Part 4—Controlled Prescription Drugs

The 2020 National Drug Threat Assessment (NDTA) is a comprehensive assessment of the threat posed to the United States by the trafficking and abuse of illicit drugs, the diversion and abuse of licit drugs, and the laundering of proceeds generated through illicit drug sales. It also addresses the role domestic groups, including organized violent gangs, serve in domestic drug trafficking. The most widely trafficked drugs are discussed in terms of their availability, consumption and overdose related deaths, production and cultivation, transportation, and distribution.
The full report may be viewed at default/files/2021-02/DIR-008-21%202020% 20National%20Drug%20Threat%20Assessment_WEB.pdf
The report is divided into the following sections: Illicit Opioids and Heroin; Methamphetamine; Cocaine; Controlled prescription drugs; Marijuana; New psychoactive substances; Transnational criminal organizations; Drug threat in U.S. Territories and in Indian Country and Illicit finance. A summary of each  section will be published each week.
Controlled Prescription Drugs
Controlled Prescription Drugs (CPDs) remain a prevalent concern within the United States— availability remains constant although abuse levels decreased from the previous years. DEA Field Divisions consistently report high CPD availability on the street within their areas of responsibility (AORs). CPD diversion continues to decrease across most categories at the national level, but some states report an increase in the number of incidents. The number of opioid dosage units available on the retail market and opioid thefts and losses reached their lowest levels in nine years.
DEA reporting in 16 of 23 Field Divisions indicates high CPD street availability for 2019. All DEA Field Divisions reported the same availability except DEA’s Seattle Field Division which reported a drop from high availability in 2018 to moderate availability in 2019.
Prescription opioids were involved in nearly 15,000 U.S. deaths in 2018, averaging 41 each day, according to the CDC. Prescription opioids were involved in 32% of all opioid overdose deaths; however, there was a notable 13.5% decrease in prescription opioid-involved death rates from 2017 to 2018. Even though prescription-involved opioid deaths decreased from the previous year, CPD misuse and diversion of these drugs has continued to rise over the past two decades. The CDC reports U.S. prescription-involved opioid overdose deaths have increased from just under 4,000 deaths in 1999 to 15,000 deaths in 2018 with a total 232,000 deaths from 1999 to 2018.
None of the states observed a significant increase of prescription opioid deaths, and 17 states reported decreasing numbers. In 2018, West Virginia experienced the highest prescription overdose death rate at 13.1 per 100,000 people while also presenting the largest decrease with 4.1 fewer deaths per 100,000 people than in 2017.
Although DEA’s Automation of Reports and Consolidated Orders System (ARCOS) reveals the number of dosage units distributed nationwide at the retail level (hospitals, pharmacies, practitioners, treatment programs, and teaching institutions) decreased from 2018 to 2019, opioids continue to rank as  five out of the seven most distributed CPDs. Hydrocodone and oxycodone products were dispensed at more than twice the rate of any other CPD, which remains a steady trend. Two stimulants—amphetamine and methylphenidate (brand name Ritalin)—have maintained a continual presence over the years, while buprenorphine, a medication used to treat opioid dependence, replaced methadone in the top seven most distributed CPDs from 2017 through 2019. During the pandemic, DEA enacted temporary measures to permit better access to individuals in need of treatment for opioid use disorder, allowing for distribution of methadone and buprenorphine outside of treatment clinics. DEA also temporarily allowed DATA-waived practitioners to prescribe buprenorphine to new patients following telephone consultation, rather than requiring an in-person visit. Authorizing greater access and availability of buprenorphine allows for patients with an opioid use disorder to receive medication assisted treatment.
While the amount of prescription opioids available on the legitimate market continued to decline since peaking in 2011, the numbers remain significant. ARCOS data indicated 9.7 billion dosage units of opioid CPDs were manufactured and distributed in 2019. This signifies the  first time that opioid prescriptions dropped below ten billion dosage units since 2010. Hydrocodone and oxycodone products comprised approximately 78% of all CPDs sold to retail level purchasers for 2019.
Opioid prescription rates continue to decrease since the peak in 2012, with the 2018 prescribing rate at its lowest point in 13 years. The 2018 nationwide prescribing rate was 51.4 prescriptions per 100 U.S. residents, which dropped from 58.6 prescriptions per 100 U.S. residents in 2017. However, the prescribing rate continues to vary state-by-state. Alabama and Arkansas continued to have the highest opioid prescription rates from 2017 to 2018, although the rate dropped below 100 prescriptions per 100 U.S. residents for both states. New York and Hawaii have the lowest opioid prescribing rates at 34 and 33.4 prescriptions per 100 U.S. residents, respectively.
Opioid manufacturing levels dropped significantly from 2016 to 2017 and have remained relatively steady since 2017. Opioids sold to retail distributors have declined by roughly 15 percent each year since 2016. The decreasing amount of pharmaceuticals available in the illicit market is likely attributable to the combined efforts of law enforcement, diversion control enforcement and community education and outreach to combat opioid and pharmaceutical abuse. The difference between the quantities manufactured versus quantities provided to retail distributors   can be explained by several reasons including commercial medical needs, scientific research, exports, and inventory.
DEA increased the 2020 aggregate production quota by 1% for fentanyl, morphine, hydromorphone, codeine, oripavine, 2018 2019 oxymorphone, ephedrine, and pseudoephedrine to account for increased medical demand during the COVID-19 pandemic. DEA also granted an exception to all DEA-registered bulk manufacturers which allowed them to exceed the cap which normally restricts manufacturers to not exceed 65% of their estimated net disposal in their inventory to ensure the availability of active pharmaceutical ingredients needed to manufacture dosage forms and avoid potential production shortages. These adjustments allow more  exibility for manufacturers to reply to elevated licit demand during the COVID-19 pandemic, if needed and to stave off a potential disruption to the global manufacturing and supply chain should COVID-19 conditions lead to widespread shutdowns. Reinstated mandatory stay-at-home orders, varying international response, and an increasingly impacted workforce would strain production and transportation.
Next series: Part 5—Marijuana.