Understanding the Scope and Magnitude of Prescription Drug Diversion

James A. Inciardi, Principal Investigator

Initiated: 2007

Funding Source: National Institute on Drug Abuse

Project Summary:

The goal of this project is to examine and describe the complex of mechanisms and players that connect illicit supplies of prescription drugs (diversion) to abusers in South Florida from three vantage points: 1) prescription drug abusers, 2) prescription drug dealers, and 3) law enforcement. More specifically, this project aims to 1) recruit samples of 1,800 treatment clients, 300 street drug users, and 300 gay male methamphetamine abusers, all with prescription drug abuse problems; 2) assess life histories of drug abuse, including current alcohol, illicit, and prescription drugs; 3) assess mechanisms of access to and acquisition of prescription drugs; 4) assess demographic, sociocultural, and psychosocial characteristics that are hypothesized to connect prescription drug abusers to their illicit sources of supply; 5) conduct in-depth interviews with sub-samples of 30 respondents from each subgroup; 6) recruit 50 prescription drug sellers from diverse networks and conduct in-depth interviews to determine which prescription drugs they sell, to whom, in what quantities, at what prices, and how they are obtained; 7) extract data from the arrest files of 300 prescription drug traffickers from the diversion unit of the Broward County Sheriff’s Department to examine the sources and mechanisms of prescription drug trafficking; and, 8) conduct in-depth interviews with 20 diversion investigators in large police agencies to obtain information about the sources of diverted prescription drugs. As such, this study seeks to develop a fuller understanding of the mechanisms and magnitude of prescription drug abuse and diversion, and how they vary across user populations which is critical for health care and regulatory agencies in order to develop appropriate prevention, risk management, treatment, policy, and enforcement initiatives.


Inciardi, James A., Hilary L. Surratt, Theodore J. Cicero, Steven P Kurtz, Steven S. Martin, and Mark W. Parrino, “The ‘Black Box’ of Prescription Drug Diversion,” Journal of Addictive Diseases, in press.

Inciardi, James A., Hilary L. Surratt, Yamilka Stivers, and Theodore J. Cicero, “FDA Approvals of Generic Drugs: Impact on the Diversion of Opioid Analgesics with a Potential for Abuse,” Journal of Opioid Management, in press.

Schneider, Michael F, J. Elise Bailey, Theodore J. Cicero, Richard C. Dart, James A. Inciardi, Mark W. Parrino, and Alvaro Muñoz, “Integrating Nine Prescription Opioid Analgesics and/or Four Signal Detection Systems to Summarize Statewide Prescription Dug Abuse in the United States in 2007,” Pharmacoepidemiology and Drug Safety, in press.

Inciardi, James A. Hilary L. Surratt, Theodore J. Cicero, and Ronald A. Beard, “Prescription Opioid Abuse and Diversion in an Urban Community: The Results of an Ultra- Rapid Assessment,” Pain Medicine, in press.

Cicero, Theodore J., Hilary L. Surratt, and James A. Inciardi, “Use and Misuse of Buprenorphine in the Management of Opioid Addiction,” Journal of Opioid Management, 3 (November-December 2007), pp. 302-308.

Inciardi, James A., Hilary L. Surratt, Yamilka Lugo, and Theodore J. Cicero, “The Diversion of Prescription Opioid Analgesics,” Law Enforcement Executive Forum, 7 (7) (2007), pp. 127-141.

Cicero, Theodore J., James A. Inciardi, and Hilary L. Surratt, “Trends in the Use and Abuse of Branded and Generic Extended Release Oxycodone and Fentanyl Products in the United States,” Drug and Alcohol Dependence, 91 (2007), pp. 115-120.

Cicero, Theodore J., Hilary L. Surratt, James A. Inciardi, and Alvaro Muñoz, “Relationship Between Therapeutic Use and Abuse of Opioid Analgesics in Rural, Suburban, and Urban Locations in the United States,” Pharmacoepidemiology and Drug Safety, 16 (2007), pp. 827-840.

Inciardi, James A. and Theodore J. Cicero, “Black Beauties, Gorilla Pills, Footballs, and Hillbilly Heroin: Some Reflections on Prescription Drug Abuse and Diversion Research over the Past 40 Years,” Journal of Drug Issues, in press.

Inciardi, James A., Hilary L. Surratt, Steven P. Kurtz, and Theodore J. Cicero, “Mechanisms of Prescription Drug Diversion among Drug Involved Club and Street-Based Populations,” Pain Medicine, 8 (2007), pp. 171-183.

