	Background

The diversion and abuse of prescription drugs are associated with  incalculable costs to society in terms of addiction, overdose, death, and  related criminal activities. One recent example of this  growing diversion problem concerns the controlled substance oxycodone,  the active ingredient in over 20 prescription drugs, including OxyContin,  Percocet, and Percodan. The data provided to DEA are available for use in monitoring the  distribution of controlled substances throughout the United States, in  identifying retail-level registrants that received unusual quantities of  controlled substances, and in investigations of illegal diversions at the  manufacturer and wholesaler levels. State Monitoring Programs Varied in Objectives and Operation

State prescription drug monitoring programs varied in their objectives and  operation. Which agency, such as a pharmacy board or public health  department, was given responsibility for the program also varied across  states. State monitoring programs are intended to facilitate the collection,  analysis, and reporting of information on the prescribing, dispensing, and  use of prescription drugs within a state. We found that state programs varied in their objectives. All states used  monitoring programs primarily to assist law enforcement in detecting and  preventing drug diversion, and but some also used the programs for  educational purposes. They  also identified patients who may have been abusing or diverting  prescription drugs and provided this information to practitioners. Monitoring programs have also been used to educate physicians,  pharmacies, and the public about the existence and extent of diversion,  diversion scams, the drugs most likely to be diverted by individuals, and  ways to prevent drug diversion. State programs varied in the controlled substances they covered, in part  because of differences in available resources and other state-specific  factors such as level of drug abuse. Some state programs had electronic reporting systems, while others were  paper-based. State Monitoring Programs Have Helped Shorten Investigation Times and May Reduce Illegal Drug Diversion

We found that states with monitoring programs have experienced  considerable reductions in the time and effort required by law  enforcement and regulatory investigators to explore leads and the merits  of possible drug diversion cases. We also found that the presence of a  monitoring program in a state may help reduce illegal drug diversion there,  but that diversion activities may increase in contiguous states without  programs. In each of the three states we studied, state monitoring programs led to  reductions in investigation times. In both Kentucky and  Nevada, an increased number of program reports were being used by  physicians to check the prescription drug use histories of current and  prospective patients when deciding whether to prescribe certain drugs  that are subject to abuse. Law enforcement officials told us that they view  these drug history checks as initial deterrents— a front-line defense—to  prevent individuals from visiting multiple physicians to obtain  prescriptions, because patients are aware that physicians can review their  prescription drug history. For an individual who may be seeking multiple  controlled substance prescriptions, the check allows a physician to  analyze the prescription drug history to determine whether drug treatment  appears questionable, and if so, to verify it with the listed physicians. As drug diverters became aware of the Kentucky program’s ability  to trace their drug histories, they tended to move their diversion activities  to nearby nonmonitored states.
Why GAO Did This Study

The increasing diversion of prescription drugs for illegal purposes or abuse is a disturbing trend in the nation's battle against drug abuse. Diversion can include such activities as prescription forgery and "doctor shopping" by individuals who visit numerous physicians to obtain multiple prescriptions. The most frequently diverted prescription drugs are controlled substances that are prone to abuse, addiction, and dependence, such as hydrocodone (the active ingredient in Lortab and many other drugs) and oxycodone (the active ingredient in OxyContin and many other drugs). Some states use prescription drug monitoring programs to control illegal diversion of prescription drugs that are controlled substances. GAO was asked to examine (1) how state monitoring programs compare in terms of their objectives and operation and (2) the impact of state monitoring programs on illegal diversion of prescription drugs. This testimony is based on GAO's report, Prescription Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion, GAO-02-634 (May 17, 2002). In that report, the programs in Kentucky, Utah, and Nevada were selected for more in-depth study because they were the most recently established programs at the time.

What GAO Found

GAO found that the 15 state monitoring programs in place in 2002 differed in their objectives and operation. The programs were intended to facilitate the collection, analysis, and reporting of information about the prescribing, dispensing, and use of controlled substances. They provided data and analysis to state law enforcement and regulatory agencies to assist in identifying and investigating activities potentially related to illegal drug diversion. The programs could be used by physicians to check a patient's prescription drug history to determine if the individual was doctor shopping to seek multiple controlled substances. Some programs also offered educational programs for the public, physicians, and pharmacists regarding the nature and extent of the problem and medical treatment options for abusers of diverted drugs. The programs varied primarily in terms of the specific drugs they covered and the type of state agency in which they were housed. Some programs covered only those prescription drugs that are most prone to abuse and addiction, whereas others provided more extensive coverage. In addition, most programs were administered by a state law enforcement agency, a state department of health, or a state board of pharmacy. GAO also found that state monitoring programs may have realized benefits in their efforts to reduce drug diversion. These included improving the timeliness of law enforcement and regulatory investigations. Each of the three states studied reduced its investigation time by at least 80 percent. In addition, law enforcement officials told GAO that they view the programs as a deterrent to doctor shopping, because potential diverters are aware that any physician from whom they seek a prescription may first examine their prescription drug utilization histories based on monitoring program data. For example, as drug diverters became aware of Kentucky's ability to trace their drug histories, they tended to move their diversion activities to nearby nonmonitored states.