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June 1991                                                         

              PHARMACEUTICAL DIVERSION AND ABUSE:                        
                OUR NATION'S OTHER DRUG PROBLEM                         


                      Thomas C. Babicke                                     
             Diversion Investigator and Instructor 
                Drug Enforcement Administration
                      Quantico, Virginia
     The news today seems to be the BIG C--cocaine, crack, 
cartel, and Colombia.  Record drug seizures are being made
across the globe.  Illicit drugs and drug-related crimes persist
everywhere.  There is not a State, city, school, or even a
family in America that has not heard about or seen the damaging
effects of drugs.  Yet, a startling fact remains.  Even if the
flood of illicit drugs into the United States could be
eradicated, and every marijuana or coca field destroyed before
t was cultivated, the United States would still have a ready
This article examines the historical development of various
the abuse of such substances.

HISTORY OF CONTROLLED SUBSTANCES                             


     Throughout history, pharmaceutical companies and
ndividuals have searched for new and more effective drugs to
cope with problems such as pain, depression, anxiety, insomnia,
and obesity.  One of the first to do so in modern history was a
German scientist, Frederick Serturner, who extracted morphine
from opium in 1805.  Morphine, a narcotic, is very effective in
opium and 10 times more addictive.  In 1832, codeine, another
narcotic, was isolated, and by 1853, Alexander Wood had invented
the hypodermic syringe.

     The American Civil War (1861-1865), the Prussian-Austrian
War (1866), and the Franco-Prussian War (1870) broadened the use
of such narcotics as morphine and codeine in treating wounded
"soldiers disease."  Then, in 1898, Bayer Laboratories marketed


     The development of barbiturates followed the same course as
narcotics.  From 1903, when the first barbiturate was created,
through the 1970s, the American public had access to an
ncreasing number of this class of drugs. (1)  In fact, the
benzodiaze-pines as a combined class of drugs easily are the
most prescribed drugs in the country.


     This class of drugs followed its own course of development.
narcolepsy and later as an appetite suppressant.  But, by the
end of the decade, the Third Reich had found an alternate use
for them--to increase the efficiency of the German army.  In
And, in 1969, astronaut Gordon Cooper was ordered to take an
amphetamine to increase his alertness prior to a manual re-entry
of the space module.

     Even the general populace is well aware of amphetamines
effects.  And, although amphetamines and some other stimulants
obesity treatment restricted, other similar drugs, such as


     Pharmaceutically controlled substances provide law
enforcement with various unique problems, basically because they
can be both legal in one case and illegal in another.  For
example, a heroin junkie has a prescription for hydromorphone
(Dilaudid), a powerful narcotic.  Does the addict have a legal
Such questions must be answered because hydromorphone can easily
be used to replace heroin.

     Law enforcement officers may be confronted with another
example of legal or illegal prescription drug use.  For
nstance, in this fictitious account, Mrs. Johnson receives a
Wednesday, a visit to Dr. Taylor provides a prescription for
Tranxene, also a benzodiazepine.  Basically, Mrs. Johnson
acquires different drugs from different doctors, an action that
quite possibly is illegal.

     Prescription fraud is another problem for law enforcement.
This occurs when offenders either steal prescription pads or
alter or photocopy prescriptions.  Some ingenious individuals
telephone number answered by a fictitious nurse.

     Then, there are the occasional problems with some doctors,
These few unscrupulous individuals contribute to the misuse or
abuse of controlled drugs by prescribing drugs illegally and for
llegitimate purposes.  In some cases, they may even deal drugs
or prescriptions or may be abusing prescription drugs


     There are several ways to attack prescription drug abuse
and the diversion of these drugs into illicit traffic.  First,
communication between law enforcement departments is essential.
Doctor shoppers and prescription forgers do not usually stay in
one location; therefore, in order to build a case against such
criminals, it is often necessary to contact neighboring police

     Law enforcement personnel must also be properly trained to
questionable prescriptions.  Officers should also be thoroughly
familiar with how to confiscate a prescription as evidence with
minimum difficulty.

     In addition, officers or investigators must be familiar
For example, if several drugs are prescribed simultaneously, do
any have similar central nervous system effects?  Law
enforcement personnel must also understand, for example, that a
they must also know that it would be highly unusual, and most
likely illegal, for a dentist to prescribe amphetamines.