Cicero, Theodore J., Richard C. Dart, James A. Inciardi, George E. Woody, Sidney Schnoll and Alvaro Muñoz, “The Development of a Comprehensive Risk Management Program for Prescription Opioid Analgesics: Researched Abuse, Diversion and Addiction-Related Surveillance,” Pain Medicine, 8 (2007), pp. 157-170.

Katz, Nathaniel P., Edgar H. Adams, James C. Benneyan, Howard G. Birnbaum, Simon H. Budman, Ronald W. Buzzeo, Daniel B. Carr, Theodore J, Cicero, Douglas Gourlay, James A. Inciardi, David E. Joranson, James Kesslick, and Stephen D. Lande, “Foundations of Opioid Risk Management,” Clinical Journal of Pain, 23 (February 2007), pp. 103-118.

Surratt, Hilary L., James A. Inciardi, and Steven P. Kurtz, “Prescription Opioid Abuse among Drug-Involved Street Sex Workers,” Journal of Opioid Management, 2(September/October 2006), pp. 283-289.

Havens, Jennifer R., Carrie B. Oser, Carl G. Leukefeld , J. Matthew Webster, Steven S. Martin , Daniel J. O'Connell, Hilary L Surratt, and James A. Inciardi, “Differences in Prevalence of Prescription Opiate Misuse among Rural and Urban Probationers,” American Journal of Drug and Alcohol Abuse, 33 (2007), pp. 309-317.

Inciardi, James A., Theodore J. Cicero, Alvaro Muñoz, Edgar H. Adams, Anne Geller, Edward C. Senay, and George E. Woody, “The Diversion of Ultram, Ultracet, and Generic Tramadol,” Journal of Addictive Diseases, 25 (2) (2006), pp. 53-58.

Inciardi, James A., Hilary L. Surratt, Steven P. Kurtz, & John J. Burke, “The Diversion of Prescription Drugs by Health Care Workers in Cincinnati, Ohio,” Substance Use and Misuse, 41 (2006), pp. 255-264.

Adams, Edgar H., Scott Breiner, Theodore J. Cicero, Anne Geller, James A. Inciardi, Sidney H. Schnoll, Edward C. Senay, and George E. Woody, “A Comparison of the Abuse Liability of Tramadol, NSAIDs, and Hydrocodone in Patients with Chronic Pain,” Journal of Pain and Symptom Management, 31 (May 2006), pp. 465-476.

Cicero, Theodore J. and James A. Inciardi, “Potential for Abuse of Buprenorphine in Office-Based Treatment of Opioid Dependence,” New England Journal of Medicine, 353 (October 27, 2005), pp. 1863-1865.

Cicero, Theodore J., James A. Inciardi, and Alvaro Muñoz, “Trends in Abuse of OxyContin® and Other Opioid Analgesics in the United States: 2002-2004,” Journal of Pain, 6 (October 2005), pp. 662-672.

Cicero, Theodore J. and James A. Inciardi, “Increasing Diversion and Abuse of Methadone Prescribed for Pain,” Journal of the American Medical Association, 293 (January 19, 2005), pp. 297-298.

Cicero, Theodore J., James A. Inciardi, Edgar H. Adams, Anne Geller, Alvaro Muñoz, Edward C. Senay, and George E. Woody, "Rates of Abuse of Tramadol Remain Unchanged with the Introduction of New Branded and Generic Products: Results of an Abuse Monitoring System, 1994 – 2004," Pharmacoepidemiology and Drug Safety, 14 (May 2005), pp. 851-859.

Kurtz, Steven P., James A. Inciardi, Hilary L. Surratt, and Linda Cottler, "Prescription Drug Abuse Among Ecstasy Users in Miami," Journal of Addictive Diseases, 24 (4) (2005), pp. 1-16.

Inciardi, James A., Hilary L. Surratt, Steven S. Martin, and Roberta Gealt, “Prevalence of Narcotic Analgesic Abuse Among Students: Individual or Polydrug Abuse?” Archives of Pediatric and Adolescent Medicine, 158 (May 2004), pp. 498-499.

Inciardi, James A. and Jennifer L. Goode, “OxyContin: Miracle Medicine or Problem Drug,” in James A. Inciardi and Karen McElrath (eds.), The American Drug Scene, fourth edition (Los Angeles: Roxbury, 2004), pp. 163-173.

Inciardi, James A. and Jennifer L. Goode, “OxyContin and Prescription Drug Diversion,” Consumers Research, July 2003, pp. 22-25.