Crime story: Detecting and preventing drug diversion
The illegal diversion of prescription medication is a growing problem in this country. Controlled substances have great potential for abuse and addiction. According to the Centers for Disease Control and Prevention, recreational use of prescription drugs is on the rise; in 2010, 2 million people reported using prescription painkillers for recreational purposes for the first time that year.
Drugs are diverted for several reasons. Sometimes patients become addicted to legally prescribed medications. Sometimes the reason for diversion is monetary profit — the street value of a single oxycodone pill can be $30. And other times, it’s simply people trying to get their hands on prescription medications for recreational purposes. Pharmacy technicians have an important role to play in helping to prevent theft and drug diversion in the pharmacy.
Doctor shoppers, prescription forgers and thieves — oh my!
Many prescription drugs of abuse are actually obtained legally, by valid prescription, but are diverted later by people selling or giving away their medication to friends, or by leaving them in a medicine cabinet where they are taken by someone else. However, prescription medication also is diverted by other means, such as doctor shopping, forged prescriptions and pharmacy theft. Pharmacy techs are often the first ones a patient sees when presenting a prescription, so techs are really on the front line of the war against diversion.
“What techs will likely see the most, but may not be aware of, is probably doctor shopping,” said commander John Burke of the Warren County Ohio Drug Task Force. Burke, who also is the current president of the National Association of Drug Diversion Investigators, describes doctor shopping as when patients go to multiple prescribers without their knowledge and obtain prescriptions for controlled substances. These patients also may use multiple pharmacies to fill their scripts, making detection more difficult.
Techs should be alert to patients who are bringing in prescriptions for the same medications from different physicians. Some states have prescription monitoring programs, and Burke suggested that utilizing those can help cut down on doctor shoppers. According to Burke, doctor shoppers are usually addicts who may be taking large doses of their drug of choice while selling some pills to support the expenses. However, some doctor shoppers are strictly in it for the profit.
The next most common form of diversion that techs are likely to see is prescription forging or alteration. “If something doesn’t look right on the script, make sure you always verify it by alerting the pharmacist and calling the prescriber’s office to make sure it is good,” Burke advised.
Yes, it’s an extra step, and yes, your day is already busy, but verifying a suspicious script is necessary if anything seems amiss. Stolen prescription pads and scanned duplicates of prescriptions are other ways that drug abusers are diverting medication. Pharmacy techs should be aware of unusual patterns. For example, a physician who normally doesn’t write prescriptions for opioids suddenly appears to be writing a large number of them — this could indicate a stolen prescription pad. Other tip-offs that a prescription may be altered or forged include unusual quantities of medication, unusual directions, no abbreviations, apparent erasures, unusual legibility and signs of photocopying.
Drug theft from the pharmacy can take place in two ways: robbery of the pharmacy or theft by an employee. Unfortunately, medications do sometimes get diverted by pharmacy staff. Be aware of suspicious activity, especially by new or temporary pharmacy employees, and if you have concerns, speak to your supervisor.
Pharmacy robbery: What to do, tips for prevention
It doesn’t take more than a casual perusal of the news to tell that pharmacy robberies are on the rise. Criminals, often armed and frequently addicted to prescription painkillers themselves, are viewing pharmacies as easy targets for big scores of drugs.
What should you do in the event of a robbery? “Cooperate,” Burke said. “Don’t ever put yourself in danger in trying to deal with someone diverting drugs. The goal is to give them the drugs and/or money they want and get them out of the store.” He added that while a robbery isn’t the time to be a hero, there are some things you can do to help police make an arrest. “Do everything you can to remember what the person looks like,” Burke advised. “Make a mental note of distinguishing features, clothing, hair, etc. The use of a height chart placed inside many pharmacies will assist in any description you need to give to police if the person leaves before they arrive.” Burke also recommended making sure the pharmacy’s camera system is operational. “If you are sure you have a crime,” Burke said, “try to notify law enforcement covertly and have them respond.” If you can’t report the crime until afterward, make sure to get as good a description as you can.
