Testimony 

Before the Subcommittee on Health, 

Committee on Energy and Commerce, 

House of Representatives 

United States General Accounting Office 

GAO

For Release on Delivery 

Expected at 1:00 p.m. EST 

Thursday, March 4, 2004 PRESCRIPTION DRUGS

State Monitoring Programs 

May Help to Reduce Illegal 

Diversion 

Statement of Marcia Crosse 

Director, Health Care—Public Health 

 and Military Health Care Issues 

GAO-04-524T 
www.gao.gov/cgi-bin/getrpt?GAO-04-524T.

To view the full product, including the scope 

and methodology, click on the link above. 

For more information, contact Marcia Crosse 

at (202) 512-7119. 

Highlights of GAO-04-524T, a testimony 

before the Subcommittee on Health, 

Committee on Energy and Commerce, 

House of Representatives 

March 4, 2004

PRESCRIPTION DRUGS 

State Monitoring Programs May Help to 

Reduce Illegal Diversion 

GAO found that the 15 state monitoring programs in place in 2002 differed in 

their objectives and operation. The programs were intended to facilitate the 

collection, analysis, and reporting of information about the prescribing, 

dispensing, and use of controlled substances. They provided data and 

analysis to state law enforcement and regulatory agencies to assist in 

identifying and investigating activities potentially related to illegal drug 

diversion. The programs could be used by physicians to check a patient’s 

prescription drug history to determine if the individual was doctor shopping 

to seek multiple controlled substances. Some programs also offered 

educational programs for the public, physicians, and pharmacists regarding 

the nature and extent of the problem and medical treatment options for 

abusers of diverted drugs. The programs varied primarily in terms of the 

specific drugs they covered and the type of state agency in which they were 

housed. Some programs covered only those prescription drugs that are most 

prone to abuse and addiction, whereas others provided more extensive 

coverage. In addition, most programs were administered by a state law 

enforcement agency, a state department of health, or a state board of 

pharmacy. 

GAO also found that state monitoring programs may have realized benefits 

in their efforts to reduce drug diversion. These included improving the 

timeliness of law enforcement and regulatory investigations. Each of the 

three states studied reduced its investigation time by at least 80 percent. In 

addition, law enforcement officials told GAO that they view the programs as 

a deterrent to doctor shopping, because potential diverters are aware that 

any physician from whom they seek a prescription may first examine their 

prescription drug utilization histories based on monitoring program data. 

For example, as drug diverters became aware of Kentucky’s ability to trace 

their drug histories, they tended to move their diversion activities to nearby 

nonmonitored states. 

The increasing diversion of 

prescription drugs for illegal 

purposes or abuse is a disturbing 

trend in the nation’s battle against 

drug abuse. Diversion can include 

such activities as prescription 

forgery and “doctor shopping” by 

individuals who visit numerous 

physicians to obtain multiple 

prescriptions. The most frequently 

diverted prescription drugs are 

controlled substances that are 

prone to abuse, addiction, and 

dependence, such as hydrocodone 

(the active ingredient in Lortab and 

many other drugs) and oxycodone 

(the active ingredient in OxyContin 

and many other drugs). 

Some states use prescription drug 

monitoring programs to control 

illegal diversion of prescription 

drugs that are controlled 

substances. 

GAO was asked to examine 

(1) how state monitoring programs 

compare in terms of their 

objectives and operation and 

(2) the impact of state monitoring 

programs on illegal diversion of 

prescription drugs. 

This testimony is based on GAO’s 

report, Prescription Drugs: State 

Monitoring Programs Provide 

Useful Tool to Reduce Diversion,

GAO-02-634 (May 17, 2002). In that 

report, the programs in Kentucky, 

Utah, and Nevada were selected for 

more in-depth study because they 

were the most recently established 

programs at the time. 
Page 1 GAO-04-524T 

Mr. Chairman and Members of the Subcommittee: 

I am pleased to be here today and thank you for the opportunity to discuss 

our work on state prescription drug monitoring programs and their use in 

addressing the diversion of prescription drugs for illegal use. 

