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Introduction: David Joranson, MSSW:
Thanks Dr. Sinatra, it's a pleasure to be with you today. That's a great introduction, I think you really set the scene. All I want to do at this point I think, by way of introduction, is to first mention that my background comes from not only having developed a national program to improve pain related policy in the United States, but earlier developed a program to help states deal with diversion and abuse of prescription controlled substances like the pain medications.
The two points that I'd like to open up with are that when we look at the problem of diversion of pain medications I'd like to suggest that we use the metaphor of the pipeline and the fundamental principle of balance. Let me say what I mean by that. Diversion of opioid analgesics occurs essentially from leaks in the pipeline for distributing FDA approved drugs from the manufacturer through the distributors to the pharmacy physicians and to the patient.
These leaks occur in two ways, essentially one from the fringes of the existing legitimate system itself, that is from certain and hopefully a few number of improper prescribers or pharmacists who are improperly dispensing. And I guess in some cases from patients who sell some or all of their medications. The second way the pipelines leaks is from attacks from the outside of the pipeline. For example, pharmacy theft and forgery and so forth. All of these are in one way or another violations of law, but I think it helps to distinguish between the leaks from the fringes of the system and the attacks on the pipeline itself.
And the second concept is that in order to address this problem of leaks in the pipeline we need to take a balanced approach. And by that I mean one which has a very high potential for targeting the specific exact source of diversion and a very low, perhaps zero potential, for interfering with legitimate medical practice and patient care. That's all I'd like to say for now.
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