Drug crime is a source of abused pain medications in the United States.

To the Editor: The International Narcotics Control Board consistently reports that, despite an extremely large number of transactions, little or no narcotic drugs are diverted from licit international trade into illicit channels. Most diversion occurs within countries, where governments attempt to prevent diversion during the manufacture and distribution of controlled substances to the retail level (e.g., pharmacies and hospitals). In the United States, diversion occurs despite a closed distribution system of licensing, security, and record keeping. Public dialogue about prescription drug abuse in the United States focuses largely on inappropriate physician prescribing and patient misuse., National media reports and highprofile charges against physicians enhance the perception that physician prescribing for pain is the main cause of increases in opioid analgesic abuse. An important but mostly overlooked diversion source involves thefts, including armed robberies, night break-ins, and employee and customer pilferage. The Controlled Substances Act makes thefts of controlled substances from Drug Enforcement Administration (DEA) registrants a federal crime, and requires pharmacists, manufacturers, and distributors to report significant thefts and losses. The authors submitted a Freedom of Information Act request to the DEA to obtain data from Form 106 ‘‘Report of Theft or Loss of Controlled Substances.’’ An electronic database was provided with annual data for 2000--2003. Each incident of theft/loss included the number of dosage units, as well as the generic name, trade name, dosage strength, and formulation of the controlled substance. We evaluated six opioid medications used for moderate to severe pain that we have studied previously: fentanyl, hydromorphone, meperidine, methadone, morphine, and oxycodone. The database contained analyzable data from registrants in only 22 Eastern states, representing 53% of the U.S. population. A total of 12,894 theft/loss incidents were reported in these states between 2000 and 2003. Theft/losses were primarily from pharmacies (89.3%), with smaller portions from medical practitioners, manufacturers, distributors, and some addiction treatment programs that reported theft/losses of methadone. Over the 4-year period, almost 28 million dosage units of all controlled substances were diverted. The total number of dosage units for the six opioids is as follows: