Allentown Examiner: In its press release, the CDC says that physicians are the major source of prescription drugs that are abused. Now, to me, that seems obvious, because they're prescription drugs. I would imagine that it's unlikely that many of them are diverted directly from the manufacturers.
Dr. Jim Harris: It's rare [theft directly from drug manufacturer]. The DEA's scrutiny from the very beginning of the supply chain to the pharmacy door is very tight. There are occasional insider thefts and non-retail robberies, but it in no way supports the magnitude of our current black market. It supports occasional addicted pharmacists, for example. The black market is too large to be supported by a missing truck. The recordkeeping requirements are very stringent. The DEA is under so much pressure to get this right, because they are being so strongly embarrassed by the size of the black market that those things they can control -- from the manufacturer up to the pharmacy door -- they do very well.
The DEA quota is set every year for the various medications that DEA regulates. We can plot every year the broad categories of opiates and stimulants -- those are the two things that are most problematic in society. The quota is the cap on manufacturing and sales every year -- and you can bet that the manufacturers manufacture right up to the cap. The quota is the only objective, national data available; a final version is published in the Federal Register every year.
To give you an idea of how out of control this has become, compare 2013 to 1994 -- 1994 is a useful data point, because it's just before Oxycontin was released, so it serves as a nice baseline to see what America was like back in the Mayberry days, before Oxycontin changed society. It is astonishing, but true, that the quotas for both prescribed stimulants and prescribed opiates have increased, nearly 19-fold. If this were a stock, it would be the envy of Wall Street.
The additional new "legitimate" prescribing could not account for a 19-fold increase. Since 1994, the US population has grown by approximately 20 percent. So that's 1.2-fold. Nineteen-fold is, of course, much larger. The difference between population growth and the new market for these medications is the black market.
I'm very discouraged by what CDC is doing. To be specific, they are indicating to the press through the press release that for people who commonly misuse prescribed controlled substances, they get them through a primary relationship with a physician. It's not true. Their own data, which they misrepresented, shows that the number one source is through secondary or tertiary relationships, meaning that there are people in between the user and the physician that are faking the magnitude and duration of disease. People have gotten very good at faking disease. As a single example only, for a person of low morals and poor employment prospects, this can be very profitable -- people who are criminally-minded will, month after month, game the system. There are people who are hired to do it: it's known as "sponsored relationships." Sponsors will seek people that could, through ongoing disease and situation, claim to have a need for one of these substances. It's a new form of currency. It's a cash equivalent.
Let's say you're getting these medications paid for by Medicaid, Medicare, or private insurance. You can take a $20 co-pay and turn it into $5000 or $6000 easily.
It's considered to be very safe. Your supply chain is safe. As the cops like to say, "Walgreens doesn't shoot anyone." The end consumers, too, tend to be financially well-off, and not in the mood to rob and shoot the dealers. The customer base is safer and more serene. People would much rather make the same money dealing pills [than illegal drugs], because the risks are lower. The risks of getting caught are lower, because it's much more difficult for law enforcement to make a case.
Anybody that's doing this long-term -- and DEA has admitted to me that they only catch the dumb ones -- the thoughtful people, they generally fake clinical activity or disease themselves, so they have medications in bottles with their own names on them, so when people are busted for gaming the medical system and dealing pills, what the cops often find are boxes full of empty pill bottles. For somebody that's dealing pills, an empty bottle is a get-out-of-jail card, because when they get medications from their network of sponsored patients, they transfer them into bottles with their own name on them. Now they can drive around with those medications with impunity. The bottles could be eight years old, but the excuse is that they never took them, and left them in the glove compartment.