The CDC's Director is taking this very seriously, saying,"Overdose with prescription drugs is one of the most serious andfastest-growing problems in this country."

The problem is showing up in a doubling of emergency room admissions due to prescription drugabuse, driven primarily by oxycodone, methadone, andhydrocodone.

Narcotic use is rampant in workers' compensation as well.Studies by the National Council on Compensation Insurance and theCalifornia Workers' Compensation Institute point to the frequentuse of narcotic opioids for workers' compensation claimants, withthe explosive growth in California particularly troubling.

One of the issues in workers'compensation is that, unlike group health, most Medicare Part Dplans, and to a lesser extent Medicaid, claimant copays arenonexistent. There is no financial skin in the game, as medicationsare free.

Another potential contributor is the potential street value ofthese drugs. While there is not conclusive documentation of thepercentage of scripts that are diverted, the sense in the industryis that diversion is not uncommon. Add to that the desire on thepart of some states toreduce the workers' compensation drug fee schedule to matchMedicaid, and it is no surprise that use is exploding (ifpharmacy benefit management companies cannot afford to manageutilization, utilization is not managed).

Here is what some of these drugs are reportedly worth on thestreet:

• The estimated street value of one 40-milligram OxyContin pillis about $40; another report indicates an 80-mg dose is going for$30 in the northeast.
• Actiq runs about $25 a dose.
• Duragesic patches range from $20-$75 depending on brand,location, and dosage.

So, narcotics are ripe for abuse. There is a big -- and veryprofitable -- secondary market for them, and their use isgrowing.

That's one side of the story.

The other side is the inability of many legitimate painsufferers to get adequate treatment.

Research publishedby Oregon State University indicates "at least 30 percent ofpatients with moderate chronic pain and over 50 percent of thosewith severe chronic pain fail to achieve adequate pain relief."

Some think the inability of those with chronic pain to gettreatment thru standard channels is a big component of the overallnarcotic diversion issue.

Joseph Paduda is the principal of HealthStrategy Associates, Inc. www.joepaduda.com.