The increasing diversion of prescription drugs for illegal purposes or 

abuse is a disturbing trend in the nation’s battle against drug abuse.1

Diversion activities can include “doctor shopping” by individuals who visit 

numerous physicians to obtain multiple prescriptions, illegal sales of 

prescription drugs by physicians or pharmacists, prescription forgery, and 

purchasing drugs from Internet pharmacies without valid prescriptions. 

The most frequently diverted prescription drugs are controlled substances2

that are prone to abuse, addiction, and dependence,3

 such as hydrocodone 

(the active ingredient in Lortab and many other drugs), diazepam 

(Valium), methylphenidate (Ritalin), and oxycodone (the active ingredient 

in OxyContin and many other drugs). According to the Drug Enforcement 

Administration (DEA), increases in the extent of prescription drug abuse 

and in emergency room visits related to prescription drug abuse, as well as 

an increase in the theft and illegal resale of prescription drugs, indicate 

that drug diversion is a growing problem nationwide. 

Some states operate prescription drug monitoring programs as a means to 

control the illegal diversion of prescription drugs. My remarks today will 

focus on (1) how state monitoring programs compare in terms of their 

objectives and operation and (2) the overall impact of state monitoring 

programs on illegal diversion of prescription drugs. My comments are 

based on our May 2002 report on state monitoring programs and their 

 1

Office of Drug Control Policy, “U.S. Drug Prevention, Treatment, Enforcement Agencies 

Take on ‘Doctor Shoppers’, ‘Pill Mills’,” Mar. 1, 2004, www.whitehousedrugpolicy.gov 

(downloaded Mar. 2, 2004). 

2

Under the Controlled Substances Act, which was enacted in 1970, drugs are classified as 

controlled substances and placed into one of five schedules based on their medicinal value, 

potential for abuse, and safety or dependence liability. 

3

According to the National Institute on Drug Abuse, addiction is a chronic, relapsing 

disease, characterized by compulsive drug seeking and use and by neurochemical and 

molecular changes in the brain, whereas physical dependence is an adaptive physiological 

state that can occur with regular drug use and results in withdrawal symptoms when drug 

use is discontinued. 
Page 2 GAO-04-524T 

usefulness as a tool for reducing diversion.4 For that report we reviewed 

information from DEA and the National Alliance for Model State Drug 

Laws on the features of existing programs. To gain a more in-depth 

understanding of these programs and the challenges they face, we also 

studied the programs in Kentucky, Nevada, and Utah. We selected these 

three states because at the time they had the most recently established 

programs. 

In brief, we found that 15 states operated monitoring programs in 2002 as a 

means to control the illegal diversion of prescription drugs that are 

controlled substances.5

 Although these programs were all intended to 

facilitate the collection, analysis, and reporting of information about the 

prescribing, dispensing, and use of controlled substances, they differed in 

their objectives and operation. They all provided data and analysis to state 

law enforcement and regulatory agencies in order to assist in identifying 

and investigating activities potentially related to the illegal prescribing, 

dispensing, and procuring of controlled substances. Further, some 

programs could be used by physicians to check a patient’s prescription 

drug history to determine if the individual may have been doctor shopping 

to seek multiple controlled substances. Some programs also offered 

educational programs for the public, physicians, and pharmacists 

regarding the nature and extent of the problem and medical treatment 

options for abusers of diverted drugs. The operation of the monitoring 

programs varied primarily in terms of the specific drugs they covered and 

the type of state agency in which they were housed. Some programs 

covered only those prescription drugs that are most prone to abuse and 

addiction, whereas others provided more extensive coverage. In addition, 

most programs were administered by a state law enforcement agency, a 

state department of health, or a state board of pharmacy. 

We found that state monitoring programs realized benefits in their efforts 

to reduce drug diversion. These included improving the timeliness of law 

enforcement and regulatory investigations. Each of the three states we 

 4

For more details on these programs, see U.S. General Accounting Office, Prescription 

Drugs: State Monitoring Programs Provide Useful Tool to Reduce Diversion, GAO-02-634

(Washington, D.C.: May 17, 2002). 

