METHADONE MAKING ITS WAY ONTO STREETS
“Free medication delivery all over Greater Vancouver.”
Pharmacist Alnazir Asaria was offering that in online ads that ran until March 2017, when the B.C. College of Pharmacists suspended him, put a reprimand letter on his file and forbade him from working as pharmacist until he passed an exam on the law.
Asaria’s offences included filling prescriptions in excess of authorized quantity, filling prescriptions after their expiry date, and filling prescriptions that were missing quantity, dose or directions.
He filled methadone prescriptions to patients without complete and signed forms and witnessed ingestion logs. He gave clients methadone pills or “carries” without a physician’s authorization. He handed out methadone without adequate documentation, including lack of controlled prescription programs, hard copy prescriptions, and controlled prescription programs without the patient’s signature.
And, Asaria made prescription changes without adequate rationale or documentation.
For nearly 50 years, methadone has been recommended for opioid users as a means to dampen their cravings and set them on a path to recovery. And, between 2011 and 2012, B.C. pharmacists dispensed methadone more than two million times to close to 16,000 patients. Then, as now, some of that methadone is making it to the street where it is resold.
“That’s not an uncommon thing that we see in the hospital someone has overdosed on methadone that they’ve bought on the street,” Evan Wood, director of the B.C. Centre on Substance Use, said. He also cited a study that found methadone implicated one in four overdose deaths.
In British Columbia, Asaria was one of the largest dispensers, which is why he attracted the attention of the B.C. College of Pharmacists and the provincial Health Ministry. Together, they did an undercover investigation of 30 other pharmacists and nine pharmacies. Yee Kwok Henry Tung was also caught in the undercover investigation and was found to have put patients at risk because of his dispensing practices. In 2015, he agreed to no longer dispense methadone.
Of the others, three pharmacists were fined $15,000 each, while one was fined $5,000 and another $2,500.
Because of regulations and enforcement provisions in various legislation, the good news is pharmacists and pharmacies can be reported, investigated and disciplined.
The bad news?
Like all legal processes, it takes a long time and, in the interim, the misbehaviour likely continues.
By 2015, the number of times methadone was dispensed had risen to nearly three million. Between 2013 and ’15, the college received more than 130 complaints and tips about the dispensing of methadone.
Among the most serious complaints were that pharmacists were providing monetary and non-monetary inducements to attract clients, were processing prescriptions through B.C.’s computerized PharmaNet network without requiring patients to personally get their drugs, were failing to witness methadone ingestion when required by law, and, in some cases where doctors were allowing patients to take the drugs home with them, were changing prescriptions to daily dispensing, which meant higher fees for them.
The complaints led to undercover operations between 2015 and ’17 that targeted nine pharmacies.
Those files are under review by the college’s inquiry committee.
During that period, another 41 pharmacies were selected for inspections based on the volume of their methadone dispensing, complaints and their geographic distribution
— 13 of these inspections were in Vancouver, 10 in the Okanagan/Kootenays, five on the Sunshine Coast, four in Northern B.C. and three on Vancouver Island.
The inspections have resulted in suspensions, remedial education and pharmacy equipment improvements.