Drug diversion is the term used for the theft of pharmaceuticals by those who have access due to their position, often nurses or doctors, sometimes pharmacists or aids within the hospital system. Sometimes these so called “diversions” will be for personal use (for those who have an addiction) and sometimes they are the first step in a drug trafficking endeavour. John Burke, president International Health Facility Diversion Association says that “the illegal diversion of prescription drugs in health-care facilities is a Canadian problem as much as it is an American one”.
Currently any Canadian company that is involved in the transport, dissemination or sale of pharmaceuticals are required to report to Health Canada whenever any of the drugs on the controlled list are lost. This loss could be due to robbery, pilfering or simple error. It seems however, according to Burke, that many of the drug diversions go undiscovered and/or unreported.
“Institutions don’t report, I think, for a variety of reasons. You know, they are concerned about being on the 6 o’clock news and showing that ‘Hey, a nurse stole drugs’” Burke told W5 in an interview.
Not only are many of the losses not reported but even of those which are reported most have no explanation as to what actually happened to those drugs, or how they were lost. According to Macleans, in a breakdown of reasons for reported loss of drugs, seventy-seven percent of the reported losses list “unknown reasons” for the loss. There is no indication that there is any consequence for the lack of knowledge of where or how the drugs were lost, and it appears there is no one following up with the pharmacies or hospitals to figure out what is happening.
According to the publicly available data from the Ontario College of Pharmacists there are currently five pharmacies listed as having had disciplinary action brought against them due to improper action. Of those five only two are now not entitled to operate, one has completed entitlement to operate back, and the remaining two are listed as entitled to operate with conditions. Some of the actions which the two pharmacies which are still operating (with conditions) did include such things as; dispensed medications to patients without prescriptions or used old prescriptions, failed to keep records of prescriptions dispensed, billed prescriptions which were not dispensed, or dispensed lesser quantities then prescribed, falsified documentation of the pharmacy.
Canada is a huge consumer of opioids, second only to the United States in per capita consumption. According to data from Health Canada there have been nine million doses of controlled substances, mostly opioids, which were reported missing between Jan 1, 2012 and Sept. 30th, 2017. Opioids continue to be prescribed at a high rate with the Canadian Institute for Health Information (CIHI) stating that there are 575 opioid prescriptions for every 1,000 Canadians, with a total of 21.3 million prescriptions of opioids dispensed in Canada last year.
Unfortunately the rates of addiction within Canada also apply to those who work within the hospital and pharmacy systems, and with the drugs being so easily available to them it is not shocking that some would turn to theft to feed their addiction. According to StatCan in 2012 the rate of substance use disorder was 21.6% percent within the country.
There have been recent cases which illustrate the problem such as Daryl Gebien, the emergency room doctor in Barrie, Ontario who had been syphoning fentanyl patches by creating fake prescriptions, some of which he used and some of which ended up on the street. For this activity Mr. Gebien ended up with a two year prison term in April of 2017. An Ottawa pharmacist, Waseem Shaheen, was sentenced to 14 years in prison for the fake hold-up he orchestrated as part of a complex drug-trafficking scheme. As well, in Trenton, a nurse, Marisa Generaux was fired and had her license suspended for seven months, though no sentencing took place, for her being caught on camera stealing a retirement home resident’s morphine more then once.
Burke warns that most hospitals and pharmacies have systems that can be bypassed by employees who have been working within the system for some time and know the loopholes and backend go-arounds. He went on to say that it is very common for health-care workers to simply divert the controlled substances by taking them or substituting them from unknowing victims within hospitals but also including individuals such as retirement home residents or those in homecare who are incapacitated.
