‘Loss unexplained’: When drugs go missing from Sask. hospitals
SASKATOON Lucky Lake, population 289 per the last census, is not a place you’d expect hundreds of opioids to suddenly disappear.
But that’s exactly what was discovered at the Lucky Lake Health Centre in June 2016.
The vanished haul included 1,000 tabs containing codeine; 165 hydromorphone tabs; 129 Ativans and 61 Ritalin tabs. All told, more than 1,400 units of pills, caps and injections were missing.
A report was made to RCMP, but the case is still under investigation.
The disappearances were filed under “loss unexplained” in mandatory reporting to Health Canada.
About 3,000 tabs, pills and injections of controlled substances were reported missing from Saskatchewan hospitals from 2015 to 2019, according to data obtained by Postmedia.
Patrick Robertson, executive director for provincial programs and pharmacy services with the Saskatchewan Health Authority, says that’s peanuts compared to the millions doses the authority dispenses each year.
What’s more concerning is that we don’t know how most of it went missing.
Reports of missing drugs have to be filed to Health Canada within 10 days and must include a reason, like spillage or theft. But 86 per cent of 136 reports list “loss unexplained,” implying theft is going undetected.
Robertson says it’s likely the rate of theft is higher than the numbers reflect, in part because it’s hard to know the motive behind a disappearance.
“All of a sudden someone goes to count the pills and there’s one missing,” he said. “Was that stolen? Or did someone not take it out and not keep track of it?”
“I think it’s hard without full and proper systems and everything else to really differentiate at the time whether its loss, a discrepancy or a diversion.”
Most often “drug diversion,” as it’s known in medical circles, is when hospital staff swipe controlled medications for personal use, rather than street-level dealing.
The health system has a number of safeguards against this, Robertson says. Reports for lost and destroyed pills usually require a double signature. More hospitals are using biometric scanning machines to limit access to medications. And controlled drugs are counted on a daily basis.
But the ways drugs can be taken are often less detectable. A 2019 article in the Journal of Hospital Medicine notes losses of controlled opioids are growing in frequency in Canada, in part because of many “avenues” for diversion. Doctors might purposely over-prescribe a medication to a patient in exchange for a kickback, or falsify a prescription altogether. Medical staff might swipe drugs bound for the waste bin.
Or they might attempt to fake an incident where drugs are destroyed. A former Saskatoon nurse is currently charged with misconduct by the Saskatchewan Registered Nurses Association for a series of instances in which she is alleged to have taken codeine for personal use. In one case, she is alleged to have reported that 40 tabs of codeine were “wasted” after they fell off a rack even though no peers confirmed that report.
“At every stage of that use, there are opportunities for diversion.” Robertson said.
Dr. Wendy Gore-hickman, a Saskatoon anesthesiologist who became an addiction advocate after triumphing in her own battle with alcohol abuse, has seen it all and more. She can recall multiple instances in her three decades of practice where a medical worker’s addictions issues were suddenly brought into focus.
“We know that people who are intensely driven are at higher risk of addiction than other people,” she said. “Those are the same kinds of qualities that get us into medical school.”
Robertson says there needs to be more action from the authority on detecting diversion. He says the health authority lacks a provincial standard process on outside audits to detect diversion, something the authority’s internal auditor is currently working to develop.
Gore-hickman says it’s also important to tackle the underlying issue and connect people who need help to addiction support programs. She believes the Physician Health Program run by the Saskatchewan Medical Association to be one of the best in the country in that regard.
She believes substance use disorders are more common among physicians than the general public realizes, in part because stigma persists even within the medical profession.
“Alcohol was my drug of choice, and I knew I was in trouble with alcohol, and I kept thinking that ‘I was top of this medical school class. Surely I could figure this out on my own. Surely I don’t need help.’” Gore-hickman said.
Like in much of the country, opioids were the drug most likely to go missing. More than 800 units of hydromorphone, sometimes sold under the brand name Dilaudid, were reported missing by the Saskatchewan Health Authority along with more than 1,000 units of various types of codeine-based medications.
The individual drug most likely to go missing was also hydromorphone by a wide margin, followed by fentanyl.
Aside from the Lucky Lake Health Centre, which reported a staggering 17 disappearances in a single audit, the most common sites for theft were Pasqua Hospital and Regina General Hospital which reported 32 and 33 incidents, respectively.