The street life of drugs
CMAJ 1999;160;26
See response from: B. Goldman
In his editorial1 [full text] Brian Goldman expresses interest in the finding in an accompanying article2 [full text] that the street value for prescription opioid analgesics is currently relatively low compared with previous anecdotal reports. This should come as no surprise, given that Vancouver has been flooded with cheap, highly potent heroin that costs $10 to $20 a hit; it makes sense that the street value of prescription drugs must be adjusted accordingly to remain competitive.
Goldman also worries about the chilling effect that prescribing regulations exert on legitimate access to some medications, citing the triplicate prescription programs in New York State and British Columbia as examples. I challenge his conclusion that these programs either deny access to effective drug therapies or lead to excessive prescribing of less desirable drugs.
When New York added benzodiazepines to its triplicate program, there was a negligible absolute increase in the prescribing of less-safe alternatives but the prescribing of benzodiazepines declined significantly.3 In BC, physicians who had written excessive numbers of prescriptions for narcotic analgesics, at a rate 10 times greater than the mean rate of their peers, were notified by the College of Physicians and Surgeons of British Columbia.4 Although this notification resulted in a 25% reduction in the number of prescriptions for these drugs, the prescribing rates within this cohort remained significantly higher than average. One of the most frequently prescribed analgesics was propoxyphene, which has limited proven effectiveness in pain management. It is difficult to accept Goldman's assertion that triplicate prescription programs exert a chilling effect on prescribers and unduly limit patient access to pain control.
John F. Anderson, MD
Medical Adviser
Clinical Support Unit
Community Health Programs
British Columbia Ministry of Health
Victoria, BC
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References
- Goldman B. The news on the street: prescription drugs on the black market [editorial]. CMAJ 1998;159(2):149-50.
- Sajan A, Corneil T, Grzybowski S. The street value of prescription drugs. CMAJ 1998;159(2):139-42.
- Lurie P, Kahn JG, Wolfe SM. Regulation of benzodiazepine prescriptions [letter]. JAMA 1992;268(4):472-3.
- Anderson JF, McEwan KL, Hrudey WP. Effectiveness of notification and group education in modifying prescribing of regulated analgesics. CMAJ 1996;154(1):31-9.