5

The 15 states were California, Hawaii, Idaho, Illinois, Indiana, Kentucky, Massachusetts, 

Michigan, Nevada, New York, Oklahoma, Rhode Island, Texas, Utah, and Washington. In 

1998, West Virginia terminated its monitoring program, but began operating a program 

again in 2003, bringing the total of state programs to 16. In addition, Virginia began 

operating a pilot program in the southwestern part of the state in fall 2003. 
Page 3 GAO-04-524T 

studied reduced its investigation time by at least 80 percent. In addition, 

law enforcement officials told us that they view the programs as a 

deterrent to doctor shopping, because potential diverters are aware that 

any physician from whom they seek a prescription may first examine their 

prescription drug utilization histories based on monitoring program data. 

For example, as drug diverters became aware of Kentucky’s ability to trace 

their drug histories, they tended to move their diversion activities to 

nearby nonmonitored states. 

The diversion and abuse of prescription drugs are associated with 

incalculable costs to society in terms of addiction, overdose, death, and 

related criminal activities. DEA has stated that the diversion and abuse of 

legitimately produced controlled pharmaceuticals constitute a 

multibillion-dollar illicit market nationwide. One recent example of this 

growing diversion problem concerns the controlled substance oxycodone, 

the active ingredient in over 20 prescription drugs, including OxyContin, 

Percocet, and Percodan. OxyContin is the number one prescribed narcotic 

medication for treating moderate-to-severe pain in the United States.6

Currently, a single 20-milligram OxyContin tablet legally selling for about 

$2 can be sold for as much as $25 on the illicit market in some parts of 

Kentucky. 

Combating the illegal diversion of prescription drugs while ensuring that 

the pharmaceuticals remain available for those with legitimate medical 

need involves the efforts of both federal and state government agencies. 

The Controlled Substances Act of 19707

 provides the legal framework for 

the federal government’s oversight of transactions involving the sale and 

distribution of controlled substances at the manufacturer and wholesale 

distributor levels. The states address these issues through their regulation 

of the practice of medicine and pharmacy. 

 6

U.S. General Accounting Office, Prescription Drugs: OxyContin Abuse and Diversion 

and Efforts to Address the Problem, GAO-04-110 (Washington, D.C.: Dec. 23, 2003). 

7

Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970 (Pub. L. No. 

91-513, §§100 et seq., 84 Stat. 1236, 1242 et seq.). 

Background 
Page 4 GAO-04-524T 

The Controlled Substances Act established a classification structure for 

drugs and chemicals used in the manufacture of drugs that are designated 

as controlled substances.8

 Controlled substances are classified by DEA 

into five schedules on the basis of their medicinal value, potential for 

abuse, and safety or dependence liability. Schedule I drugs—including 

heroin, marijuana, and hallucinogens such as LSD and PCP—have a high 

potential for abuse and no currently accepted medical use. Schedule II 

drugs—including methylphenidate (Ritalin) and opiates such as 

hydrocodone, morphine, and oxycodone—have a high potential for abuse 

among drugs with an accepted medical use and may lead to severe 

psychological and physical dependence. Drugs on schedules III through V 

have accepted medical uses and successively lower potentials for abuse 

and dependence. Schedule III drugs include anabolic steroids, codeine, 

hydrocodone in combination with aspirin or acetaminophen, and some 

barbiturates. Schedule IV contains such drugs as the antianxiety 

medications diazepam (Valium) and alprazolam (Xanax). Schedule V 

includes preparations such as cough syrups with codeine. All scheduled 

drugs except those in schedule I are legally available to the public with a 

prescription.9

Under the act, DEA provides legitimate handlers of controlled 

substances—including manufacturers, distributors, hospitals, pharmacies, 

practitioners, and researchers—with registration numbers, which are used 

in all transactions involving controlled substances. Registrants must 

comply with a series of regulatory requirements relating to drug security 

and accountability through the maintenance of inventories and records. 

