christopher R, Flowers. Prescription opioid usage and abuse relationships: an evaluation of state prescription drug monitoring program efficacy. Subst Abuse Res Treat. 2009; 3: 41–51.
- Collaboration or Coercion? Partnering to Divert Prescription Opioid Medications
Journal of Urban Health
Volume 90, Issue 4 , pp 758-767
- Cover Date
- Print ISSN
- Online ISSN
- Springer US
- Additional Links
- Prescription opioid abuse
- Elder abuse
- Author Affiliations
- 1. Department of Emergency Medicine, Rhode Island Hospital, Providence, RI, USA
- 2. The Warren Alpert Medical School at Brown University, Providence, RI, USA
- 6. 593 Eddy St., Providence, RI, 02903, USA
- 3. The Miriam Hospital, Providence, RI, USA
- 4. Yale School of Public Health, New Haven, CT, USA
- 5. Fenway Community Health, Boston, MA, USA