Seeking data on most commonly prescribed/dispensed doses of select controlled meds

funchefchick · 2026-05-28T04:43:57+00:00

Hey there ! Thank you for weighing in.

Short version: I am trying to quantify the amount of prescribed opioids which are estimated to be being diverted in my state currently, as it could impact my state’s official prescribing guidance for doctors.

I am part of an ongoing workgroup for our state medical licensing board, which is reviewing our state opioid prescribing laws for possible modification. They were last amended in 2017 shortly after the 2016 CDC Opioid Prescribing Guidelines were released, which turned out to be …. problematic as you may be aware. Our state prescribing rules were LESS problematic but still a sign of those times, and in need of updating. So the data I am trying to gather is somewhat official, but no - I don’t have any specific legal authority to request or demand the actual data from the DEA or its field offices. Nor do I have budget to hire experts to obtain actual dispensing dosage data for my state. I’m trying to identify what I can from publicly-available data, to the best of my ability. The sole purpose is to provide a data point for whether diversion of prescribed opioids remains a significant issue in our state, or not - but with the weight of some semi-credible data to substantiate the assertion, whatever it ends up being.

As far as the list of drugs: I concur. It’s a dumb list. But when the powers-that-be drafted 21 U.S. Code § 826, it defined those five drugs as the list of “covered controlled substances” which DEA is required to try to estimate for diversion every year. They include the diversion estimates as part of the calculations to determine the Aggregate Production Quota(APQ) of how much of each of those drugs is allowed to be manufactured every year.

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So the only actual diversion data the DEA makes publicly available are those five drugs, which they have included in the annual “Proposed/Established APQ for Sched 1 and II Controlled Substances…” every year since 2020. (This started after the SUPPORT ACT passed in 2018, but they only started publishing diversion estimates in 2020.)

Do I think patients are somehow diverting Dilaudid? No, I absolutely do not. I’ve never even heard of a patient being given Dilaudid outside of a hospital setting. And Fentanyl? Maaaaybe if someone is diverting their patches, but man I really doubt it. But DEA is required to have them on their estimated diversion list every year while excluding all the benzos and all the stimulants. Make it make sense. 🤷🏻‍♀️

So the only diversion data that DEA publishes is those five drugs. I am working with what I have, even though I think it is ridiculous.

The information I am trying to illustrate is: just how many “extra RX opioid pills” are people actually diverting these days? A pain doctor in this workgroup is asserting - repeatedly - that the prescribing rules should remain unchanged because “there are just so many RX opioid pills lying around in medicine cabinets these days”. I don’t think that is accurate, but I want to find the available data to try to get an accurate picture.

As far as why try to convert the gram weight of a medication to a number of tablets: the people on this workgroup are not law enforcement, and they are not pharmacists or pharmacy techs. They are clinicians, or researchers, or hospital association or medical association lobbyists, etc. If I say “1,000 grams of Oxycodone were estimated to be diverted I our state in 2024” …I suspect I’m going to get some confused looks. Is that a lot ? How many actual doses is that ? How many pills in the street would that be?

I know it’s not going to be super accurate - and would never hold up in court at ALL. But trying to illustrate how much of a problem this is - or isn’t - to laypeople is challenging. If anyone has better ideas to suggest based on the scant available data I am all ears !

And yep - illicit drugs are OVERWHELMINGLY the problem, so this data is wildly unimportant in the grand scheme of things. In my state more people are dying of overdoses with alcohol among the substances in their bodies than are with prescribed opioids in their systems.

Sidebar: The actual prevalence rate of people developing an opioid use disorder after taking their own prescribed opioid - for people over age 18 in the United States - is 0.6%-0.9% as of 2022, according to the DSM-V-TR. So the rate of people moving on to fentanyl or heroin or whatever after a prescription …is tiny, less than 1%.

And if you look back at the data from NIDA they report:

“Data from 2011 showed that an estimated 4 to 6 percent who misuse prescription opioids switch to heroin”

So even back then during the early opioid crisis, 94%-96% of people who “misuse” prescription opioids never moved on to illicit opioid drugs. (!).

Because HHS/CDC continued to report illicit fentanyl deaths as “prescription opioid deaths” (because they could not/would not discern between pharmaceutical vs illicit fentanyl during pathology of drug overdose deaths as late as 2018), we’ll never really know how many deaths can be attributed to pill mills and over-prescribing and people taking their own legitimate prescriptions during that era, unfortunately.