Although all registrants, including pharmacies, are required to maintain 

records of controlled substance transactions, only manufacturers and 

distributors are required to report their transactions involving schedule II 

drugs and schedule III narcotics, including sales to the retail level, to DEA. 

The data provided to DEA are available for use in monitoring the 

distribution of controlled substances throughout the United States, in 

identifying retail-level registrants that received unusual quantities of 

controlled substances, and in investigations of illegal diversions at the 

manufacturer and wholesaler levels. Although data are reported to DEA 

regarding purchases by pharmacies, the act does not require the reporting 

of dispensing information by pharmacies at the patient level to DEA. 

 8

Section 201, classified to 21 U.S.C. § 811. 

9

Some schedule V drugs that contain limited quantities of certain narcotic and stimulant 

drugs are available over the counter without a prescription. 

Controlled Substances Act 
Page 5 GAO-04-524T 

State laws govern the prescribing and dispensing of prescription drugs by 

licensed health care professionals. State medical practice laws generally 

delegate the responsibility of regulating physicians to state medical 

boards, which license physicians and grant them prescribing privileges.10

In addition, state medical boards investigate complaints and impose 

sanctions for violations of the state medical practice laws. States regulate 

the practice of pharmacy based on state pharmacy practice acts and 

regulations enforced by the state boards of pharmacy. The state boards of 

pharmacy are also responsible for ensuring that pharmacists and 

pharmacies comply with applicable state and federal laws and for 

investigating and disciplining those that fail to comply. According to the 

National Association of Boards of Pharmacy, all state pharmacy laws 

require that records of prescription drugs dispensed to patients be 

maintained and that state pharmacy boards have access to the prescription 

records. 

State prescription drug monitoring programs varied in their objectives and 

operation. While all programs were intended to help law enforcement 

identify and prevent prescription drug diversion, some programs also 

included education objectives to provide information to physicians, 

pharmacies, and the public. Program operation also varied across states, 

in terms of which drugs were covered and how prescription information 

was collected. Which agency, such as a pharmacy board or public health 

department, was given responsibility for the program also varied across 

states. Additionally, methods for analyzing the data to detect potential 

diversion activity differed among state programs. 

State monitoring programs are intended to facilitate the collection, 

analysis, and reporting of information on the prescribing, dispensing, and 

use of prescription drugs within a state. The first state monitoring program 

was established in California in 1940, and the number of programs has 

grown slowly. We reported that the number of states with programs has 

grown from 10 in 1992 to 15 in 2002; the number of programs stands at 16 

in 2004. 

 10The types of practitioners who prescribe drugs and may be monitored by a state program 

vary among states. Physicians are the majority of covered practitioners, but in most states 

many nonphysicians who also have prescribing authority may be covered, including 

physician assistants, dentists, optometrists, podiatrists, veterinarians, and certain types of 

nurses, such as nurse practitioners and advanced practice nurses. 

State Regulation of the 

Practice of Medicine and 

Pharmacy 

State Monitoring 

Programs Varied in 

Objectives and 

Operation 
Page 6 GAO-04-524T 

We found that state programs varied in their objectives. All states used 

monitoring programs primarily to assist law enforcement in detecting and 

preventing drug diversion, and but some also used the programs for 

educational purposes. Programs assisted law enforcement authorities both 

by providing information in response to requests for assistance on specific 

investigations and by referring matters to law enforcement officials when 

evaluations of program data revealed atypical prescribing or dispensing 

patterns that suggested possible illegal diversion. The programs evaluated 

prescribing patterns to identify medical providers who may have been 

overprescribing and inform them that their patterns were unusual. They 

also identified patients who may have been abusing or diverting 

prescription drugs and provided this information to practitioners. For 

example, the programs in Nevada and Utah sent letters to physicians 

containing patient information that could signal potential diversion 

activity, including the number and types of drugs prescribed to the patient 

during a given time period and the pharmacies that dispensed the drugs. 

Monitoring programs have also been used to educate physicians, 

pharmacies, and the public about the existence and extent of diversion, 

diversion scams, the drugs most likely to be diverted by individuals, and 

ways to prevent drug diversion. 

