Where diverted prescription opioids actually come from

The best national measurement is the National Survey on Drug Use and Health. In 2024, an estimated 2.8% of the US population aged 12 and over — about 8.0 million people — misused prescription pain relievers in the past year. Asked how they obtained the most recent pain reliever they misused, they answered as follows.

Source of the last pain reliever misused	Percent of past-year misusers
Prescription from one doctor	40.5%
Given free by a friend or relative	31.3%
Bought from a friend or relative	6.9%
Bought from a drug dealer or other stranger	7.6%
Some other way	6.4%
Took from a friend or relative without asking	4.0%
Prescriptions from more than one doctor	2.0%
Stole from a doctor’s office, clinic, hospital or pharmacy	1.3%

Two things follow immediately. First, the largest single route is a prescription that was legitimately written — to that person, by one doctor. Second, the routes that identity verification would directly interdict are small: stealing from a provider is 1.3%, and obtaining prescriptions from multiple doctors is 2.0%.

There is a wrinkle worth knowing. A pooled analysis of four years of the same survey showed that the “free from a friend or relative” figure is driven overwhelmingly by infrequent users. Among people who misused on 1–29 days in a year, 61.9% got it free from a friend or relative; among those who misused on 200–365 days, that falls to 26.4%, while obtaining it by prescription from physicians rises to 27.3% and purchase from a dealer rises to 15.2%. The people at highest risk have a different supply pattern from the population average.

What we cannot honestly claim

There is no US epidemiological estimate of the share of diversion attributable to prescription forgery or false-identity dispensing. We looked. It is not in the national survey, which never separates forgery out; it is bundled into an unmeasured fraction of a 6.4% “some other way” residual. It is not in the pooled peer-reviewed analysis, which explicitly lumps “written fake prescriptions” together with theft, internet purchase and “some other way.” It is not in the Government Accountability Office’s review of DEA diversion control, which names forgery as a mechanism and assigns it no magnitude. This is a verified absence, not a failure to search.

So: it is not supportable to claim that positive identification addresses a large share of diversion, and IntellaRx does not claim it. Any vendor who gives you a percentage here is giving you a number that does not exist.

What positive identification does defensibly do

The case for it is real, but it is a different case. It rests on four things that do not require an unmeasured diversion share to be true:

• It protects the patient from misattribution. If a specimen or a dispensing event can be tied to the wrong person, the wrong person bears the consequence — a positive toxicology result, a flag in a monitoring record, a lost prescription. Chain-of-custody identity is a patient protection before it is anything else. See custodial toxicology.
• It protects the integrity of the data everything else depends on. Monitoring programs, dose calculations and outlier analyses are only as good as the identity resolution underneath them. A record attached to the wrong person corrupts every inference drawn from it.
• It removes the informal courier. Where a patient cannot collect medication themselves, someone else does — a family member, a neighbor, a paid driver. That handoff is an unsupervised point in the chain. Verified delivery to the patient closes it without anyone having to be accused of anything. See pharmaceutical delivery.
• It gives a clinician a defensible answer. A prescriber who can demonstrate that the person who received the medication was the person it was written for is in a materially different position from one who can only say they assumed so.

Diversion inside the health system is documented

One diversion channel is measured, and it is not patients. Between 2000 and 2013, CDC recorded six US outbreaks of infection caused by drug diversion by healthcare personnel — three technicians and three nurses, in every case tampering with injectable controlled substances. The result was 34 patients with gram-negative bloodstream infections, 84 infected with hepatitis C, and nearly 30,000 people requiring notification of potential exposure. A single subsequent outbreak infected 32 of 1,074 cardiac catheterization patients.

This is worth stating on a page about diversion because it locates part of the risk where the data actually puts it, rather than where assumption puts it.

And the lethal supply is now elsewhere entirely

Whatever share of harm diverted prescriptions once carried, the current mortality is dominated by a supply that no prescribing control reaches. CDC surveillance across 45 states and the District of Columbia found that during 2023, approximately 72,000 drug overdose deaths — nearly seven in ten — were estimated to involve illegally manufactured fentanyls. DEA’s own drug information states that “most fentanyl on the illicit marketplace comes from clandestine manufacturing,” while noting that licit fentanyl can also be diverted and misused.

A caveat CDC itself publishes and we reproduce: for the 9.9% of fentanyl-detected deaths with insufficient evidence to classify the fentanyl as illegal or prescription, it was classified as illegal on the grounds that most fentanyl overdose deaths involve illegal fentanyl. Part of the illicit share is therefore an assumption, not a measurement.

Questions this raises

Why publish data that weakens the case for one of your own components?

Because the alternative is selling an agency a capability on a premise that will not survive its first analyst. The case for positive identification is strong on patient protection, data integrity and closing the informal-courier gap. It does not need an invented diversion percentage, and attaching one would make the honest parts of the argument look like marketing. See what positive identification is for.

If most misuse comes from a legitimately written prescription, what actually helps?

Better clinical decisions at the point the prescription is written, and better support around the patient afterwards — which is what most of this program is. That means diagnosis and history available to the prescriber, behavioral health screening, safe storage, naloxone in the home, and follow-up that notices a problem early. See the program and safe storage and rescue medication.