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“Don’t Squeeze the Balloon: An International Perspective on Preventing Prescription Drug Overdoses”

DEA Chronicles By D. Linden Barber

Last year the United Nations Office on Drugs and Crime (UNODC) and the World Health Organization (WHO) published a paper on reducing opioid overdose mortality. The paper addressed opioid overdoses related to heroin use and concluded that reduction in supply is an effective measure governments can take to reduce heroin overdoses. The UNODC and WHO also addressed overdose incidents related to the misuse of opioid prescription drugs. However, these organizations did not state, or even suggest, that reduction in supply of prescription narcotics would reduce opioid overdoses. Instead the UNODC and WHO found that “[m]easures to limit the contribution of prescription medicines to opioid overdose include addressing the inappropriate prescription of opioids and other sedatives and inappropriate sales by pharmacies without a prescription.” This approach to preventing overdose incidents with prescription narcotics makes perfect sense. Supply is already limited by the Governments of countries which are Parties to the International Drug Control Conventions. For example, in the United States, the DEA approves the importation of narcotic raw material used in manufacturing prescription opiates. The Agency also establishes annual aggregate production quotas and assigns individual quotas to bulk and dosage unit manufacturers. The problem with prescription drug abuse is not a failure to control supply. Rather, it is the inappropriate prescribing of these drugs that fuels opioid addiction, abuse, and overdose incidents. The ONDCP strategy to reduce prescription drug abuse will be more effective if it places a heavier emphasis on taking action to curb inappropriate prescribing of these drugs. I was once an advocate for aggressively targeting the supply chain as a means of preventing the diversion and abuse of prescription drugs. After all, targeting the supply chain is an effective law enforcement strategy for preventing the misuse of illicit drugs. But the results of that strategy with prescription drugs have been ineffective as evidenced by the rising abuse of those products. The governments of the world will continue to ensure adequate supply of pharmaceutical narcotics for medical purposes; therefore, effective enforcement must focus on the prescribers who inappropriately prescribe or over-prescribe these drugs. Targeting the legitimate supply chain shifts, but does not solve, the problem. Would focusing law enforcement efforts on prescribers rather than the entire supply chain be more effective at preventing prescription drug abuse? We’d like to know what you think.

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