Monitoring programs also differed in operational factors, some of which 

have cost implications. These factors included the choice of controlled 

substance schedules monitored, approaches to analyzing and using data, 

computer programming choices, number and type of staff and contractors, 

turnaround times and report transmittal methods, and number and type of 

requests for information. 

State programs varied in the controlled substances they covered, in part 

because of differences in available resources and other state-specific 

factors such as level of drug abuse. Two of the states we studied—

Kentucky and Utah—covered schedules II through V. These states’ 

program officials told us that covering those schedules allowed them 

flexibility to respond if drugs on other schedules became targets for 

diversion. Most experts agree that covering all controlled substance 

schedules prevents drug diverters from avoiding detection by bypassing 

schedule II drugs and switching to drugs in other schedules. 

States used different approaches to analyze the prescription information 

they received. A few states used a proactive approach, routinely analyzing 

prescription data collected by the programs to identify individuals, 

physicians, or pharmacies that had unusual use, prescribing, or dispensing 

patterns that could suggest potential drug diversion, abuse, or doctor 
Page 7 GAO-04-524T 

shopping. Trend analyses were shared with appropriate entities, such as 

law enforcement, practitioners, and regulatory and licensing boards. In 

contrast, most state programs generally used the prescription data in a 

reactive manner to respond to requests for information. These requests 

may have come from physicians or from law enforcement or state officials 

based on leads about potential instances of diversion. According to state 

program officials, most programs operated in a reactive fashion because of 

the increased amount of resources required to operate a proactive system. 

Some state programs had electronic reporting systems, while others were 

paper-based. If data are reported electronically, there are ongoing 

computer maintenance and programming choices and their attendant 

costs. Similarly, some state programs engaged private contractors to 

collect and maintain the data, while others did so in-house. If a private 

contractor collects the raw data from dispensers and converts them to a 

standardized format, the program pays annual contracting costs for 

database maintenance. Kentucky and Nevada privately contracted with the 

same company to collect data for their program databases. Utah, in 

contrast, collected and maintained drug dispensing data in-house, using its 

own software and hardware. 

The number and type of staff a state chose to operate its monitoring 

program also varied. In 2002, Kentucky’s program employed four full-time 

and four part-time staff to help ensure the accuracy of its reports, 

including a pharmacist-investigator who reviewed each report before it 

was sent. Nevada’s program operated with one employee because a 

private contractor collected the data. In contrast, in 2002 Utah’s program, 

with three full-time employees and no private contractor, had one program 

administrator who collected all dispensing data, converted them to a 

standardized format for monitoring, and maintained the database. The two 

other staff answered requests. 

If the program seeks to provide more timely responses to report requests, 

such as same-day responses, the costs involved in returning the response 

to the requester may increase. For example, in 2001 Kentucky spent up to 

$12,000 in 1 month for faxing reports. Monitoring program officials from 

Kentucky, Nevada, and Utah told us in 2002 that they estimated 3- to 4-

hour turnaround times for program data requests, and all mainly used 

faxing, rather than more costly mailing, to send reports to requesters. 

Same-day responses may be preferable for physicians who want the 

prescription drug history for a patient being seen that day and for law 

enforcement users who need immediate data for investigations of 

suspected illegal activity. 
Page 8 GAO-04-524T 

As users become more familiar with the benefits of monitoring program 

report data, requests for information and other demands on the programs 

may increase. In Kentucky, Nevada, and Utah, use had increased 

substantially, mostly because of an increase in the number of requests by 

physicians to check patients’ prescription drug histories. In Kentucky, 

these physician requests increased from 28,307 in 2000, the first full year of 

operation, to 56,367 in 2001, an increase of nearly 100 percent. Law 

enforcement requests increased from 4,567 in 2000 to 5,797 in 2001, an 

increase of 27 percent. Similarly, Nevada’s requests from all authorized 

users also increased—from 480 in 1997, its first full year, to 6,896 in 2001, 

an increase of about 1,300 percent. 

