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DEA: Stopping Diversion of Prescription Opioids Starts With Providers

About half of people who misuse prescription drugs get them for free from a friend or family member, the federal government found — but another 22 percent report getting them from a single doctor.

Martin Redd thinks better educating providers could cut down on both groups.

"It's a cultural shift for practitioners," said Redd, diversion program manager for the Louisville Field Division of the U.S. Department of Justice Drug Enforcement Administration. "In the early 1990s, there was a push for practitioners to take care of pain by whatever means possible. They were pushed by patients, pushed by their peers, pushed by the drug companies to do what they could to alleviate pain. Now it's slowly progressed into what we call 'the opioid epidemic.' "

On Nov. 18-19, the DEA, with the Federation of State Medical Boards, will have a free Practitioner Diversion Awareness Conference in Nashville, aimed at those who prescribe medications. The two days are separate; practitioners need attend only one, and the Nov. 18 date already is full, Redd said. For Nov. 19, the DEA started registration at 325 but has managed to use other rooms at the Renaissance Nashville Hotel to increase the capacity to 425, he said, adding that Tennesseans seem "hungry for information" about the abuse that's ravaging their state.

The conference is modeled on a similar, successful one aimed at pharmacists, which the DEA took to every state in a four-year period. The agency set the same goal of hitting all 50 states with this conference, which has already been in Orlando, Florida; Charleston, West Virginia; and Louisville, Kentucky, where Redd is based, this year.

This conference, which runs from 8 a.m. to 5 p.m. Central Standard Time, is designed not only for physicians and midlevel providers such as nurse practitioners and physician assistants, but also for dentists and veterinarians, which have seen increasing levels of diversion as the epidemic rages.

"In the veterinary world, people will physically hurt their dog to bring the dog in to get hydrocodone or fentanyl or something like that, and then take it themselves," Redd said. "That's very prevalent."

The conference will cover how to watch for those instances, as well as look at methods used to divert drugs, what drugs are most abused and trends. It will cover options for patients, disposal of drugs and how the state monitors prescriptions.

It won't go into treatment options — doctors, nurses, dentists and veterinarians all have a higher risk, on average, than the general population for abusing drugs, a combination of access and stress, experts say — but will cover the scope of the DEA, which looks for regulatory compliance with existing laws.

"All we do is monitor and evaluate the controlled substances — we don't tell anybody how many to write, or that they shouldn't see this patient, or that they can only see so many," Redd said. "Those are myths we have to quash. ... Our job is to make sure regulatory compliance is where it needs to be."

For example, Redd said, if drugs in an office aren't secured, if patients' records aren't complete, if specialists are ordering large quantities of a controlled substance that they normally wouldn't use in their practices, that's when the DEA gets involved. Discipline of practitioners is handled by their professions' boards of examiners.

"There's a very small amount of practitioners who are doing the wrong thing," he said. "Everybody else, I think, wants to do the right thing for patients. They just need more education."

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