Drug Enforcement Administration

Office of Diversion Control

N AT I O N A L FORENSIC L A B O R AT O R Y I N F O R M AT I O N SYSTEM

NFLIS Special Report

Narcotic Analgesics, 2001–2003 June 2004
Copyright www.streetdrugs.org
©

Highlights
■ From 2001 to 2003, an estimated 137,332 narcotic analgesic drug items were analyzed by state and
local laboratories in the United States, representing nearly 3% of all items analyzed. The number
of narcotic analgesics analyzed increased 25% over this 3-year period, from 39,175 in 2001 to
48,914 in 2003.

■ Nearly 7 in 10 narcotic analgesics were identified as either hydrocodone (35%) or oxycodone

(34%). In addition, 8% were identified as methadone, 7% as codeine, 5% as morphine, and 5%
as propoxyphene.

■ Several narcotic analgesics significantly increased between the 1st quarter of 2001 and the 4th
quarter of 2003. Oxycodone increased 30% from 2,771 in the 1st quarter of 2001 to 3,589 in the
4th quarter of 2003, hydrocodone increased 39% from 2,742 to 3,819, and methadone increased
98% from 593 to 1,172.

■ Morphine and oxycodone had the lowest ratios of the number of prescriptions dispensed per drug
items analyzed by state and local laboratories, possibly indicating a higher level of diversion
compared to other narcotic analgesics. In comparison, propoxyphene had the highest ratio,
followed by codeine and hydrocodone.
 DEA Message: FEDERAL PRESCRIPTION DRUG INITIATIVES
An estimated 6.2 million people abused prescription drugs in 2002, with the non-medical use of
narcotic analgesics, tranquilizers, stimulants, and sedatives ranking second only behind marijuana
in illicit drug abuse. Narcotic analgesics have emerged as a particularly serious problem. Emergency
department visits related to narcotic analgesics abuse have increased 163 percent since 1995. To
reverse the escalating trend of prescription drug abuse, the Office of National Drug Control Policy
(ONDCP), the Drug Enforcement Administration (DEA), and the Food and Drug Administration
(FDA) have developed a multifaceted plan that includes medical and consumer education,
investigative and enforcement efforts, and business outreach initiatives. Highlights are below.

William J. Walker Education: The medical community is an important contributing factor to diverted controlled
Deputy Assistant Administrator substances, and this initiative seeks to educate doctors who treat chronic pain on the risks associated
Office of Diversion Control with opioid therapy. The DEA, with support from the FDA and in consultation with medical
Drug Enforcement Administration associations, proposes to require the completion of an approved continuing education course as a
prerequisite to renewing or obtaining a DEA registration. In addition, public service announcements
will be developed that appear during Internet drug searching, alerting consumers to the dangers and
illegality of making online direct purchases of controlled substances.
Enforcement: The Internet is the most popular source for diverted Schedule III through V
prescription drugs. The regulatory system that allows state-licensed pharmacies to dispense
Table of Contents prescription drugs upon receipt of a valid prescription is being undermined by an increasing number
of “rogue” Internet sites that advertise and sell drugs directly to consumers. Some domestic sites
DEA Message ......................2
require the completion of a questionnaire that is then allegedly reviewed by a doctor to verify that
Introduction ..........................3 a “prescription” has been issued. Other sites, both domestic and foreign, sell directly to the consumer,
leading not only to abuse and diversion but also to the introduction of counterfeit or contaminated
National and Regional products into the U.S. market. The DEA and the FDA continue to aggressively enforce actions
Estimates ..............................4 against illegal Internet suppliers, while also enlisting the support of legitimate online businesses
such as Internet Service Providers (ISPs), search engines, credit card companies, and shippers.
Quarterly Trends ..................5
Risk Management Plans: Before new drug products are approved for marketing, the FDA evaluates
Narcotic Analgesics the product’s labeling and risk management plan to ensure proper marketing and patient safety.
by Location ..........................6 When products such as high-dose, sustained-release opioids are under review, DEA will advise the
Diversion of FDA with respect to management of the risk of abuse and diversion.
Narcotic Analgesics ..............7 Prescription Monitoring Programs: Prescription Monitoring Programs help prevent the diversion of
pharmaceutical controlled substances by providing automated information systems at the retail level.
Narcotic Analgesics
States with prescription monitoring programs can collect and analyze prescription data more effi-
Reported in STRIDE ..........7 ciently than states without such programs, where the collection of prescription information requires
manual review of pharmacy files. The programs have demonstrated their effectiveness by providing
early detection of doctor shoppers and by identifying the source of diverted drugs. Federal support
for Prescription Monitoring Programs has been enhanced by the Hal Rogers Prescription Drug
Monitoring Program, administered by the Bureau of Justice Assistance with support from the DEA.
  :  , ‒

