Kiosks Begin to Sell Bootlegged Prescription Pain Killers

The number of narcotic prescription drugs that have reached the street ballooned from a small number caught in raids on kiosks in 2015, to many hundreds in 2017

In this June 14, 2011, file photo, various prescription drugs on the automated pharmacy assembly line
AP Photo/Matt Rourke, File

Addictive prescription drugs, including sleeping pills, tranquilizers and opioid painkillers, have begun to show up in the street, where they are sold alongside so-called kiosk drugs, the Health Ministry said.

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Ministry officials say that in recent years, addictive prescription medications have increasingly made their way from the medical establishment to the street. They are sold mainly at kiosks. Most are bought by heavy users, who use them as replacements for illegal drugs, to amplify their effects or to calm them while withdrawing from other drugs.

“Until three years ago, there were almost no seizures of drugs of this type,” said Dr. Roni Berkowitz, head of the ministry’s Enforcement and Inspection Division. “Since 2015, when we began seizing drugs like these in raids on kiosks, there has been an upward trend, as reflected in the quantity, variety and strength of the substances. “

The area around Tel Aviv’s central bus station is the main distribution center for such drugs, he said, but they have also been found in Rishon Letzion, Holon and Be’er Sheva. “And we know for certain that what we’ve seized is only a tiny fraction of what’s out there,” he added.

Berkowitz said the growing “leakage” of prescription drugs to the street has paralleled a rise in the number of prescriptions written for addictive drugs such as certain painkillers, and this is not coincidental. “We’re not talking about counterfeit drugs, but mainly about genuine medications that reached the market through trade in or theft of legal prescriptions,” he said.

Since these drugs are covered by the national health insurance plan, the prescription holder pays only a nominal price. Thus the potential profit from their resale is “enormous,” Berkowitz said. “The price of a single pill can reach 50 shekels [$14] or more.”

The system, known as “doctor shopping,” is simple: The prescription is copied on a color copier, and the copies are then taken to several private pharmacies, enabling a single prescription to be filled repeatedly. Because there is no online national registry for narcotic prescriptions, the pharmacies have no way of knowing that a given prescription has already been filled.

A wide variety of prescription drugs have been seized in recent years, including opioid painkillers like OxyContin, Hydrocodone, Tramadol and immediate-release morphine; anti-anxiety drugs like Clonex and Assival; the tranquilizer Lorivan; the antidepressant Trazodone; and Subutex, which is used to treat opiate withdrawal,

Prescription drugs, unlike such popular drugs as MDMA, are not usually found at parties and clubs, Berkowitz said. Rather, they appeal mainly to heavy drug users.

But of all the prescription drugs leaking into the streets, the that one stands out is fentanyl. A powerful opioid painkiller, fentanyl is used in operating rooms as an anesthetic. It’s also prescribed to people suffering from strong chronic pain, either post-operative or due to digestive problems or kidney failure.

Fentanyl is known to be extremely addictive, even for patients who use it legally. It is one of the drugs responsible for a rising trend of addiction to painkillers in the United States, and in recent years, in Israel as well.

In the streets, “the price of a single fentanyl patch can reach 100 shekels,” Berkowitz said. Fentanyl is also used differently in the streets than it is in the medical world: Each patch is cut into several pieces and each individual piece is heated; the user then inhales the vapor.

Fentanyl is considered 100 times stronger than morphine, due to its ability to penetrate the central nervous system quickly and attach itself to pain receptors. Last January, it was added to Israel’s list of dangerous drugs, along with other medications that have begun leaking into the streets.

But fentanyl is just one of a class of drugs known as synthetic opioids. Some are much stronger even than fentanyl, making it extremely easy to overdose of them. One of these is carfentanil, which has also been put on the dangerous drug list.

Carfentanil is the strongest opioid in commercial use. It is 100 times stronger than fentanyl and 10,000 times stronger than morphine, and it is mainly used to tranquilize or anesthetize large animals such as elephants.

In Israel, it is still not well known, and there’s no evidence that it has yet hit the streets. But in other Western countries, is has appeared on the street mixed with other drugs and is already wreaking havoc.

In 2016, an unusually large number of people died from overdosing on heroin in the United States, and these deaths were attributed to the fact that the heroin had fentanyl and carfentanil mixed in it, without the users’ knowledge. Even people exposed to minuscule doses of carfentanil have failed to respond to outside stimuli, suffered respiratory problems and had their lips turn blue.

According to the U.S. Centers for Disease Control, there has been a dramatic rise in the number of deaths from overdoses of heroin, semi-synthetic or fully synthetic opioids since 2013. In 2012, there was less than one such death per 100,000 people. But five years later, the figure had jumped to over six deaths per 100,000 people. Both the United States and Canada reported a sharp rise in shipments of carfentanil and other strong opioids to North American customers in 2016.

A report published in January by a subcommittee of the Senate Committee on Homeland Security and Governmental Affairs showed how easy it is for Americans to obtain opioids and other illegal drugs. They can be bought online via Chinese websites, which ship them to the United States by express mail.

The report identified 500 such deals in 43 states. The purchases cost a mere $230,000, but those drugs could be sold on the street for about $766 million, it said. The most common currency used for these purchases was bitcoin.

In Israel, there is still no evidence of carfentanil having reached the streets, or of anyone buying fentanyl or similar drugs from China. Nevertheless, the Health Ministry believes that what has happened in other Western countries will ultimately reach Israel, and therefore decided to add carfentanil to the dangerous drug list now.