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

The problem is showing up in a doubling of emergency room admissions due to prescription drug abuse, driven primarily by oxycodone, methadone, and hydrocodone.

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

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

Another potential contributor is the potential street value of these drugs. While there is not conclusive documentation of the percentage of scripts that are diverted, the sense in the industry is that diversion is not uncommon. Add to that the desire on the part of some states to reduce the workers' compensation drug fee schedule to match Medicaid, and it is no surprise that use is exploding (if pharmacy benefit management companies cannot afford to manage utilization, utilization is not managed).

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

• The estimated street value of one 40-milligram OxyContin pill is 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 very profitable -- secondary market for them, and their use is growing.

That's one side of the story.

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

Research published by Oregon State University indicates "at least 30 percent of patients with moderate chronic pain and over 50 percent of those with severe chronic pain fail to achieve adequate pain relief."

Some think the inability of those with chronic pain to get treatment thru standard channels is a big component of the overall narcotic diversion issue.

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