     Specific legal expertise and training is often necessary to
nvestigate pharmaceutical diversion cases.  For example, an
nvestigation may involve fourth and fifth amendment rights and
crimes differ from jurisdiction to jurisdiction.  Therefore, to
build a successful case, officers and investigators must be
familiar with various applicable laws.


     Gathering information about doctor shoppers, script
forgers, or physicians selling prescriptions and investigating
the resulting cases can often be difficult, tedious, and time
consuming.  However, several States have found a partial answer
to this problem in the form of a Multiple Copy Prescription
Hawaii, Idaho, Illinois, Indiana, Michigan, New York, Rhode
legislation, in most cases for Schedule II drugs only.

     The prescription forms are provided to physicians at a
nominal cost and are usually in three parts; however, Rhode
form, the prescribing physician keeps a copy, and the third copy
s sent to the designated State agency for statistical purposes.

     These multiple copy prescription laws have had some
Alcoholism and Substance Abuse, published an analysis of their
triplicate prescription form program for 1985 through 1988. (2)
According to this enlightening report, prescriptions stolen by
Fiscal Year 1988 show a drastic reduction in the number of

     In addition, the State of New York, in a bold move,
extended their triplicate prescription law to include
benzodiazepines.  These drugs, which include drugs such as
Valium and Xanax, are the most prescribed pharmaceuticals in the
United States.  The results were substantial.  In a letter dated
June 6, 1989, to the DEA Administrator, the Secretary to New
York's Governor reported that "during a week in December 1988
and a week in January 1989...benzodiazepine prescriptions filled
by 21 pill mill pharmacies in New York City had fallen by 79

Obstacles to MCPPs

     Obviously, MCPPs can be very effective in stopping
not without controversy.  Large pharmaceutical companies have
continually lobbied against these prescription programs.  In
addition, the American Medical Association (AMA) does not
alternative in the form of prescription forms labeled PADS
(Prescription Analysis and Data Synthesis) and PADS II.

     However, the dramatic effect of MCPPs cannot be disputed.
MCPPs help to:

     *  Acquire controlledsubstance prescription information at
        the patient level (Federal information systems do not
        monitor controlled substances at this level);

     *  Reduce the abuse and isuse of Schedule II and
        othercovered controlled substances without adversely
        affecting the supply of these drugs for legitimate
        medical needs;

     *  Discourage the indiscriminate prescribing and dispensing
        of affected controlled substances by monitoring the
        prescribing physicians;

     *  "...collect information for law enforcement and
        regulatory purposes which identified potential
        controlled substance diversion by prescribing and
        dispensing practitioners, doctor shoppers and other drug
        abusers, and prescription forgers"; (5)

     *  Reduce prescription forgery by limiting the availability
        of prescription blanks, which could be stolen or
        acquired by potential prescription forgers.

     For the most part, States that have enacted multiple copy
benefits.  As a result, States using MCPPs have also been able
to squelch the critics complaints quite effectively by citing
the programs accomplishments.


     The diversion, misuse, and abuse of pharmaceutically
controlled substances has long been a law enforcement problem.
Continued cooperation and the sharing of information among the
various law enforcement agencies are essential to develop the
expertise to investigate these crimes.  However, tools such as
Multiple Copy Prescription Programs have helped to deal with
this problem effectively and need to be promoted.  In fact, a
establishing multiple-copy prescription programs." (6)

     But, none of these efforts can be truly effective without a
concerted effort to educate the public about the dangers of


     (1)  In 1903, Barbitol was synthesized and first used.
Barbitol was followed by phenobarbitol (Luminal) in 1912,
amobarbitol (Amytal) in 1923, pentobarbital (Nembutal) along
clordiazepoxide (Librium) in 1947.  Diazepam (Valium), a smaller
early 1970s.  Valium was the leading seller among all

     (2)  Triplicate Prescription Control Section, "1988
Operation Report With a Four Year Analysis," State of Illinois,
Department of Alcoholism and Substance Abuse, 1988.

     (3)  Ibid.

     (4)  Letter to DEA Administrator John Lawn from Gerald C.
Crotty, Secretary to Governor Mario Cuomo of New York, dated
June 6, 1989.

     (5)  U.S. Department of Justice, Drug Enforcement
Administration, "Multiple Copy Prescription Programs Resource
Guide," July 1987, pp. 4-5.

     (6)   Final Report, The White House Conference for a Drug
Free America, Washington, D.C., 1988, p. 66.