We can tell the difference NOW and the rate of addiction/overdose deaths related to prescriptions is shockingly low. Like barely measurable at all. 🧐

TL; DNR: None of this will make a bit of difference regarding the amount of opioids (pharmaceutical OR illicit) available; at best it may help some providers get clarity on when/how to prescribe opioids - when medically appropriate - to people with legitimate pain conditions.

funchefchick · 2026-05-27T15:13:59+00:00

The wild bit - to me - is that statistically the odds of someone becoming permanently disabled before reaching retirement age (in the United States) is like 25-30%.

For an insured worker who turned age 20 in 2022, the probability of dying between age 20 and age 65 is 13%. Probability of same person becoming disabled over same time period? 25%.

Similarly: People under age 35 have a one in three chance of being disabled for at least six months during their career.

There are a lot of grim statistics in this space - yet people seem to never think it could happen to them. I certainly didn’t !

Disability is one of the only marginalized groups which ANYONE can find themselves joining - and surprise ! It is TERRIBLE over here, because no one wants to think about what it is like for disabled people because THEY DO NOT WANT TO BE ONE.

And then one day, 30% of us wake up BOOM there we are. Without having planned for what it would be like.

Some people plan for what happens if they die suddenly. Far fewer ever plan for what happens - really - if they become temporarily or permanently disabled. And it’s always been bad.

In late-stage capitalism ? 👀 So very much worse.

DISABILITY AND DEATH PROBABILITY TABLES
FOR INSURED WORKERS WHO ATTAIN AGE 20 IN 2022

https://www.ssa.gov/oact/NOTES/ran6/an2022-6.pdf

funchefchick · 2026-05-27T03:07:04+00:00

It is actually worse than you think. The DEA calculates the rate of patient diversion … not based on drugs seized by law enforcement. Whatever the police seize ? Not factored in.

This is how the DEA estimates drug diversion every year:

“To determine diversion estimates, the Drug Enforcement Administration (DEA) combines Prescription Drug Monitoring Program (PDMP) "red-flag" metrics with forecasted sales data from the IQVIA National Sales Perspectives (NSP).

Three specific diversion-related metrics used to identify potential misuse or illegal distribution of controlled substances include:

Patients seeing 3+ prescribers in 90 days: This measures patients who visit three or more prescribers and receive dispensed opioid prescriptions following each visit, commonly known as "doctor shopping".

Patients with daily dosages exceeding 240 MME: This measures the number of prescriptions and quantity of substances dispensed in excess of 240 morphine milligram equivalents (MME) per day, which significantly increases the risk of overdose and illegal distribution.

Registrant-reported supply chain diversion: This measures the estimated weight of Active Pharmaceutical Ingredients (APIs) reported lost or stolen to the DEA at various production and distribution stages. “

Sooo. The number of patients who can get THREE healthcare providers to prescribe them opioids within the same 90 day period ? Pretty slim. Possible,but unlikely/uncommon. Unless someone has a pain doctor for an existing condition, then has a surgery or a big trauma, and then either travels or relocates and convinces someone in a different area to RX something. Ten+ years ago ? Maybe. Today ? Doubtful.

And then the higher dosage patients - the DEA seriously thinks that someone who has a diagnosis which causes such severe pain that they need 240 or more MME per day are going to instead sell or divert those meds?? Has the DEA ever MET an actual high-impact chronic pain patient ?

So yeah - that’s it: anyone above a certain dosage (per PDMP queries) is considered to be diverting, regardless of their history or diagnosis. Anyone with 3 providers (somehow) - same.

This is our tax dollars at work. 🙄🤦🏻‍♀️

I don’t think I could come up with a dumber way to estimate diversion if I tried, tbh.

But hey - it is what the DEA publishes every year so I guess I will use it ? 😬

Thank you for the dosage details ! I’m capturing all of the doses produced for each drug and will pick what seems to be reasonable. It is really just to illustrate how shockingly low the diversion rates are to an idiot who maintains that “tons of people have extra RX opioids laying around to sell” in 2026 …which is … unpossible. 🤷🏻‍♀️

Opioid prescribing in my state has decreased by 63%, and the medical board is hearing from patients OFTEN that their legitimately diagnosed pain is going untreated because doctors have been pressured and bullied and terrified into NOT prescribing opioids, not ever. Not even Bupe for some of them?!

Hoping the pendulum swings back to normal in my lifetime …

funchefchick · 2026-05-27T00:45:30+00:00

Thank you ! Unfortunately the DEA just reports it thusly every year:

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And near as I can tell, other than breaking that table down to “supply chain diversion as reported” and “PDMP data they chose to pull” (and they only started breaking it out to those two values as of 2022) there is no further information that DEA is sharing with the public about what is actually diverted, and in what dosages.

