Mechanisms of prescription drug diversion among drug-involved club- and street-based populations.
OBJECTIVE
Prescription drug diversion involves the unlawful channeling of regulated pharmaceuticals from legal sources to the illicit marketplace, and can occur along all points in the drug delivery process, from the original manufacturing site to the wholesale distributor, the physician's office, the retail pharmacy, or the patient. However, empirical data on diversion are limited.


METHODS
In an attempt to develop a better understanding of how specific drug-using populations are diverting prescription opioids and other medications, or obtaining controlled drugs that have already been diverted, qualitative interviews and focus group data were collected on four separate populations of prescription drug abusers in Miami, Florida--club drug users, street-based illicit drug users, methadone maintenance patients, and HIV positive individuals who abuse and/or divert drugs.


RESULTS
Sources of abused prescription drugs cited by focus group participants were extremely diverse, including their physicians and pharmacists; parents and relatives; "doctor shopping"; leftover supplies following an illness or injury; personal visits to Mexico, South America and the Caribbean; prescriptions intended for the treatment of mental illness; direct sales on the street and in nightclubs; pharmacy and hospital theft; through friends or acquaintances; under-the-door apartment flyers advertising telephone numbers to call; and "stealing from grandma's medicine cabinet."


CONCLUSIONS
While doctor shoppers, physicians and the Internet receive much of the attention regarding diversion, the data reported in this paper suggest that there are numerous active street markets involving patients, Medicaid recipients and pharmacies as well. In addition, there are other data which suggest that the contributions of residential burglaries, pharmacy robberies and thefts, and "sneak thefts" to the diversion problem may be understated.
Inciardi
James A
JA
Center for Drug and Alcohol Studies, University of Delaware, Coral Gables, Florida 33134, USA. jainyc@aol.com
Surratt
Hilary L
HL
Kurtz
Steven P
SP
Cicero
Theodore J
TJ
D000293:Adolescent; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000453:epidemiology; D000701:Analgesics, Opioid; D023241:Antiretroviral Therapy, Highly Active; D019970:Cocaine-Related Disorders / Q000453:epidemiology; D016578:Crack Cocaine; D003469:Culture; D004345:Drug Industry; D011307:Drug Prescriptions; D005260:Female; D005431:Florida / Q000453:epidemiology; D017144:Focus Groups; D006679:HIV Seropositivity / Q000523:psychology; D006213:Hallucinogens; D006556:Heroin Dependence / Q000453:epidemiology; D006801:Humans; D013287:Illicit Drugs; D008297:Male; D008691:Methadone; D008875:Middle Aged; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D010361:Patients; D010604:Pharmacy; D010820:Physicians; D016320:Substance Abuse Treatment Centers; D019966:Substance-Related Disorders / Q000453:epidemiology*; D011795:Surveys and Questionnaires
D000701:Analgesics, Opioid; D016578:Crack Cocaine; D006213:Hallucinogens; D013287:Illicit Drugs; D018817:N-Methyl-3,4-methylenedioxyamphetamine; D008691:Methadone