In his 13 years as a San Francisco police officer, Gregory Watts has arrested countless drug dealers. But only recently did he begin to notice that many of them resembled his grandparents.
Easy access to prescription drugs, authorities say, has created a growing population of elderly, sick or disabled people who sell their medications on the street, often to support themselves financially or to raise money to purchase harder drugs.
In San Francisco's drug-plagued Tenderloin district, where Watts patrols, prescription drug sales have tripled over the past decade and now comprise about a third of drug-related arrests. Police say dealers are as likely to stock painkillers like Percoset or Oxycontin as they are to push heroin or cocaine.
The shift has also fueled changes in the profile of those who participate in the local drug economy.
"I arrested a gal who was dying of cancer. I have literally seen a guy go into that building, get his prescription, walk across the street and start selling it," said Watts one recent morning in the Tenderloin. "A lot of the pill salesmen have major, major medical issues."
That morning, Watts and his partner, Patrick Faye, arrested an older man the officers had spotted trying to sell a zipped bag of Vicodin and antibiotics. Frail and shaking, the man had track marks on his legs, a sign Watts knew, of heroin addiction.
"Any needles?" Watts paused while patting him down.
"Yes," the man muttered.
Up until a year ago, pharmacists and physicians had no way of knowing, in real time, how recently a patient had filled a prescription. A statewide electronic database now allows pharmacists to look up that information, but they're not required by law to access it. Of the nearly 1,100 pharmacies in the Bay Area, Bureau of Narcotics records show only about 120 are connected to the system.
As a result, pharmacies are not always aware of patient activity. Police say many pharmacists fill the fake or duplicate prescriptions, ignoring or unaware of the warning signs, such as full cash payment. The loopholes also mean easy access to drugs. Patients are able to shop around for doctors, falsely report a prescription lost or stolen and get a replacement.
"When you have people who don't have much money and they know they have this one pill that can bring them $15 to $20, then that's a temptation," said Karen Hill, a nurse practitioner at San Francisco's Glide Health Services, which provides chronic pain management to the uninsured and homeless.
Various agencies in the Bay Area are attempting to address the problem, including police, clinics, pharmacies, the district attorney's office and even the federal Drug Enforcement Administration, which this year installed a taskforce to target wayward pharmacies and practitioners.
At the urging of police, a local Walgreen's pharmacist is training other local pharmacists this month on spotting faulty prescriptions. More than 20 police departments and Bay Area agencies are asking residents to drop off their unused medications September 25 for the DEA's nationwide "Take-Back" Day. Hill said Glide and some other clinics try to deter misuse of drugs by requiring random drug tests and attendance at support group sessions. Pharmacies in the area have also hired security to deter robbers. And police say some drug companies have even begun manufacturing drugs in gel tablets, making them tougher to chop up and smoke.
"They'll find a way, though," Watts said.
Despite the efforts, down-and-out patients have found prescription sales a dependable way to make money. Nicknamed the "hillbilly heroin," opiate-based painkillers such as Oxycontin are chopped up, snorted, smoked or injected for an immediate high. While on the street, a single rock of crack cocaine may sell for about $25; a single 80 milligram pill of Oxycontin may sell for as much as $40.
Veteran dealers buy a bottle of pills from a patient for about $1,000 and make up to $5,000 in re-sales. Other customers include self-medicators who cannot obtain a prescription through legal means, and out-of-towners, who come to the Tenderloin to retain anonymity.
"There's more young kids driving in from the South Bay and the North Bay who just want to get high," Watts said. "They stand out like a sore thumb. They're dressed like yuppies and they're milling around talking to people that I know for a fact sell pills."
The sellers represent a fraction of dealers, but the new breed is still a cause of concern for police, especially in the Tenderloin, where rampant drug sales attract other crime.
"Let's not be naïve. A guy selling a few pills – he's going to buy some cigarettes, a beer, some food – he's not some highly organized criminal," said Joe Garrity, captain of the district. "But he's selling drugs and it creates problems. The disorganized crime brings other problems with it."
Swept up in the department's targeted arrests, patients selling their own medication have typically fallen through the cracks. But in San Francisco, that may soon change. Instead of routing some of the dealers through the regular court system, various city agencies are discussing the possibility of handling individual cases in drug court or through the Community Justice Center, a San Francisco court with a focus on rehabilitation that handles mostly drug possession and quality of life cases from four police districts in the city.
"It's pretty desperate times out there," said Tomiquia Moss, who coordinates the various programs run through the CJC, which include substance abuse treatment, mental health counseling and job and education assistance. "We're going to see if we can work with them to deal with some of the issues that have them selling in the first place."
While DEA investigators say they're focusing on pharmacies and doctors – "the source," spokeswoman Casey McEnry said – law enforcement and social service agencies say a rehab-focused approach would better address the root causes of prescription drug dealing.
The reality, some clinics say, is that they can't control what patients do with their medications. For impoverished dealers, arrests and jail time are no deterrent to a drug sale that could help feed a family—or a fix.
"We know there's money to be made out there with selling Vicodin and different things," Hill said. "That's just a truth."
A version of this article appears in the Bay Area edition of The New York Times.