Additionally, as drug marketing practices change and monitoring programs 

mature, the operational needs may shift as well. For example, states face 

new challenges with the advent of Internet pharmacies, because they 

enable pharmacies and physicians to anonymously reach across state 

borders to prescribe, sell, and dispense prescription drugs without 

complying with state requirements.11 In addition, if users want program 

reports to reflect more timely information, dispensing entities would have 

to report their data at the time of sale, rather than submitting data 

biweekly or monthly, to capture the most recent prescription dispensing. 

If users want to be alerted if a certain drug, practitioner, or pharmacy may 

be involved in a developing diversion problem, programs would have to 

initiate periodic data analysis to determine trends or patterns. Such 

program enhancements would entail additional costs, however, including 

costs for computer programming, and data analysis. 

States that are considering establishing or expanding a monitoring 

program face a variety of other challenges. One challenge is the lack of 

awareness of the extent to which prescription drug abuse and diversion is 

a significant public health and law enforcement problem. States also face 

concerns about the confidentiality of the information gathered by the 

program, voiced by patients who are legitimately using prescription drugs 

and by physicians and pharmacists who are legitimately prescribing and 

dispensing them. Another challenge states face is securing adequate 

 11For more details on Internet pharmacies, see U.S. General Accounting Office, Internet 

Pharmacies: Adding Disclosure Requirements Would Aid State and Federal Oversight, 

GAO-01-69 (Washington, D.C.: Oct. 19, 2000). 
Page 9 GAO-04-524T 

funding to initiate and develop the program and to maintain and modify it 

over time.12 

We found that states with monitoring programs have experienced 

considerable reductions in the time and effort required by law 

enforcement and regulatory investigators to explore leads and the merits 

of possible drug diversion cases. We also found that the presence of a 

monitoring program in a state may help reduce illegal drug diversion there, 

but that diversion activities may increase in contiguous states without 

programs. 

The ability of the programs to focus law enforcement and regulatory 

investigators who are working on suspected drug diversion cases on 

specific physicians, pharmacies, and patients who may be involved in the 

alleged activities is crucial to shortened investigation time and 

improvements in productivity. States that do not have programs must rely 

on tips from patients, practitioners, or law enforcement authorities to 

identify possible prescription drug abuse and diversion. Following up on 

these leads requires a lengthy, labor-intensive investigation. In contrast, 

the programs can provide information that allows investigators to pinpoint 

the physicians’ offices and pharmacies where drug records must be 

reviewed to verify suspected diversion and thus can eliminate the need to 

search records at physicians’ offices and pharmacies that have no 

connection to a case. 

In each of the three states we studied, state monitoring programs led to 

reductions in investigation times. For example, prior to implementation of 

Kentucky’s monitoring program, its state drug control investigators took 

an average of 156 days to complete the investigation of alleged doctor 

shoppers. Following the implementation, the average investigation time 

dropped to 16 days, or a 90 percent reduction in investigation time. 

Similarly, Nevada reduced its investigation time from about 120 days to 

 12Federal grants are available to states to establish new monitoring programs and to 

enhance existing programs under the Harold Rogers Prescription Drug Monitoring 

Program. DEA’s Office of Diversion Control, in collaboration with the Department of 

Justice’s Bureau of Justice Assistance, provides grants to states to establish new programs 

and to enhance existing monitoring programs through the Harold Rogers Prescription Drug 

Monitoring Program. The fiscal year 2003 grantees are Alabama, Florida, Maine, New 

Mexico, and Wyoming for new programs, and California, Idaho, Nevada, and New York for 

enhanced programs. The grantees in fiscal year 2002 were Ohio, Pennsylvania, Virginia, and 

West Virginia for new programs, and California, Kentucky, Massachusetts, Nevada, and 

Utah for enhanced programs. 

State Monitoring 

Programs Have 

Helped Shorten 

Investigation Times 

and May Reduce 

Illegal Drug Diversion 
Page 10 GAO-04-524T 

about 20 days, a reduction of 83 percent, and a Utah official told us that it 

experienced an 80 percent reduction in investigation time. 

