Go figure: fraud data

Drug diversion

Abuse of addictive prescription drugs has reached epidemic levels in the U.S. The drugs are readily available in large quantities, thus fueling addicts, creating new generations of users, and sometimes killing users who overdose.

Painkillers are among the largest sources of abuse. Muscle relaxants, anti-anxiety medicines and others are often part of the mix as well.

Dishonest pain clinics are a significant source of trafficking. Crooked doctors write prescriptions for large quantities of drugs such as OxyContin. Private or taxpayer-funded insurance programs frequently pay for the prescriptions.

Addicts frequent the clinics in large numbers for hits. Clinics typically sell the addicts prescription drugs in large and potentially deadly quantities. Minimal or no examinations are given to determine medical need. Clinics also sell to street dealers, who resell to addicts at large markups.

Opioid painkillers cause more overdose deaths in the U.S. than heroin and cocaine combined. (Centers for Disease Control report, October 2011)

By 2010, enough addictive painkillers were sold to medicate every American adult with a typical 5 mg dose of hydrocodone every four hours for one month. (ibid)

Overdoses from opioid painkillers were involved in 14,800 of the 36,450 drug deaths in 2008. Painkillers were involved with 73 percent of the 20,044 prescription-drug overdose deaths in 2008. (ibid)

Prescription drugs in 2007 accounted for most of the increase in deaths from drug overdoses since 1999. (ibid)

1.2 million emergency-room visits were related to misuse or abuse of pharmaceuticals in 2009 (an increase of 98.4 percent) compared with 1 million emergency-room visits for illicit drugs such as heroin and cocaine. (ibid)

Overdose rates from opioid painkillers in 2008 was nearly four times the rate in 1999. Concurrently, sales of painkillers in 2010 were four times the sales in 1999. (ibid)

Three percent of physicians accounted for 62 percent of opioid painkillers in one study. (ibid)

Drug deaths outnumber traffic fatalities for the first time in 30 years, fueled by a rise in abuse of addictive prescription drugs. (Los Angeles Times analysis of data from the Centers for Disease Control, September 2011)

Drugs kill one person every 14 minutes. Most major causes of preventable death are declining, but drugs are an exception. (ibid)

Insurance fraud is a major financier of America’s epidemic diversion of addictive prescription drugs such as OxyContin.

Drug diversion costs health insurers up to $72.5 billion a year in bogus claims involving opioid abuse alone; (Prescription for Peril, Coalition Against Insurance Fraud, 2007)

Private health insurers lose up to $24.9 billion annually; (ibid)

Diversion costs individual private insurance plans up to $857 million annually; (ibid)

Nearly half of Aetna’s member/pharmacy anti-fraud team’s caseload involved prescription benefits in 2006; (ibid)

Expenses of suspected doctor-shopping members of Medco Health Solutions were nearly seven times higher than the monthly cost of members without excessive prescription claims; (ibid) and

Abuse suspects incurred $41 in claims for office visits and outpatient treatment for every $1 in narcotic prescription claims against WellPoint. (ibid)