Robert Bianchi, President and Chief of Scientific and Technical Affairs at the Prescription Drug Research Center, on waking up to the value of pain medications to people in severe pain and people that are at the end of life that need to have some kind of relief~
“We have to make the drugs available to them while we prevent the abuse or misuse in a social setting where it is not necessary. So we are recognizing that, to use a term, we can’t arrest our way out of this dilemma. Arresting users on the street really doesn’t help solve the problem. And we’re finally recognizing that this is a disease that needs to be treated, just like other diseases.”
Robert Bianchi: You can’t leave it up to the government to solve this problem.
Brian Wilson: The Drug Enforcement Agency is the federal law enforcement entity tasked with combatting drug trafficking. The DEA has sole responsibility for pursuing illegal drug operations in the U.S. and abroad. Bob Bianchi is the President and Chief of Scientific and Technical Affairs at the Prescription Drug Research Center. Formerly with the DEA, he brings a unique perspective to the opioid crisis in America.
The Changes Over Time in Federal Government’s Focus Regarding Illicit Drug Use
Robert Bianchi: Prior to the formation of the DEA in 1973, there were various federal agencies that patrolled the use of illicit drugs. Prior to the 60s, drug use was not considered an acceptable behavior. Most people didn’t think that drug use would be acceptable in the future.
But things changed. In the 60s and 70s. We saw the advent of designer drugs like LSD, DMT, PCP, sometimes called the alphabet drugs. And the federal focus on enforcing the drug laws was really directed toward marijuana and cocaine until now, when the focus changed to heroin, stimulants, amphetamines, and depressants. So, the drug landscape was changing as time went on and has now moved into the area where the abuse of prescription drugs has become, not only acceptable but extremely popular.
So, when I retired from the DEA I started working with the pharmaceutical industry to try to develop new formulations that would be more difficult to abuse. And the FDA was very much in favor of that because they realized that they needed to do something, so they provided incentives to the industry to develop these new abuse deterrent formulations. So that’s how I got involved in the opioid situation that we’re in today.
Brian Wilson: You were in a position to see the wave of this crisis coming. It is, in many ways, a perfect storm. Is it not?
The U.S. Has Only 5% of the World’s Population Yet Consumes 80% of the World’s Supply of Pain Killers
Robert Bianchi: Well yes. A number of things have come together that have created this crisis. The United States, believe it or not, consumes 80% of the world’s supply of pain killers, and we only have five percent of the total world population. So there’s something peculiar about our culture.
And we do not tolerate the slightest discomfort. Every single day you see ads for prescription drugs that you’re being encouraged to ask your doctor about, after they read the litany of side effects, including death. We are one of two countries that allow direct consumer advertising. And I think that has contributed, in part, to our chemical dependent society. We are looking for instant gratification, solutions to all our problems. That’s the society that we live in in the United States.
Brian Wilson: I think maybe people look at it and they go, “How dangerous can these drugs be? I see them on TV advertised every day”.
Leftover Pain Killers Sit in Home Medicine Cabinet and Nobody Monitors Them
Robert Bianchi: Yes. That’s true. And you know, they are approved by the FDA. They’re prescribed by trained physicians. Friends and family use them, so how could this stuff be bad? Unfortunately, a lot of people start with a legitimate prescription and it doesn’t take much to get them dependent on the drug. And many of them get them from family or friends, and 54% of those peoples don’t pay for them. They get them free. And sometimes they’ll steal them from medicine cabinets. We know that the physicians that are prescribing these opioids prescribe many more than would normally be consumed by the average patient.
So then you have a bottle sitting on the shelf with the very potent drug substance that nobody is monitoring. Anybody can come into the house, whether it’s a resident, even people that have put their homes up for sale that have people coming through to look at the house will rifle through medicine cabinets looking for opioids in the medicine cabinets. And we really haven’t addressed what to do with that. Flushing it down the drain is not acceptable.
Impetus for DEA “Take Back” Program
Robert Bianchi: So the DEA, 10 years ago, started a program called the take back program where they would take any unused prescriptions back, no questions asked, and they would destroy it. And incredibly, since the program started in 2010, they have obtained almost 10 million pounds of prescription drugs.
Brian Wilson: That’s astonishing, but is it an effective program?