The Role of NFLIS: These drug initiatives complement the DEA Office of Diversion Control’s
National Forensic Laboratory Information System (NFLIS), a valuable analytical resource that
supports strategic drug control activities, including the illegal diversion of pharmaceutical drugs.
This NFLIS report presents findings on narcotic analgesics, a category of prescription drugs that
have become a major problem in America over the past decade. NFLIS supports the DEA and other
drug control agencies in tracking prescription drug trafficking and abuse and in developing effective
solutions to these problems.

This report was prepared under contract

DEA-03-C-0013, Drug Enforcement
Administration, U.S. Department of Justice. William J. Walker
Deputy Assistant Administrator
2
 Introduction
The National Forensic Laboratory Information System Narcotic analgesics can be diverted from legitimate markets in
(NFLIS) is a program sponsored by DEA’s Office of a number of ways. The most common method of diversion,
Diversion Control that systematically collects results from especially for Schedule II drugs (e.g., OxyContin®, Percodan®,
drug analyses conducted by state and local forensic and methadone), involves doctor shopping and illegal sales by
laboratories. These forensic laboratories analyze drug evidence pharmacies. Other diversion methods include illegal Internet
secured in law enforcement operations across the country. purchases, prescription fraud, improper prescribing practices
NFLIS offers a valuable resource for monitoring and by physicians, and pharmacy theft. Internet purchases are an
understanding illicit drug abuse and trafficking, including increasing problem, especially for Schedule III, IV, and V
diverted pharmaceuticals such as narcotic analgesics. This drugs (Schedule III drugs include Vicodin®, Lortab®, and
value is in part due to the fact that the identification of Lorcet®; Schedule IV drugs include Darvon®; Schedule V
specific drugs is verified through chemical analysis. drugs include codeine cough syrups).

Narcotic analgesics, derived from natural or synthetic opiates, This narcotic analgesics special report presents findings on
are a category of pain medications that has emerged as a major narcotic analgesics reported to NFLIS between 2001 and
drug problem in the United States. While these drugs have 2003. Supplemental information on narcotic analgesics is
been used illicitly for decades, their abuse has increased presented from DEA’s System To Retrieve Information from
substantially since the mid-1990s. Drug abuse–related Drug Evidence II (STRIDE) as well as prescription data from
mentions of narcotic analgesics at emergency departments IMS Health’s National Prescription Audit database.
nearly tripled between 1995 and 2002, from 45,254 to
119,185.1 In some areas, drug abuse deaths related to narcotic
analgesics have exceeded deaths linked to cocaine or heroin.

Participating Laboratories, by Census Region

WA
Midwest
ND ME
MT MN
Niagara Co.
Erie Co. VT
OR University of
SD St. Paul WI NH Massachusetts
West ID Rapid City
MI
Onondaga Co.
Monroe Co.
NY
MA
Medical Center
WY N. Illinois Detroit Lake Co. New York City
Yonkers CT RI
IA Canton-Stark Co. Suffolk Co.
Hudson Co. Nassau
NE OH Burlington Co.
Co.
DuPage Co. IN Columbus Mansfield Newark
Sacramento Co. NV IL Newark Philadelphia Ocean Co.
Independence Indianapolis- Miami Valley PA NJ Union Co.
Fresno County Jefferson Co. Cape May Co.
UT Johnson Co. Marion Co. Hamilton Co. Allegheny Co.
San Francisco Denver St. Charles Co.
MO
San Mateo
Santa Clara Co.
CA Grand Junction
CO
Aurora Co.
KS
Sedgwick Co.
St. Louis Co. St. Louis MD
Baltimore Co.
DE
Northeast
Las Vegas
Kern Co. Baltimore City
MSSU Regional WV
Ventura Co. Los Angeles SEMO Regional Anne Arundel Co.
Los Angeles Co. San Bernardino Scottsdale VA
KY
AZ
NM NC
San Diego PD Phoenix Mesa Charlotte-Mecklenburg Co.
OK TN

  :  , ‒

AR SC

GA Charleston
Honolulu MS AL
North LA
LA
TX
HI Harris Co. New Orleans
Austin Jefferson Parish
Pinellas Co. FL Indian River
Bexar Co. Acadiana Sarasota Co.
AK Pasadena Broward Co.
Miami-Dade
South
Participating State lab system Participating local lab
Reporting State lab system Reporting local lab
1 Drug Abuse Warning Network (DAWN), 2003. The DAWN Report: Narcotic Analgesics.
Substance Abuse and Mental Health Services Administration.

