By Stanley Tromp, Globe and Mail, Feb. 19, 2016
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Narcotics are often stolen by
health workers for their own use, or to be sold on the
street
The number of prescription drug thefts and losses
has been rising at smaller B.C. hospitals
over the years, with
opioids most often disappearing, Health Canada data show.
Across British Columbia, the units of narcotics lost have
more than tripled, from 778 in 2012 to 2,416 in 2014. For the first half of 2015, the most recent statistics
available, 1,710 units were lost.
The problem, highlighted by the overdose death of Vancouver hospital care aide Kerri O'Keefe
last August, has prompted B.C.
Health Minister Terry Lake to write to all the province's health authorities and ask them to
raise their narcotics security level.
But Ms. O'Keefe's mother is
doubtful that busy hospitals
are capable of taking all the
measures necessary to crack down on
access to institutional narcotics. She notes that her daughter became addicted
to the drugs left as dregs in the bottoms of syringes and
vials. Those leftovers should have gone into a biohazard bin, and under current
reporting regulations, the
diversion of such waste is not reportable.
"I'm a skeptic at the moment," said Sharon O'Keefe in an interview.
"Who is going to be the
watchdog?"
Ms. O'Keefe said she had no
idea her daughter was addicted to opioids, and she was astonished upon learning
after her daughter's death about the
ease with which she obtained her narcotics. Even while Kerri was on an extended sick leave, she
still got into the hospital for her drugs.
"How could she get so
many drugs for so
long?" Ms. O'Keefe asked.
Hugh Lampkin, president of the Vancouver Area Network of Drug Users (VANDU), said that in
his 10 years on Vancouver
streets, he never saw a health worker selling drugs.
But the former heroin addict from Montreal, who is in his
50s and attending university for the
first time (in mechanical engineering), noted he takes opioids wherever he can
find them for pain and he is quite sure some of them come from hospitals.
"I do morphine and T3s,
but I try to stay away from oxys because it's too
easy to get addicted. I have constant pain from arthritis in my neck and a compressed vertebrae. My MRI and X-ray tests showed it's
real and I'm not faking it. But doctors won't prescribe me any painkillers
because I'm a former addict," he said.
Mr. Lampkin noted that not
enough is being done to cut off the
medical sources of black-market opioids.
"Hospital employees may have studied hard, and
it's their career, but they're in a position of trust and looking after other
people's lives, and for that reason alone they should be charged if they steal.
When hospital drugs get onto the street and people die from overdoses,
it's a very big issue to me."
A coroner's inquest into
Kerri's death called for better security measures for hospital pharmaceuticals.
The drugs are often stolen - officially called "drug diversion" - by
addicted health workers for their own use, or to be sold on the street for large profits. Some can be fatal when
not used as prescribed.
By law, B.C. hospitals must report each missing unit of opiates and
other controlled drugs to
Health Canada in Ottawa within 10 days. Under the Access to Information Act, The Globe and Mail obtained a database of
these losses from January,
2012, to May, 2015. In total, 7,023 units of drugs disappeared in that period.
The figures show the painkillers morphine and
oxycodone most often disappear, with the heaviest losses
by far from smaller and
rural hospitals.
Mission Memorial Hospital lost 1,128 tablets of
morphine and oxycodone in 2014 from "pilferage" - nearly as many
units as the rest of the B.C. hospitals
combined. One category in the
database is marked only as "loss
unexplained," and covers morphine losses at
Campbell River and Peace Arch hospitals.
The most cryptic category, just
called "other," was used for the loss of
500 millilitres of the painkiller Doloral in
2013 at Queen's Park Care
Centre, a 214-bed care home in New Westminster. Last year, narcotics were
"lost in transit" from St. Paul's Hospital, and in a "break and entry" at the B.C.
Cancer Agency.
"There are many ways
that losses can occur
without it being a theft,"
Mr. Lake said in a statement. "Sometimes nurses forget to log a dose that
they gave; sometimes it gets dropped on the floor,
or behind cabinets."
But Tasleem
Juma, a spokeswoman for the Fraser Health Authority acknowledged the diversions "were not the result of outside
individuals."
Ms. Juma
also noted the number of
diversions from the Mission
hospital is low, but the quantity of narcotics missing
in one incident was high.
The documents, as well as
internal audits of the
Fraser Health Authority and Vancouver Coastal Health, show failures in
narcotics control have been a continuing issue.
Health Canada's western
region enforcement official said in a September, 2014, letter that Fraser
Health had not followed regulations on
supervision, secure drug
storage, and inventory counts. Michele Babich,
executive director of Lower Mainland Pharmacy Services, replied with a
corrective action plan. But another Health Canada compliance officer noted in a
letter of January, 2015, that a few storage and access problems remained.
Mr. Lake and Ms. Babich said this week that security has much improved since
then in Lower Mainland hospitals,
with new CCTV cameras, automated dispensing cabinets and other safeguards.
Ms. Juma
said Fraser Health is also looking at
developing new drug
disposal policies.
But there appears to have
been little police action on
the problem.
Under the federal Controlled Drugs and Substances Act, anyone - especially
in a position of trust - who possesses strong painkillers for the purpose of trafficking can be
imprisoned for life. Critics have long complained of police inaction on the problem.
The last time in B.C. someone was charged for such
thefts was when the RCMP was called in after an
internal investigation at
Elk Lake Hospital in Fernie in 2011. A worker confessed and was charged with
stealing a small amount of
hydromorphone for personal use. In 2009, Masset RCMP investigated a large
oxycodone theft from the Northern Haida Gwaii Hospital, but no charges were
laid.
Cynthia Johansen, CEO of the College of Registered Nurses
of B.C., called the drug diversions - and the underlying issues of mental health and addiction
among nurses - an emotional matter. She emphasized the college's aim to steer nurses toward treatment
rather than punishment while protecting public safety.
"That helps move people
out of practice quickly and toward treatment," Ms. Johansen said, noting
addiction rates among nurses are about the same as in the
general population.
She said if a nurse with an
addiction is caught stealing drugs
from hospital, the nurse will be required to
stop practising immediately.
"Dealing with issues
around diversion or stealing would almost be secondary to that because the public isn't protected if
we're not dealing with the
addiction issue at the front end. So
we really do focus on that
first and foremost."
Health officials note the hospital drug
losses are small in the overall context of the millions of prescriptions written yearly.
Professor Benedikt
Fischer, a narcotics abuse expert at the University of Toronto, agreed and said there are
much bigger drug diversions
by other means, such as double doctoring, and patients passing their surplus
medications on to friends.
"Moreover, the main problem of opioid
diversion across Canada is that we prescribe way too many of those, and in too
high doses. We live in a highly opioid-saturated society."
Ms. O'Keefe said at the least, she hopes health officials take a less
cavalier attitude towards drug
thefts and disposals, and
in addition to measures to ensure narcotics are not stolen outright, she is
hoping for stricter rules on
disposal.
"Maybe she wouldn't have
made it," she said of her daughter. "But maybe that would stop others
from having easy access."
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