Effectiveness of DEA “Take Back” Program
Robert Bianchi: Well it has some effect because it gets those drugs off the potential marketplace. They’re not sitting in medicine cabinets. But unfortunately, that only happens twice a year. So in the interim, we need some other mechanism to dispose of these excess drugs. And if we can do that, we would go a long way to preventing people from starting experimenting with the drugs that they can get free from a medicine cabinet at home.
Brian Wilson: Let’s talk about kiosks. How effective are they?
Medication Disposal Kiosks – What Are They and How Effective Are They?
Robert Bianchi: Well I think they certainly do help making it convenient for people to dispose of their drugs. And that has to be an objective in any of these drug disposal programs, is it has to be convenient. So if you go to the drug store and they’ll take it back, that is making it a lot easier. But there are regulations in place that make it difficult to do that, and certainly the pharmacies that are under DEA regulation don’t want to encounter the administrative burden of collecting and accounting for everything that is turned into them. But they are another tool that is available to us to help get these drugs off the street.
Brian Wilson: We talk often about this term diversion. Explain in layman’s term, when we talk about wanting to avoid diversion of the drug, what you mean.
Avoiding Drug Diversion at Various Levels in the Supply Chain
Robert Bianchi: Well diversion can be at several different levels in the supply chain. And we’ve had some issues where the national distributors who are bound by their DEA registration to report suspicious orders of any control substance, so that if a pharmacy is ordering large amounts of opioids and it’s inconsistent with surrounding pharmacies, that needs to be reported to law enforcement. So the distributors are sending out hundreds of thousands of tablets to small pharmacies in small towns without reporting it to the DEA, that is one level of diversion.
The other level of diversion is at the pharmacy. Pharmacy thefts are on a rise and it doesn’t necessarily mean an armed robbery because a lot of what’s going on, almost 50% of the pharmacy thefts are inside jobs where employees are stealing the medication. And that is another area where you’re diverting the drugs. Many pill mills have popped up over the years where a physician is prescribing opioids without doing any examination, taking cash payments, filling the prescription for what is obviously a opioid that is used for abuse. They are prolific, they were really a big problem in Florida, up until about five years ago when the Attorney General had a crusade, but it’s still a focal point of a lot of those pill mills or pain clinics where people go to get their meds, paying for them in cash, there’s no medical insurance, there’s no physical exam, but there is a doctor that’s writing the prescription.
And the last and final diversion point is in the house where the medications are in the medicine cabinet. They need to be in some way protected, just to avoid the temptation of somebody in the household trying to experiment.
Announcer: You’re listening to Opioids: Hidden Dangers, New Hope. More when we return.
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Brian Wilson: So, Bob. What do you feel is on the horizon here? What’s next?
We Can Not Arrest Our Way Out of the Opioid Crisis
Robert Bianchi: Well we’re finally waking up and there’s really a major consideration that these drugs are very, very valuable to people that are in severe pain, people that are end of life that need to have some kind of relief. So we have to make the drugs available to them while we prevent the abuse or misuse in a social setting where it is not necessary. So we are recognizing that, to use a term, we can’t arrest our way out of this dilemma. Arresting users on the street really doesn’t help solve the problem. And we’re finally recognizing that this is a disease that needs to be treated, just like other diseases. Now the CDC is also issuing guidelines that physicians should not be prescribing opioids as the first method of treatment. There are other methods that should be considered, other drugs that should be considered as well, before going to what might be considered the last resort.
So we, as a society, and the parents in the Country need to take some responsibility for doing something. You can’t leave it up to the government to solve this problem. It is a very complex problem and it needs the resources from the general population, especially parents. And it’s amazing, I talk to parent groups how ignorant they are about the dangers of various drugs. And they need to be educated first, and we need to be talking to the kids early on in the process to know what is good and what is bad, just like crossing the street. You need to be told, they need to be instructed from day one that these drugs can be dangerous.
Brian Wilson: Our thanks to Mr. Bob Bianchi for lending his expertise to this conversation. You know it’s easy to think that there’s nothing that we as individuals can do to make a dent in something as massive as the opioid crisis now facing this Country. But you can make a difference by properly disposing of your prescription medications before they end up in the wrong hands. Visit DisposeRx.com today and learn how just a few seconds of proper care can help you or someone you love avoid a lifetime of addiction and heartache. That’s DisposeRx.com.
Announcer: Thank you for listening to Opioids: Hidden Dangers, New Hope. Subscribe today where you get your podcast or visit opioids-hiddendangers-newhope.com for more information. This presentation is underwritten by DisposeRx.