feussner3

Another data source that can be utilized to examine MPH use is the DEA ARCOS (Automation of Reports and Consolidated Orders System). This system tracks certain controlled substances like MPH from point of manufacture to a location where it will ultimately be dispensed to the consumer. Consumption is defined as those quantities received by pharmacies, hospitals/clinics, practitioners and teaching institutions. Assessed on a per capita basis, ARCOS data indicate that there is wide variability in the use of MPH from one state to another and one community to another within the states. For example, in 1997, Michigan used more than twice as much MPH than either New York or California. Within all three of these states there was more than a 5-fold difference between the consumption in the highest three digit zip code region and the lowest. These data are consistent with epidemiological studies using actual prescription data64-65 that show areas of very low and very high prescribing of MPH. Those states with the highest levels of MPH use in 1997 are included in Table 4.

Diversion and Trafficking:

All Schedule II stimulants, including cocaine and methamphetamine, have medical utility
in the U.S. and pharmaceutical products containing these substances are available for medical use. Unlike cocaine and mothamphetamine where illicit manufacturing and illegal smuggling into the U.S. account for the vast majority of available drug for abuse, pharmaceutical products diverted from legitimate channels are the only sources of MPH available (DEA is not aware of any clandestine production of MPH). Diversion of MPH has been identified by drug thefts, illegal sales and prescription forgery. Law enforcement encounters involving illegal activities with MPH are good indicators of the scope of its diversion and trafficking.

From January 1990 to May 1995, MPH ranked in the top 10 most frequently reported controlled pharmaceuticals diverted from licensed handlers with nearly 2,000 incidents of drug theft. Most reports were generated by pharmacies and most thefts occurred during night break-ins. From January 1996 to December 1997, about 700,000 dosage units were reported missing or stolen from licensed handlers. Night break-in, armed robbery and employee theft were the three major sources of the diverted MPH.
The DEA does not routinely receive data from state law enforcement agencies or their forensic laboratories concerning drug related cases. However, what MPH data has been shared with DEA from state officials (primarily as a result of DEA's request for information when conducting a review in 1995) combined with data from DEA's own investigative case files and forensic laboratories, indicate that MPIt is diverted in a number of ways by a wide range of individuals and organized groups: from health care professionals to organized drug trafficking rings. DEA case files show that MPH is associated with criminal drug trafficking activities including street sales, multi-state distribution rings, multi-drug distribution rings, smuggling from Mexico and distribution and use by narcotic addicts. The extent and severity of these activities is similar to other non-clandestinely produced Schedule II substances of comparable availability (i.e. morphine sulfate, meperidine, pentobarbital).

Law enforcement data indicate that a number of states have experienced significant problems with MPH diversion and abuse. In the 1970s and 1980s, MPH was extensively abused among street addicts and methadone clinic clients in Missouri, Oregon and Washington. Studies conducted in Washington66 and Oregon46 evaluated the extent and severity of this abuse. Intravenous abuse of MPH alone or in combination with narcotics was most commonly found. Talwin NX and Ritalin combination (referred to by addicts as "T & R") was trafficked in a number of states including Ohio, Kansas, Illinois and Missouri as well as major western Canadian cities. Abuse of this drug combination was also documented in the medical literature. For example, Carter and Watson69 identified 29 emergency room patients that presented at the Truman Medical Center in Kansas City, Missouri from August 1987 to November 1992 with complications associated with abuse of this combination. In light of recent diversion trends related to the treatment of ADHD, it is interesting to note that one of the first "attention deficit seams" occurred in Missouri in the early 1980s and was associated with obtaining Ritalin for T&R traffickers. In this scam, Medicaid patients took their alleged ADD children to several doctors to obtain Ritalin prescriptions. The prescriptions were filled in numerous pharmacies 'to avoid detection and both the office visit and the medication were paid by Medicaid. The parents then sold the Ritalin ($500/1000 tablets) to drug traffickers who combined a Ritalin tablet with a Talwin NX tablet and sold the set for anywhere from $8 to $50. Various permutations of this doctor shopping seam have been reported in Iowa, Ohio, New York, Wisconsin, Colorado and Illinois.