Officials from Kentucky, Nevada, and Utah told us in 2002 that their 

programs may have helped reduce the unwarranted prescribing and 

subsequent diversion of abused drugs in their states. In both Kentucky and 

Nevada, an increased number of program reports were being used by 

physicians to check the prescription drug use histories of current and 

prospective patients when deciding whether to prescribe certain drugs 

that are subject to abuse. Law enforcement officials told us that they view 

these drug history checks as initial deterrents— a front-line defense—to 

prevent individuals from visiting multiple physicians to obtain 

prescriptions, because patients are aware that physicians can review their 

prescription drug history. For an individual who may be seeking multiple 

controlled substance prescriptions, the check allows a physician to 

analyze the prescription drug history to determine whether drug treatment 

appears questionable, and if so, to verify it with the listed physicians. In 

Kentucky, a physician could request a drug history report on the same day 

as the patient’s appointment, and usually received the report within 4 

hours of the request. In 2002, Kentucky’s program typically received about 

400 physician requests daily, and provided data current to the most recent 

2 to 4 weeks. 

The presence of a monitoring program may also have an impact on the 

prescribing of drugs more likely to be diverted. For example, DEA ranked 

all states for 2000 by the number of OxyContin prescriptions per 100,000 

people.13 Eight of the 10 states with the highest numbers of prescriptions—

West Virginia, Alaska, Delaware, New Hampshire, Florida, Pennsylvania, 

Maine, and Connecticut—had no monitoring programs, and only 2 did—

Kentucky and Rhode Island. Six of the 10 states with the lowest numbers 

of prescriptions—Michigan, New Mexico,14 Texas, New York, Illinois, and 

California—had programs, and 4—Kansas, Minnesota, Iowa, and South 

Dakota—did not. 

 13OxyContin, Hearings Before the Subcommittee on the Departments of Commerce, 

Justice, and State, the Judiciary, and Related Agencies, House Committee on 

Appropriations, 107th Cong. Part 10., pp. 21, 22 (2001) (Statement of Asa Hutchinson, 

Administrator of the Drug Enforcement Administration). 

14New Mexico’s monitoring program was terminated in June 2000. 
Page 11 GAO-04-524T 

Another indication of the effectiveness of a monitoring program is that its 

existence in one state appears to increase drug diversion activities in 

contiguous states without programs. When states begin to monitor drugs, 

drug diversion activities tend to spill across boundaries to states without 

programs. One example is provided by Kentucky, which shares a boundary 

with seven states, only two of which had programs in 2002—Indiana and 

Illinois. As drug diverters became aware of the Kentucky program’s ability 

to trace their drug histories, they tended to move their diversion activities 

to nearby nonmonitored states. OxyContin diversion problems worsened 

in Tennessee, West Virginia, and Virginia—all contiguous states without 

programs—because of the presence of Kentucky’s program, according to a 

2001 joint federal, state, and local drug diversion report.15

Although monitoring programs can enhance the ability of states to detect 

and deter illegal diversion of prescription drugs, the number of states with 

such programs has grown only slightly over the past 12 years from 10 in 

1992 to 16 in 2004. A lack of awareness of the magnitude of the problem; 

concerns about confidentiality on the part of patients, physicians, 

pharmacists, and legislators; and difficulty in accessing funding have kept 

the numbers of monitoring programs low. Cooperative efforts at the state 

and national levels are seeking to overcome these challenges and increase 

the number of states with programs. 

Mr. Chairman, this concludes my prepared statement. I would be pleased 

to respond to any questions you or other Members of the Subcommittee 

may have. 

For more information regarding this testimony, please contact Marcia 

Crosse at (202) 512-7119. Individuals making key contributions to this 

testimony include Martin T. Gahart, Roseanne Price, and Opal 

Winebrenner. 

 15Appalachia High Intensity Drug Trafficking Area Investigative Support Center, with the 

assistance of the National Drug Intelligence Center, The OxyContin Threat in Appalachia 

(London, Ky.: Aug. 2001). 

Concluding 

Observations 

Contact and 

Acknowledgments 

(290362) 
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