How can you help prevent robberies? “Stay alert to what is going on in the store, and even outside,” Burke advised. “Be careful of people hanging around the pharmacy with no prescription who seem to be ‘casing’ the pharmacy and the drugs on the shelves behind you.” According to Burke, most pharmacy robbers have been in the store several times before deciding to commit the crime.
In the meantime, new ways to thwart crooks are being introduced. For example, the New York Police Department recently began an initiative to hide fake, GPS-equipped pill bottles among the shelves of New York area pharmacies to help catch thieves in the event of a robbery.
A final caution
While drug diversion is a significant problem, it’s important to remember that the vast majority of people getting prescription drugs are legitimate patients. “Try and weed out those who are diverting medications, but be careful not to negatively impact legitimate patients,” Burke said. “Sometimes we can be so zealous in our work to identify the drug diverter that we unwittingly deprive those who desperately need the medication for pain relief.”
FDA approves three new drugs for Type 2 diabetes
SILVER SPRING, Md. — The Food and Drug Administration has approved three new drugs for Type 2 diabetes made by Takeda, the agency said Friday.
The FDA announced the approval of Nesina (alogliptin), Kazano (alogliptin and metformin) and Oseni (alogliptin and pioglitazone) tablets.
Alogliptin is a new active ingredient, while metformin and pioglitazone are drugs already on the market.
"Controlling blood sugar levels is very important in the overall treatment and care of diabetes," FDA Division of Metabolism and Endocrinology Products director Mary Parks said. "Alogliptin helps stimulate the release of insulin after a meal, which leads to better blood sugar control."
Canadian provinces to reduce reimbursements for six generics
NEW YORK — Canada’s provincial and territorial governments have reached a deal that they said would save money on drugs, but that generic drug makers said had left them "disappointed."
According to published reports, a group of premiers — heads of government for Canada’s provinces and territories — had reached a coordinated deal to reduce the prices their governments paid for six generic drugs, though Quebec did not take part; that province announced in November 2012 the elimination of its "15-year rule," a rule unique to the province that required its prescription drug plan to reimburse the price of the original drug even after patent expiration had made cheaper generics available. Currently, provinces pay between 25% and 40% of the cost of branded drugs for six key generics, but under the deal, they will pay 18% starting in April.
The drugs are the generic versions of Pfizer’s cholesterol drug Lipitor (atorvastatin); King Pharmaceuticals’ blood pressure drug Altace (ramipril); Pfizer’s antidepressant Effexor (venlafaxine); Pfizer’s angina drug Norvasc (amlodipine); AstraZeneca’s gastroesophageal reflux disease drug Prilosec (omeprazole); and Eisai and Johnson & Johnson’s GERD drug Aciphex (rabeprazole).
While praising a decision by the provincial governments not to pursue a plan to tender for generic drugs, the Canadian Generic Pharmaceutical Association was displeased with the reimbursement reduction.
"CGPA is pleased that provincial governments have decided not to proceed with tendering for generic pharmaceutical products. Tendering for generic drugs could result in drug shortages and delayed savings to Canada’s healthcare system." CGPA president Jim Keon said. "We are, however, disappointed by the provincial governments’ announcement of further cuts to retail or reimbursed prices for generic prescription medicines."
Canada’s generic drug industry saw significant expansion starting in 1969, when the Patent Act was amended to allow manufacturers to import the active ingredients for making generic versions of branded drugs. But the generics industry in Canada hasn’t made the same strides as its U.S. equivalent. While generics account for 80% of dispensed prescriptions here, the equivalent rate in Canada is more than 60%, according to IMS Health.
According to published reports, the provinces hope the new plan will save them nearly $100 million, including about $10 million in Saskatchewan alone. But the CGPA said prices had already been "dramatically" reduced.
Meanwhile, the plan could hurt pharmacy retailers, according to reports. Credit Suisse downgraded the shares of Canadian drug chain and drug manufacturer The Jean Coutu Group following the news, even though the company’s profits increased by 10% to $55.8 million in the third quarter due to higher generic drug sales.