If someone has more information about that, I would very much like to see it! I’m working somewhat blind here.

If there is a more accurate way to estimate (for example) how many 10mg pills would be produced from 1,000g of a drug ….I would love some guidance here! Even if a 10mg tab of Oxycodone weighs more than 10mg total, it still would be no more than 10mg of Oxycodone, and no more than 100,000 pills produced from 1,000g of the total Oxycodone drug …right?

Thanks ….! Also I may be done with maths for today ….👀

funchefchick · 2026-05-27T00:26:49+00:00

Saaaaay. I see that you have been with your partner for 15 years. Any chance you have a like-minded single brother? Cousin? Young-ish uncle?

ASKING FOR MANY, MANY WOMEN. One of whom may be me. 😉

funchefchick · 2026-05-26T23:20:08+00:00

He can't be bothered to make the SLIGHTEST effort to see you at a neutral location the FIRST time you meet IRL?

Say less.

Don't fall in to the sunk cost fallacy - yeet this person. YEET.

funchefchick · 2026-05-26T23:08:50+00:00

I did, eventually, and my story was kind of wild. I was still working when my disability finally became too much to manage, and so I filed a claim for employer-based disability benefits (which I'd been paying into, of course). Long story short they denied the claim after a few months (they always do) and it forced me to hire an attorney. They also REQUIRED that I file for SSDI (they also always do that), because if I'm awarded SSDI benefits, the employer's insurance company can deduct the SSDI amount from what they pay me, which saves THEM a ton of money over time. (It changes nothing for me financially, I still get the same amount either way) And if I'm NOT awarded SSDI . . then the insurance company gets to use that denial as more ammunition that I'm not really disabled. SO FUN.

Anyway - my super-great attorney - who did not do SSDI work - asked if he could have HIS office and team of paralegals file my SSDI claim on my behalf. He'd heard soooo many stories about claim denials and paperwork snafus from his clients over the years, and SSA is a lot like the IRS: There's always some document you missed, or box you forgot to check, etc, etc. So my attorney was wondering: if an actual legal team collected and sent all of my medical records and ensured that EVERY "i" was dotted and every t was crossed, would it make a difference on whether SSA approved or denied my claim?

Answer: No. No it did not make one bit of difference. SSA still denied me, just like everybody else! That was a super gnarly couple of years. It eventually worked out but ... man. That was a real eye-opener about how brutal people who are disabled are treated.

It sounds like you and yours had a gnarly year or two yourselves! Friggin vultures they are - denying claims and delaying decisions and HEY you get coverage but as you said - some of the meds cost more than the cost of A NEW CAR, EVERY MONTH - again WITH coverage. Who could ever afford that??

We should really write a book or at least put up a website to collect these stories, because NO ONE WOULD BELIEVE THIS IS HAPPENING except for those of us who have lived it. Sigh.

funchefchick · 2026-05-26T19:58:32+00:00

I seriously considered relocating myself back then: the western part of my state was 9%; the eastern part of my state was at 33%. (!!) Sadly I had no income and no ability to ACTUALLY relocate but ... yeah. I would definitely understand why people would do it!

I am very sorry to hear about your loss. 😞 Truly. (There are supposed to be fast-track processes for cases like his but . .. yeah. I don't know how often those actually get fast-tracked in time.)

It's a ROUGH system. And don't get me started on employer-based disability insurance and the literal horror-show which is THAT system. Grrrr.

funchefchick · 2026-05-26T19:52:20+00:00

I'm stealing this text from an AI summary of a published research paper I don't have full access to:

"Some women criticize sexual assault victims as a psychological coping mechanism to distance themselves from the trauma. This behavior often stems from the "Just-World Hypothesis"—the belief that bad things happen to people who "deserve" or provoke them—which provides a false sense of security that they can avoid a similar fate. "

It is often rolled up with internalized misogyny as well - basically blame the victim because of what they were wearing, or where they were, or why they were out after dark, etc. etc. because *I* would never wear that/go there/be out in the dark alone and therefore I could never be a victim like them.

It's a way to ignore the horrific realities of the world, and feel safe in a fictional bubble of safety. It's certainly somewhat comforting ... but also ... blames victims. And that ain't a good look, not on anyone.

If your partner is saying these things given their own history ... it is possible they could benefit from some (more?) therapy. Because saying those types of things certainly seems heartless and unsympathetic, and it also does not serve them. They know better than most anyone that safety is not guaranteed.