3
 National and Regional Estimates
From 2001 to 2003, an estimated 137,332 narcotic analgesic Figure 1. Distribution of narcotic analgesics by region,
drug items were analyzed by state and local laboratories in the 2001–2003.
United States, representing nearly 3% of all drugs analyzed
(Table 1). Over this 3-year period, the number of narcotic West Midwest

analgesic items analyzed by state and local laboratories

increased 25%, from 39,175 in 2001 to 48,914 in 2003. 17% 19%
34%
Collectively, hydrocodone (35%) and oxycodone (34%) 12% 42% 8%
represented more than two-thirds of all narcotic analgesics 8% 6%
reported from 2001 through 2003. An additional 8% of 21% 33%
narcotic analgesics were identified as methadone, 7% as
codeine, 5% as morphine, 5% as propoxyphene, and 6% as
other narcotic analgesics. Northeast South

There were substantial differences in the types of narcotic 11%

5% 17% 14%
analgesics reported across census regions (Figure 1). The 6%
highest relative percentages of oxycodone (51%) and 6% 42%
16%
methadone (16%) were reported in the Northeast, while the
South (42%) and West (42%) reported the highest proportions 51% 32%

of hydrocodone. In the Midwest, 34% of narcotic analgesics

were reported as hydrocodone and 33% as oxycodone. The Hydrocodone
West reported the highest percentage of codeine (12%). Oxycodone
Methadone
Codeine
Other

Table 1 NATIONAL ESTIMATES FOR NARCOTIC ANALGESICS

Estimated number and percentage of total narcotic analgesics, 2001–2003.

Total 2001 2002 2003

Drug Number Percent Number Percent Number Percent Number Percent
Hydrocodone 47,399 34.5% 13,659 34.9% 16,838 34.2% 16,903 34.6%
Oxycodone 47,093 34.3% 13,004 33.2% 17,569 35.7% 16,520 33.8%
Methadone 11,299 8.2% 2,490 6.4% 3,842 7.8% 4,967 10.2%
Codeine 9,932 7.2% 3,572 9.1% 3,603 7.3% 2,757 5.6%
  :  , ‒

Morphine 7,037 5.1% 2,103 5.4% 2,400 4.9% 2,534 5.2%

Propoxyphene 6,853 5.0% 2,264 5.8% 2,486 5.0% 2,103 4.3%
Other narcotic analgesics 7,719 5.6% 2,083 5.3% 2,507 5.1% 3,130 6.4%
Total Narcotic Analgesic Items 137,332 100.0% 39,175 100.0% 49,245 100.0% 48,914 100.0%
Total Analyzed Items 5,367,533 1,830,221 1,821,714 1,715,597
% Identified as Narcotic Analgesics 2.6% 2.1% 2.7% 2.9%

Note: Percentages may not sum to 100% due to rounding.

4
 Quarterly Trends
National Trends Regional Trends Adjusted for Population
This section describes national trends for the number of This section presents regional trends per 100,000 persons
narcotic analgesic items analyzed for 3-month periods between age 15 and older for the top three narcotic analgesics. By
January 2001 and December 2003. Overall, the number of region, the estimated number of hydrocodone items increased
narcotic analgesics identified by state and local laboratories significantly in the Northeast, more than tripling during this
increased 25% from 8,569 in the 1st quarter of 2001 to 10,705 3-year period from 0.3 to 1.0 per 100,000 persons (131 to
in the 4th quarter of 2003, with a peak of 13,573 in the 1st 432 items) (Figure 5). The highest rates of hydrocodone
quarter of 2002 (Figure 2). Oxycodone increased 30% from continue to be reported in the South. Oxycodone significantly
2,771 to 3,589, and hydrocodone increased 39% from 2,742 to increased in the Northeast, more than doubling from 1.5
3,819 (Figure 3). Methadone nearly doubled during this period, to 3.4 per 100,000 persons (636 to 1,456 items) (Figure 6).
increasing from 593 in the 1st quarter of 2001 to 1,172 in the The highest rates of oxycodone continue to be reported in
4th quarter of 2003 (Figure 4). Codeine peaked in the 1st the Northeast, followed by the South and the Midwest.
quarter of 2002, then declined more than 50% through 2003. Methadone significantly increased across all regions except
the Northeast during the 3-year period (Figure 7).
Figure 2. National estimates of narcotic analgesics,
2001–2003. Figure 5. Hydrocodone by region, 2001–2003.
16,000
5 West
14,000
Midwest
12,000 4 Northeast
Number of Items

