It’s the Same, Only It’s Not: Perceptions of the Prescription Drug Market in Comparison With Other Illicit Drug Markets

• Date: 01 July 2018
• Published date: 01 July 2018
• DOI: 10.1177/0022042618762731
• Subject Matter: Articles

https://doi.org/10.1177/0022042618762731

Journal of Drug Issues

2018, Vol. 48(3) 393 –408

© The Author(s) 2018

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DOI: 10.1177/0022042618762731

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Article

It’s the Same, Only It’s Not:

Perceptions of the Prescription

Drug Market in Comparison With

Other Illicit Drug Markets

Jennifer Gatewood Owens1 and Michelle Smirnova1

Abstract

Given the rapid rise of prescription (Rx) opioid overdoses in the United States, it is crucial to

understand how people acquire Rx drugs. Prior research suggests individuals obtain Rx drugs

through both legal and illegal channels, but there has been limited qualitative research focused

upon the intersections between Rx drug markets and other drug markets. To understand the

similarities and differences, we interviewed 40 incarcerated women about their experiences

with both markets. Based upon these conversations, we find that few women received pills

exclusively through doctors and 90% of them had used illicit markets or informal social networks

to acquire Rx drugs. Although there is extensive overlap between the users, dealers, and

operations between Rx and illicit drug markets, these women draw attention to how certain

agents, processes, and social reactions differ in meaningful ways that are crucial to an effective

public health response.

Keywords

drug markets, prescription drug misuse, substance use, qualitative interviews, incarcerated

women

Introduction

Drug overdose has become the leading cause of accidental death in the United States, and of the

52,404 people who died of a drug overdose in 2015, 20,101 were from prescription (Rx) pain

relievers (Rudd, Seth, David, & Scholl, 2016). Eighty percent of new heroin users started out

misusing Rx painkillers (Jones, 2013; Quinones, 2015). As such, understanding Rx drug misuse

is a crucial component in reducing drug abuse and informing social policy.1 However, combating

Rx misuse is particularly difficult given that unlike most other illicit drugs, Rx drugs may be used

licitly with a doctor’s supervision. Users can get Rx drugs from a variety of sources, including

their doctors, friends, or the illicit street drug market (Inciardi, Surratt, Kurtz, & Cicero, 2007;

Lee, 2013; Worley & Thomas, 2014). However, there is minimal research that attempts to under-

stand whether Rx drug markets are analogous to other illicit drug markets or whether they are

distinct in meaningful ways. The purpose of the research presented in this article is to better

1University of Missouri–Kansas City, USA

Corresponding Author:

Jennifer Gatewood Owens, Assistant Professor, Department of Criminal Justice and Criminology, University of

Missouri–Kansas City, Cherry Hall Room 438, 5030 Cherry Street, Kansas City, MO 64110-2447, USA.

Email: owensjen@umkc.edu

762731JODXXX10.1177/0022042618762731Journal of Drug IssuesOwens and Smirnova

research-article2018

394 Journal of Drug Issues 48(3)

understand what, if any, differences exist between illicit drug markets (heroin, methamphet-

amines [meth], crack, etc.) and illicit Rx drug markets (drugs sold outside a pharmacy to a person

without a Rx).

Previous research has identified a strong link between Rx drug misuse and negative outcomes,

including social isolation (Harrell, 1992), arrest (Ford & Wright, 2017), as well as increases in

“illicit drug use, alcohol abuse, mental health problems, risky sexual behaviors, and overdose

deaths” (Papp & Kouros 2017, p. 61). Rates of Rx misuse and drug use in general are exceed-

ingly high among those arrested and incarcerated in U.S. jails and prisons. Recent estimates sug-

gest 16% of state and almost 50% of federal inmates were arrested for drug law violations

(Carson & Anderson, 2016), but far more struggle with drug use. Upon arrest, approximately one

half to two thirds of incarcerated populations (i.e., inmates in jails, state prisons, and federal

prisons) meet the criteria for alcohol or drug dependence or abuse, yet only 7% to 17% received

treatment (National Institute on Drug Abuse [NIDA], 2011).

Despite the large number of people who report misusing Rx drugs and the growing number

of people arrested and incarcerated for crimes associated with its misuse, we know little about

what these markets look like and those who would have extensive knowledge—presently

incarcerated former users—are rarely consulted. For example, the largest studies in the United

States on drug use do not sample from institutionalized populations (e.g., National Survey on

Drug Use and Health [NSDUH]). This is a particularly alarming absence given their high rates

of drug use, and thereby knowledge of drug markets and practices. Furthermore, given that

women are more likely to (a) go to doctors (CDC, 2013), (b) be prescribed Rx drugs (CDC,

2013), and (c) become addicted to them (Cotto et al., 2010), incarcerated women may serve an

important role in the illicit Rx drug market economy. In recognizing this underutilized source

of knowledge, we interviewed 40 incarcerated women about their experiences with both the

illicit and Rx drug markets to better understand how these two markets may be similar or

different.

While active offender research can address women who reside outside of prison, we know

that women who are apprehended and sentenced to prison are different from those who avoid

detection. Incarcerated populations are more likely to be repeat offenders with extensive

criminal histories who are either less skilled at avoiding detection or simply lack the resources

to keep their use or criminal behaviors hidden (e.g., lacking employment, homeless; Johnson,

2004). Yet without consultation from this group, some of the most marginalized populations

would remain disenfranchised by researchers and our knowledge of drug markets would

remain limited. There are also advantages to using a prison-based sample compared with

those actively involved in drug markets. For example, incarcerated respondents are less likely

to be under the influence of drugs and have had time to reflect on their lives (Copes &

Hochstetler, 2010). These factors increase the quality of interviews and provide a richer pic-

ture of market activities than one obtained through exclusively talking to active offenders in

the community.

Illicit Drug Markets and Illicit Rx Drug Markets

Much of the early qualitative and ethnographic work of illicit drug markets focuses upon the

dynamics, roles, and actions of the market participants (Ritter, 2006). Drug markets vary not

only in terms of the types of drugs they sell but how and where these markets operate (e.g.,

open markets on the streets or closed markets operating behind closed doors), whether they are

mediated by technology (e.g., cars, security cameras, cell phones, emails), as well as how

policing strategies might alter distribution practices (May & Hough, 2004). Identifying how

specific drugs are bought, sold, exchanged, and distributed can help researchers and policy

makers design more effective prevention strategies (Natarajan & Belanger, 1998). Furthermore,