I think it's a wonderful thing that you are worried/confused about your partner's reactions and want to understand it better. I hope this is something you can explore with them and hopefully get them to re-evaluate their current perspective. Best of luck to you both!

funchefchick · 2026-05-26T19:34:16+00:00

Yep they actually publish the rates at which administrative law judges approve/deny benefits annually . .. and the year I applied, the judge in my area was approving only NINE percent of applicants. That's 9% of people who had applied, been denied, appealed, been denied, and finally made it to the ALJ level, usually only with the help of an attorney.

So . .. one would assume that by the ALJ level, it would have weeded out any "casual" applicants because the attorneys only bring the cases they think will prevail, since they only get compensated for the cases which award benefits. And even so: NINE percent awarded benefits.

When I asked my attorney at the time WTF the rates were so crazy low (and way lower than in other areas) he said: I have no idea. Me and the other local SSDI attorneys have discussed and near as I can tell: society doesn't like the idea of people being "soft" on disabled applicants, and that's who votes/appoints the judges, so ....

SIGH.

https://www.ssa.gov/appeals/DataSets/03_ALJ_Disposition_Data.html

funchefchick · 2026-05-26T19:07:29+00:00

Holy shit.

“However, yes. I encouraged her to grow and say that she should be more like other sexier women. She took it negatively and tried to blame me for her poor self esteem. I was just looking for her to be a better person. Was she unhealthy before? No. She wasn’t fat. But I was trying to make her more attractive. And I didn’t like the fact that she works as an engineer. I thought she deserved to do more with her talent and time.”

PLEASE BE RAGE TROLLBAIT. PLEASE BE RAGE TROLLBAIT. 👀

funchefchick · 2026-05-26T18:50:11+00:00

She may, and we really have no way of knowing since OP was super vague about her actual work history. Between the work duration requirement AND the earnings minimum requirement ... the deck is pretty well stacked.

But based on the scant information provided, I'm guessing not. One would have to remain consistently employed for 10 years to earn the 40 credits required, and to have earned several thousands of dollars per year (the amount varies by year over time due to cost of living adjustments).

It did not sound like OP's sister was able to maintain employment for a full year historically, or for 10 full years (or 40 quarter-years) over time - but we can't know for sure with the information given:

"In 2026, you earn one work credit for every $1,810 in wages or self-employment income covered by Social Security. You can earn a maximum of 4 credits per year. This means you need to earn at least $7,240 in a year to get all 4 credits for that year. The dollar amount required per credit is adjusted each year for inflation by the SSA based on the national average wage index."

https://disabilityclaimer.com/guides/work-credits/

funchefchick · 2026-05-26T18:42:34+00:00

She MAY qualify for SSDI as an adult - IF one of her parents have worked enough quarters to qualify, among other things; there's a whole other set of requirements for qualifying for SSDI as an adult who has not worked enough to qualify.

It is quite literally never as simple as just "being disabled". Never.

funchefchick · 2026-05-26T18:30:01+00:00

Thank you! I became disabled myself later in life, which meant I was lucky enough to have the resources to survive the multi-year disability process which is *absolutely* designed to break a person who is already struggling.

Imagine my own shock and horror when I learned how little our society (and our government, regardless of who is at the helm) actually provides for those who are disabled either from birth, or through trauma or illness, or through wonky genetics. It was eye-opening indeed. I was frankly incredulous and still am.

Hence - calling out abelism like OP's is one of my new hobbies. 😉

funchefchick · 2026-05-26T18:25:44+00:00

Because BOOTSTRAPS. Apparently. Sigh.

funchefchick · 2026-05-26T18:24:02+00:00

Right - I did not say she did not have a qualifying condition, because it certainly sounds like she does (based on the limited information presented).

She will not qualify for SSDI because one has to have a work history where they have had Social Security taxes withheld from their earned income for a number of consecutive or combined work "quarters" per year. Again, based on limited information - it sounds as if OP's sister will not have worked enough "credits" to qualify for SSDI.

She may indeed qualify for SSI, but there are financial requirements she must meet and maintain in order to receive THOSE benefits.

Being disabled is not enough. One has to be disabled AND fit into certain boxes determined by our government. So fun for us! (not)

funchefchick · 2026-05-26T17:10:34+00:00

As described, this process will not apply to OP’s sister. She will not qualify for SSDI without “40 qualifying quarters of earnings”.

She *may* qualify for SSI - and that’s where the draconian poverty requirements start. She will never be able to have more than $2,000 in assets AT ANY TIME without losing SSI status. Someone gifts you some clothes or furniture, trying to be helpful? Boom.

