‘DRUG DIVERSION’ A GROWING PROBLEM FOR CANADA’S HEALTH-CARE FIELD
On June 8, 2016, Kitchener nurse Leigh Wardlaw was assigned a homecare shift: Her job was to care for a 13-year-old boy dying of brain cancer and to administer him morphine every two hours.
Seven hours into the shift, the boy’s parents became concerned about the state of the nurse: Wardlaw was falling asleep and unsteady on her feet.
They asked the homecare agency to check on her and, when a supervisor arrived, she found Wardlaw in the boy’s room “swaying back and forth with her eyes closed.”
When the supervisor asked when she injected the last round of morphine, Wardlaw told her it was administered at 10:30 p.m. It wasn’t yet 10 p.m.
A subsequent narcotics count revealed that two or three vials of morphine were missing, along with 30 doses of Ativan, an anti-anxiety medication.
Despite attempts to dissuade her, Wardlaw insisted on driving home. She was stopped by police officers who recovered three needles and one used syringe with the boy’s name on it.
Wardlaw later admitted that she had injected herself with the morphine prescribed for the 13-year-old, who died two days after the incident. Wardlaw was charged with a handful of criminal offences, including impaired driving and theft, and sentenced to 18 months in jail.
In an interview, Wardlaw told the Citizen her opioid addiction was the culmination of a series of tragedies in her life — and long untreated depression.
“The addiction, it overcomes you, it really does overcome you,” she said in trying to explain her actions. “I’ve just started dealing with my mental health from that situation because how do you live with yourself after doing something like that, right?”
Earlier this year, she had her nurse’s licence revoked for what is known, in medical circles, as “drug diversion.” It has become a pressing issue for hospitals and pharmacies as the country’s opioid epidemic continues unchecked.
“The illegal diversion of prescription drugs in health-care facilities is a Canadian problem as much as it is an American one,” says John Burke, president of the International Health Facility Diversion Association, a U.S.based network created to detect and prevent drug thefts in the health-care system.
Pharmacies, hospitals and transport companies are required to report to Health Canada every time controlled drugs are lost, whether through robbery, pilferage or errors.
Health Canada data shows that nine million doses of controlled substances — most of them opioids — were reported missing between Jan. 1, 2012, and Sept. 30, 2017. The annual number of pills, patches and packages reported missing has climbed steadily since 2013.
Canada is second only to the United States in the per capital consumption of opioids.
According to the Canadian Institute for Health Information, 21.3 million prescriptions for opioids were dispensed in the country last year: 575 opioid prescriptions for every 1,000 Canadians.
Health-care workers are not immune to the opioid crisis. Studies suggest they suffer the same rate of addiction as the general population. (The U.S. National Institute on Drug Abuse says that eight to 12 per cent of people prescribed opioids will develop an addiction problem.)
The temptation to steal drugs can sometimes overwhelm addicted professionals. Cases such as nurse Wardlaw, or Joshua Ramsammy, the former Ottawa pharmacist are not isolated events.
Consider:
Nurse Marisa Genereaux, of Trenton, Ont., was fired from a retirement home after she was twice captured on camera entering a resident’s room to steal the client’s morphine. In January 2018, her licence to practise as a nurse was suspended for seven months;
In March 2018, Ottawa pharmacist Waseem Shaheen was sentenced to 14 years in prison for faking a holdup at a Rideau Street I.D.A. store as part of an elaborate drug-trafficking scheme. More than 5,000 fentanyl patches were diverted from the three pharmacies that he operated, court heard, and sold on the street by an accomplice; and
Daryl Gebien, a former emergency room doctor in Barrie, was given a two-year prison term in April 2017 after pleading guilty to forging hundreds of fake prescriptions for fentanyl patches, most of which he used but some of which ended up on the street. Gebien said his fentanyl addiction followed his abuse of Percocet, a drug prescribed for a back injury in 2008.
Hospitals and private pharmacies have put measures in place to curtail drug diversions.
Under the federal government’s Narcotic Control Regulations, pharmacists must “take all reasonable steps” to protect the narcotics under their control. Among other things, pharmacists are required to count and reconcile narcotics supplies at least every six months.
According to the Ontario College of Pharmacists, a reconciliation involves a detailed audit of drugs sold and dispensed versus actual stock levels. Such audits can identify losses and potential problems.
At The Ottawa Hospital, narcotics are kept in an electronic, locked cabinet and can only be removed with proper approval and documentation. A second nurse or other health-care practitioner must to be on hand to supervise and record the disposal of unused narcotics.
But Burke warns that most systems have flaws than can be circumvented by veteran employees. Commonly, he says, health-care workers divert narcotics by taking them from unwitting patients, or by substituting saline or Aspirin for the drugs.
Burke recommends hospitals maintain a strong human resources department to screen applicants for addiction issues, and put in place systems to quickly identify and treat staff members who develop drug problems.
“The sooner you get a person into rehab, the more apt you are for a successful rehab,” he says.
His organization also recommends that hospitals develop a “diversion team” to examine drug dispensing data for oddities and red flags.