City auditor red-flags opioid prescriptions
Warns of evidence that highly addictive drugs were overprescribed to city staff
The deadly opioid crisis is in the crosshairs of Toronto’s auditor general, who warns of evidence that specific physicians overprescribed highly addictive drugs to city staff under their benefits plan.
As a result, some doctors could be hearing from their governing body while, as a result of a related probe,10 city staff reimbursed for massive amounts of Viagra in recent years will face tough questions from their boss.
The findings are in Beverly RomeoBeehler’s update, released Tuesday, of her 2016 probe of millions of dollars in questionable city staff claims for narcotics including fentanyl, a powerful painkiller central to the deadly overdose crisis, and for sexual enhancement drugs including Viagra.
The auditor general has since obtained, from the city’s former benefits administrator, identification numbers for physicians who dispensed drugs in a sample of cases she examined. Romeo-Beehler was not able to see medical records or drug receipts from the dispensing pharmacies, which limited the city’s ability to detect how many, if any, of the prescriptions were fraudulent for the purpose of resale.
Her probe had raised the prospects of patients “double-doctoring” — getting prescriptions from multiple physicians.
“Overall, we did not find clear signs of double-doctoring in the sampled claimants, but we noted many cases showing signs of potential over-prescription of fentanyl or oxycodone by physicians,” the update states.
“Recent research in Ontario has shown an unfolding opioid crisis and increasing trend of opioid prescriptions, and clearly demonstrated the risk of over-prescription leading to addictions and overdoses.”
Her sample of claims found 27 staff and four retirees reimbursed for “potentially excessive” quantities of fentanyl, a painkiller 100 times more potent than morphine and 750 times stronger than codeine. For morphine, 14 doctors prescribed nine patients at least quadruple the “recommended watchful dose.”
For oxycodone, another highly addictive painkiller, 17 doctors prescribed “excessive dosages,” with one patient getting more than 800 milligram “equivalents” per day from one doctor.
Based on consultations with a medical specialist and the College of Physician and Surgeons of Ontario — the watchdog for doctor conduct — “we are in the process of referring to (CPSO) the names of physicians who appeared to have prescribed excessive dosages of fentanyl and oxycodone,” Romeo-Beehler wrote, adding that information does not identify any patients.
The city is also referring cases to the Ontario College of Pharmacists “for further review and consideration” where pharmacists dispensed potentially excessive doses of fentanyl and oxycodone.
Health Quality Ontario recently warned the number of opioid prescriptions in Ontario and the number of patients filling those prescriptions continue to rise despite heightened awareness of overdose risk.
Opioid-related overdoses are believed last year to have killed more than 2,400 Canadians, hundreds of them Ontarians — triggering emergency plans by provincial and local governments to reduce the needless deaths.
The auditor general also updated her probe into city staff reimbursed for an “excessive quantity of ondemand erectile dysfunction drugs (obtained) from different doctors.”
They include one person paid back $15,300 over three years for drugs including Viagra and Cialis.
Some city staff were reimbursed for daily doses of two types of Cialis which are not supposed to be taken together.
“We have recently provided details of our analysis results on the suspicious claims to city management staff for follow up,” wrote RomeoBeehler.
Toronto’s auditor general earlier recommended the city follow the lead of many other employers and put a cap on the amount of erectile dysfunction drugs staff can claim.