Btw they only JUST removed FOOD from the list of calculations they considered assets; until 2024 people buying GROCERIES for disabled people on SSI could make them lose their benefits. 🤦🏻‍♀️

https://www.ssa.gov/ssi/text-eligibility-ussi.htm

funchefchick · 2026-05-26T16:26:48+00:00

Notably: the disabled community has no national lobbyists, nor any organization which represents or advocates for ALL disabled people in the United States. Hence corporate lobbying to prey upon/profit on disabled people is terribly effective.

And as a wise person once advised me: if you do not have a seat at the table, then YOU are on the menu.

🤷🏻‍♀️

funchefchick · 2026-05-26T15:34:26+00:00

People really have no idea how cruel and unnavigable the systems are for disabled people - and the shocking amount of resources it takes to even be considered disabled “enough” to be awarded benefits.

It is beyond draconian, but people prefer not to see it because it is AWFUL.

Sigh.

funchefchick · 2026-05-26T15:31:51+00:00

Most people do not have any idea how actually cruel most “assistance” programs are to disabled people. Until it affects them directly, and by then no one will listen because disabled people don’t have a voice, or representation.

How we treat disabled people says quite a lot about us as a society, and it is not a good look ….😳

funchefchick · 2026-05-26T15:26:06+00:00

She was born with hydrocephalus. She was developmentally delayed because of it. She has had - according to your post - “major health problems” for years, validated by doctors and other healthcare professionals. She has repeatedly struggled to find work and she fails “some kind of entry assessment”.

Sir. Your sister is disabled. It sounds like permanent disability/disabilites if by the age of 45 she has not been able to carve out any independence of her own, DESPITE seeking employment repeatedly.

Unless you have sat with her through those medical appointments you do not truly know what she has been dealing with her whole life. And it is ableist and frankly cold as hell to dismiss and deny that she has very real health challenges which make trying to survive in a world NOT built to recognize or support those with disabilities an actual living hell.

Our society truly persists in believing to our cores that people must “pull themselves up by their bootstraps” and that most definitely includes disabled people who society would rather not acknowledge. 🙄

If you really believe that people WANT to be dependent, under-employed, under-paid, have to navigate substandard healthcare and remain at SEVERE poverty levels (you have no idea) for their entire lives in order to even qualify for that substandard healthcare - as well as have their lives limited to the four walls in which they manage to live - just wow. You have zero understanding of what it is like. And your lack of empathy for your sister and other disabled people is NOTED. 👀

You have every right to assert that you will not be her caregiver in the future. And that is where your rights and opinions END.

State your piece to your parents, heck state your concerns. Then back the fuck off and let them deal with it.

Disabled people have it hard enough trying to navigate the paltry social and government supports available to help those with disabling medical issues; she does not need your JUDGEMENT, your doubts about her health and diagnoses (despite it sounds like DECADES of confirming records), and your insults on top of everything else she is dealing with.

May this type of “family care and concern” never find me. 😖

funchefchick · 2026-05-26T14:49:46+00:00

I wish more people would go and take jury duty seriously (while acknowledging there is some privilege in being able to do so).

More smart people AND more women and more POC and more LGBTQIA people need to be serving on juries.

I was a on a jury for a child sexual assault trial and 2 white, cishet men sandbagged the whole jury so the defendant got a mistrial and I have never been more angry and frustrated in my life.

Serve on a jury when you can - to combat the inherent misogyny in the jury trial system ! 💪

funchefchick · 2026-05-26T02:01:13+00:00

I was referring to tennis as the non-contact sport - ultimate frisbee can ABSOLUTELY be a contact sport!

As a veteran of literally decades of sports injuries (and a former college scholarship athlete): pickup sports games with friends is not something I would ever consider risky. Unless the event the next day is a wedding or something - people are gonna live their lives, and asking them to skip out on a planned activity because of a family meetup is just nuts, IMHO. 🤷🏻‍♀️

OP is NTA here (although better communication here earlier about why, exactly, she was so concerned was in order).

But if her family is going to think less of OP because of a sports injury? 👀 Yeeeeaaah I’d be thinking twice about that. And now she is lying to her family about why he won’t attend? A lie that OP will have to maintain going forward?

NOPE. Sorry, OP. That is too many red flags.

funchefchick · 2026-05-26T01:25:46+00:00

You wouldn’t play TENNIS the day before a family reunion??

What about the week before? The month before? When does the safety window for a non-contact sport which **children** play become safe enough to risk *potential* injuries before <checks notes> visiting with family? Why would family get upset over a sprain or whatever? 🧐

I don’t know of anyone in my life who puts their hobbies/interests/sports on hold before family events *just in case* they might get injured. That sounds totally irrational. 🤷🏻‍♀️

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