Items per 100,000

10,000 South
8,000 3

6,000
2
4,000
2,000 1
0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q3 Q3 Q4
2001 2002 2003
2001 2002 2003
Figure 3. National estimates: oxycodone and hydrocodone,
2001–2003. Figure 6. Oxycodone by region, 2001–2003.
6,000 5
West
5,000 Midwest
4 Northeast
Items per 100,000
Number of Items

4,000 South
3
3,000
2
2,000 Oxycodone
Hydrocodone
1
1,000

0 0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

  :  , ‒

2001 2002 2003 2001 2002 2003

Figure 4. National estimates: methadone, morphine,

Figure 7. Methadone by region, 2001–2003.
codeine, and propoxyphene, 2001–2003.
1,400 2.0
West
1,200 Midwest
1.5 Northeast
Items per 100,000
Number of Items

1,000 South
800
1.0
600
Methadone
400 Morphine 0.5
200 Codeine
Propoxyphene
0 0.0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

2001 2002 2003 2001 2002 2003

5
 Narcotic Analgesics by Location
The types of narcotic analgesics reported by forensic ■ Chicago (Illinois State Police – Chicago Laboratory)
laboratories vary across the country. Among cities included in
■ Dallas area (Texas Department of Public Safety –
this analysis, the highest relative percentages of oxycodone
Garland)
were reported along the East Coast in Philadelphia (60%),
■ Denver (Denver Police Department Crime Laboratory)
Miami (53%), and Boston (49%). Nationally, 34% of narcotic
analgesics were reported as oxycodone. The highest ■ Miami (Miami-Dade Police Department Crime
percentages of hydrocodone were reported in the South Laboratory)
(Dallas: 66%) and the West (San Diego: 51%). Nationally,
■ Portland (Oregon State Police Forensic Laboratory –
35% of narcotic analgesics were reported as hydrocodone.
Portland)
In Chicago, 43% of narcotic analgesics were identified
as methadone, substantially higher than the national average ■ Philadelphia (Philadelphia Police Department Forensic
(8%). The following analysis presents the distribution of Science Laboratory)
narcotic analgesics for NFLIS laboratories located in the
■ San Diego (San Diego Police Department Crime
following selected U.S. cities:
Laboratory)
■ Atlanta area (Georgia Bureau of Investigation – Decatur)
■ St. Louis (St. Louis Police Department Crime
■ Boston (Massachusetts Department of Public Health – Laboratory)
Boston Laboratory)

70%
60%
50% 70%
40% 60%
70%
30% 50%
60%
20% 40%
50% 70%
10% 30%
40% 60%
0% 70% 20%
Portland 30% 50%
60% 70% 10%
20% 40%
50% 60% 0%
10% 30% Boston
40% 50%
0% 20%
30% 40% Chicago
10%
20% 30%
70% 0%
10% 20% Philadelphia
60%
0% 10%
50% Denver 70%
0%
40% 70% St. Louis 60%
30% 60% 50%
20% 50% 40%
  :  , ‒

10% 40% 30%

0% 30% 20%
San Diego 70%
20% 10%
60%
10% 0%
Atlanta 50%
0%
Hydrocodone Dallas 40%
Oxycodone 30%
Methadone 20%
Codeine
10%
Morphine
Propoxyphene 0%
Miami
Hydromorphone

6
Diversion of Narcotic Analgesics
Narcotic analgesics used for non-medical reasons are diverted
Table 2 PRESCRIPTIONS DISPENSED PER DRUG ITEM
from legitimate markets through doctor shopping, prescription
IDENTIFIED IN NFLIS, 2001–2003
forgery, pharmacy theft, and other methods. NFLIS can
provide some approximation for the extent of the diversion of Drug items Ratio of prescriptions
narcotic analgesics by comparing prescription data to forensic identified dispensed per drug
laboratory data. Table 2 presents the estimated number of Drug in NFLIS item identified*
prescriptions dispensed per drug item reported in NFLIS
Methadone 11,299 497
for selected narcotic analgesics for 2001 through 2003.
Morphine 7,037 1,638
Methadone had the lowest ratio of prescriptions dispensed Oxycodone 47,093 1,872
per drug items analyzed by forensic laboratories. It should Hydrocodone 47,399 6,561
be noted that methadone dispensed in treatment programs Codeine 9,932 10,588
is not included in the prescription data. Oxycodone and Propoxyphene 6,853 12,740
morphine also had low prescription-to-seizure ratios, *Prescription data are from IMS Health’s National Prescription
indicating a higher level of diversion given availability. In Audit database (2001-2003).
comparison, propoxyphene had the highest ratio, followed by
codeine and hydrocodone. While hydrocodone and oxycodone
(e.g., OxyContin® ) are reported to NFLIS at similar levels,
hydrocodone (e.g., Vicodin® ) is prescribed at about three times
the rate of oxycodone.

