By Stanley Tromp, Globe and Mail, Feb. 19, 2016
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."