The US Drug Enforcement Administration (DEA) recently released its annual National Drug Threat Assessment. While highlighting challenges with illicit drugs, domestic gangs, and transnational criminal organizations, the DEA also provided visibility to current trends and anticipated challenges for prescription drug distribution within the legal drug distribution chain. Some of the key points the DEA raised this year include:

Losses in Transit The DEA reports that "diversion incidents continue to decline; however, [controlled prescription drugs] lost in transit or diverted by medical professionals remains a prevalent threat." The DEA's critical finding was that Wisconsin accounted for almost half of all losses in transit, followed by Arizona and Missouri. Overall, losses in transit have doubled since 2015. All other categories of loss incidents (i.e. customer theft, robberies, night break-ins, etc.) have either seen no change or experienced a downtrend over the last four years. While the DEA noted employee theft is still an important issue to guard against, the rate of employee theft continues to decrease on a year-over-year basis, and only accounts for 7% of all controlled substance losses.

ARCOS The DEA stated that the newly-implemented features within ARCOS (e.g., distributors' ability to view data on customers' use of other distributors) continue to provide distributors with valuable information to help identify "red flags." The DEA is likely to increasingly expect manufacturers and distributors to use this tool as part of their customer due diligence practices.

The Rise of Benzodiazepines The DEA continues to forecast a concerning shift away from prescription opioids to prescription benzodiazepines and illicit fentanyl. Specifically, the DEA notes that, while it is encouraged by a decrease in prescription opioid-involved deaths, benzodiazepines and antidepressants were involved in an increasing number of overdose deaths, nearly 8% and 9.5%, respectively. Also, the DEA acknowledges the well-documented crisis of overdose deaths attributable to imported illicit fentanyl over the last few years. While it does not associate these shifts with its quota reduction policies, the DEA does note an incredible 47% reduction in its manufacturing quotas for the seven most prevalent opioids from just 2016 to 2018.

However, Opioid Overdoses Are Still Worrisome In terms of opioid prescription rates, the states with the highest number include Alabama, Arkansas, Tennessee, Mississippi, and Louisiana. (Oddly enough, states with the highest overdose death rates from prescription opioids—West Virginia, Maryland, Kentucky, and Utah—are not included in the top five list.) The states with the lowest opioid prescribing rates include Minnesota, Massachusetts, California, New York, and Hawaii. As one final note regarding the DEA's monitoring of opioids, it noted buprenorphine has now replaced methadone in the top seven list of most distributed controlled substances. The full National Drug Threat Assessment Report can be found on the DEA website, and pages 31-41 are of particular interest to prescription drug manufacturers, distributors, and pharmacies.