Narcotic Analgesics Reported in STRIDE

The DEA’s System To Retrieve Information from Drug From 2001 to 2003, a total of 3,415 narcotic analgesics
Evidence II (STRIDE) collects results of drug evidence were reported in STRIDE, representing about 2% of all
analyzed at the eight DEA laboratories located across the drug items reported to STRIDE. Overall, 33% of narcotic
country. Drug exhibits are submitted by the DEA, other analgesics were reported as hydrocodone, 32% as oxycodone,
federal law enforcement agencies, and some local police 9% as codeine, 8% as methadone, 6% as morphine, and 5%
agencies. While STRIDE captures both domestic and as propoxyphene. During the 3-year period, hydrocodone
international drug cases, the following data reflect only results increased from 291 in 2001 to 485 in 2003, while oxycodone
for drugs obtained in the U.S. declined from 480 to 291.
MOST FREQUENTLY IDENTIFIED NARCOTIC ANALGESICS IN STRIDE, 2001–2003
Total 2001 2002 2003
Drug Number Percent Number Percent Number Percent Number Percent
Hydrocodone 1,120 32.8% 291 25.1% 344 32.8% 485 40.2%
  :  , ‒
Oxycodone 1,079 31.6% 480 41.4% 308 29.4% 291 24.1%
Codeine 299 8.8% 84 7.2% 97 9.2% 118 9.8%
Methadone 257 7.5% 82 7.1% 78 7.4% 97 8.0%
Morphine 220 6.4% 59 5.1% 80 7.6% 81 6.7%
Propoxyphene 174 5.1% 71 6.1% 58 5.5% 45 3.7%
Hydromorphone 133 3.9% 56 4.8% 46 4.4% 31 2.6%
Merperidine 34 1.0% 13 1.1% 12 1.1% 9 0.7%
Fentanyl 22 0.6% 2 0.2% 6 0.6% 14 1.2%
Buprenorphine 16 0.5% 1 0.1% 7 0.7% 8 0.7%
Other narcotic analgesics 61 1.8% 21 1.8% 13 1.2% 27 2.2%
Total Narcotic Analgesic Items 3,415 100.0% 1,160 100.0% 1,049 100.0% 1,206 100.0%
Total Analyzed Items 176,597 61,729 59,701 55,167
% Identified as Narcotic Analgesics 1.93% 1.88% 1.76% 2.19%

Note: Percentages may not sum to 100% due to rounding.

7
Acknowledgement
This report was prepared under contract DEA-03-C-0013,
Drug Enforcement Administration, U.S. Department of Justice.
Points of view expressed in this document do not necessarily
represent the official position of the DEA or the U.S.
Department of Justice. Citation of this source is appreciated.
Suggested citation:
Strom, K.J., Wong, L., Fornnarino, L., Eicheldinger, C., Bethke,
A., Ancheta, J., and V. Rachal. (2004). NFLIS Special Report:
Narcotic Analgesics, 2001-2003. Washington, DC: U.S. Drug
Enforcement Administration.

Obtaining Additional Copies of Publication

Copies may be obtained, free of charge, from RTI or the DEA.
To submit comments or suggestions on this report, for more
information on NFLIS, or to become a participating laboratory,
please use the following contact information.

Drug Enforcement Administration RTI International*

Office of Diversion Control Health, Social, and Economics Research Unit
600 Army Navy Drive 3040 Cornwallis Road, PO Box 12194
Arlington, VA 22202 Research Triangle Park, NC 27709-2194

Attention: Liqun Wong, DEA Program Officer Attention: Valley Rachal, NFLIS Project Director
Phone: 202-307-7176 Phone: 1-800-334-8571, ext. 7712
Fax: 202-353-1263 Fax: 919-485-7700
E-mail: liqun.l.wong@usdoj.gov E-mail: jvr@rti.org

June 2004

*RTI International is a trade name of Research Triangle Institute.