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I have some personal insight into this issue from a professional standpoint that I hope sheds some light into the larger issue at hand...

I consulted to a company that promoted Physician Dispensing, i.e. prepackaged medications in specific counts and dosages that were maintained and provided directly by the doctor versus writing a scrip and then the individual went to a pharmacy and filled it. actually a very good construct, and the system that managed the whole thing included a link to a PDR (Physicians Desk Reference) that given the medical history and medications currently in use would help the doctor in not over prescribing/providing medications that would cause problems due to interactions. I became very familiar with different laws in all 50 states especially as it pertained to Physician compensation and things such as cost recovery i.e. how much the Dr. paid for them and how much the insurer would pay for them dispensed to the patient. OxyCodone was a big problem years back and continues to be, it is a highly restricted drug and prescriptions issued cannot be extended or reissued by “loss” or other excuses. We acted as the agency to enable doctors to prescribe directly and were require to provide guidance to the patient on use as well as observe and record the shall I say trajectory (healing) of the patient so as not to just fill a scrip and laugh all the way to the bank.

I cannot tell you how many “practices” would call daily looking for this specific medication and they were willing to pay whatever rate to get them. They were refused on multiple grounds as it was clear they were part of the pipeline. Rigorous controls were in place, I know so as I was Director of Operations for the whole company.
The breakdowns occurred in curious places, most notably doctor shopping by the patients. One of the requirements of the system was a patient profile that listed all medications they were using, dosage amounts etc. Placed in the system it watched for contra indications, in other words interactions between prescriptions that would cause other issues even potentially fatal ones. It was voluntary and there was no way at the time to track the reality of how many doctors they were getting medications from and what they were. In digging deeper I became aware of a system in place from the DEA that could do so. It could track ALL prescriptions per person and disallow any multiples as they were clear indications of pill collectors who would fill and sell their meds to eager middlemen. Upon further inquiry the system was not functioning, and so many people were indeed obtaining multiple prescriptions of say Oxy and then selling them directly or to accumulators and you can see how it flowed. i could not even after much probing and questioning ascertain WHY the system was left down other than there was complicit participation (bribes, money sharing) going on along the food chain and Florida was ground zero in all of this.

In closing I will say that if this system as it was designed was in operations the management of this and other drugs of it’s ilk would be reduced significantly. Also under the microscope would be continuous prescribing by doctors with no associated therapeutic backing as to why they are still providing the medication to the patient without documented reasoning under very strict guidelines including loss of license and prosecution. This to me is why so many “synthetic” or bootleg out of country providers have moved into the game, one OXY tablet can go for $30 dollars or more.

This was circa 2013 and if you multiple the non aligned rules and monitoring across all 50 states they know where gaps are and how to use them to provide this to a ready market.

Ask any question you like, I fought to limit and eliminate all of this across the country and refused to participate as did the company I was working with. The problems root issue was the DEA and the monitoring system that would have picked this up along the way. Somebodies palm was being greased I am convinced and they should be found and prosecuted to the full extent of the law.