Diversion & Abuse of Controlled Prescription Drugs | CASAColumbia

Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.

Under the Counter: The Diversion and Abuse of Controlled Prescription Drugs in the U.S.

Published: July 2005

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This report is a comprehensive analysis of how widely controlled prescription drugs—including opioids, central nervous system depressants, stimulants and steroids—are abused and by whom. It looks at the health and social consequences of such abuse and how these drugs are diverted from their normal distribution channels. It describes efforts underway to reduce such diversion and abuse and explores the barriers and gaps that remain in prevention and control.


CASAColumbia’s work for this report involved:

  • A review of more than 2,000 publications
  • An extensive analysis of 15 national data sets to understand the scope of the problem, document the populations most at risk and explore the consequences associated with prescription drug diversion and abuse in the U.S.
  • Interviews with more than 200 experts in this area
  • Focus groups with physicians, dentists, veterinarians, pharmacists and individuals abusing or addicted to controlled prescription drugs
  • Two landmark national surveys—one of 979 physicians and the other of 1,030 pharmacists—to better understand the mechanisms of diversion of prescription drugs and how medical professionals deal with this problem
  • An investigation of the availability of controlled prescription drugs on the Internet  


More than 40% of physicians surveyed did not ask about prescription drug abuse when taking a patient’s health history, and one-third did not regularly call or obtain records from the patient’s previous (or other treating) physician before prescribing controlled, potentially addictive drugs like opioids, depressants and stimulants. 47% of physicians said that patients commonly tried to pressure them into prescribing a controlled drug.

The report’s key findings included:  

  • From 1992 to 2002, while the U.S. population increased 13%, the number of adults 18 and older who abused controlled prescription drugs climbed 81% and the number of 12-to-17-year-olds abusing such drugs jumped 212%
  • From 1992 to 2003, abuse of controlled prescription drugs grew at a rate twice that of marijuana abuse, 5 times that of cocaine abuse and 60 times that of heroin abuse
  • From 1992 to 2003, prescription drug abuse increased 7 times faster than the increase in the U.S. population
  • The number of Americans—15 million —who admitted to abusing controlled prescription drugs exceeded the combined number who admitted to abusing cocaine (almost 6 million), hallucinogens (4 million), inhalants (2 million) and heroin (0.3 million) 

Among the physician survey’s major findings:  

  • 59% of physicians believed that patients account for the bulk of the diversion problem
  • Physicians perceived the 3 main mechanisms of diversion to be patient doctor-shopping, patient deception or manipulation of doctors, and forged or altered prescriptions
  • 74% of physicians have refrained from prescribing controlled drugs during the past 12 months because of concern that a patient might become addicted to them
  • Only 19% of physicians received any medical school training in identifying prescription drug diversion
  • Only about 40% of physicians received any medical school training in identifying prescription drug addiction and abuse

Among the pharmacist survey’s major findings:

  • 28% of pharmacists did not regularly validate the prescribing physician’s information (DEA number) when dispensing controlled drugs; 1 in 10 rarely or never did so
  • 61% did not regularly ask whether the patient was taking any other controlled drugs when dispensing a controlled medication
  • When a patient presents a prescription for a controlled drug, 26.5% “somewhat or very often” think it is for purposes of diversion or abuse; 78% become “somewhat or very” concerned about diversion or abuse when a patient asks for a controlled drug by its brand name
  • 52% believed that patients account for the bulk of the diversion problem
  • 29% have experienced a theft or robbery of controlled drugs at their pharmacy within the last 5 years; 21% did not stock certain controlled drugs in order to prevent diversion
  • Only about half had received any training in preventing prescription drug diversion or identifying abuse or addiction since pharmacy school


The report includes a broad list of recommendations designed to train health care providers, strengthen efforts to control Internet diversion, strengthen monitoring and enforcement designed to prevent and detect diversion, and improve FDA regulation of controlled prescription drugs. Other recommendations include safeguarding these drugs from children, public education and improved treatment for addiction.

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