Flashcards in Lecture 14-15: Drug Diversion + Pharm Security Deck (19)
Define drug diversion
• Defined as the illegal acquisition of prescription drugs
for personal use orprofit
• A redirection of a prescription drug from its lawful
purpose to illicit use, whether or not there is criminal
Define Double Doctoring
if a pt receives a Rx of a controlled substance and see another practioner within 30 days, they must disclose they already received a prescription
No person shall seek or obtain:
• a substance included in Schedule I, II, III or IV, or an
authorization to obtain a substance included in Schedule I, II, III, or IV from a practitioner, unless the person discloses to the practitioner particulars relating to the acquisition by the person of every substance in those Scheduled, and of every authorization to obtain such substances, from any other practitioner within the preceding thirty days.
what does making a false document include?
Everyone commits forgery who makes a false
document, knowing it to be false, with intent that it should in any way be used or acted on as genuine, to the prejudice of any one whether within Canada or not; or that a person should be induced, by the belief that it is genuine, to do or refrain from doing anything, whether in Canada or not.
• altering a genuine document in any material part;
• making a material addition to a genuine document or adding to it a false date, attestation, seal or other thing that is material; or
• making a material alteration in a genuine document by erasure, obliteration, removal or in any other way.
selling Rx pads is also forgery
what is the punishment of forgery?
• is guilty of an indictable offence and liable to imprisonment for a term not exceeding 10 years; or
• is guilty of an offence punishable on summary conviction.
Forgery - use, trafficking, possession
Everyone commits an offence who, knowing or
believing that a document isforged
• uses, deals with or acts on it as if it were genuine;
• causes or attempts to cause any person to use, deal with or act on it, as if the document were genuine;
• transfers, sells or offers to sell it or makes it available, to any person, knowing that or being reckless as to whether an offence
will be committed under paragraph (a) or (b);or
• possesses it with intent to commit an offence under paragraphs (a) to (c).
• Hydromorphone (Dilaudid®)
• Oxycodone (Oxycontin®, OxyNEO®)
• Products containing codeine (Codeine Contin®, Tylenols #1-4)
• Methylphenidate (Ritalin®, Biphentin®, Concerta®)
• Diazepam (Valium®)
• Alprazolam (Xanax®)
• Clonazepam (Rivotril®)
• Bromazepam (Lectopam®)
• Increases bioavailability of ethanol, meperidine, methadone and other psychotropic agents
• Effective for alcohol and opiate withdrawal
Over the Counter
• Codeine Cough Elixir (Exempted Codeine Product)
• Pseudoephedrine single entity (deginegestant)
• Used as an ingredient in other illicit drug
• Dimenhydrinate (Gravol)
How are drugs diverted?
• Forged/Fraudulent prescriptions
• Internal staff
• Double Doctoring
• Family/ Friends
• Controlled Drugs and Substances in Hospitals and Healthcare Facilities: Guidelines on Secure Management and Diversion Prevention (CSHP)
• "Drug Dealers"
Sources for drugs to be diverted?
• Prescribers: inappropriate treatment choices, engaged in
illegal drug trafficking activities
• Pharmacists: not checking for accuracy of the prescribers’
information, dispensing medications based on incomplete info
• Changing writing on prescriptions
• Double doctoring: obtaining prescriptions for a single
drug from multiple doctors concurrently
• Forcing or influencing physicians to write prescriptions
• patients acting like physicians
• Sharing prescriptions with others
what signs to look out for?
• Unusual behavior, appearance, knowledge of controlled substances
• Overall “assertive” (“pushy”, domineering) personality
• A medical history with textbook symptoms, or very vague history
• Claims to have no regular doctor and no health insurance
• Requests a specific controlled drug, reluctance to try a different drug
• No interest in their diagnosis, follow-up appointments, or referrals
• Exaggerates medical problems orsymptoms
• Exhibits psychiatric issues: mood disturbances, suicidal thoughts,
what does ACP standard 6 say?
Determining the authenticity of a
• “Before dispensing a prescription, a pharmacist or a
pharmacy technician must determine the authenticity
of the prescription by taking reasonable steps to:
• Identify the prescriber;
• Determine whether the prescriber is legally authorized to prescribe the drug or blood product for which the prescription has been given; and
• Assess whether the prescription has been altered, forged, or stolen
how to detect altered, forged, photocopied Rx?
• Quantity (10 changed to a 40)
• Addition of drugs on a prescription
• Usually on Rx blanks that have been stolen
• Written in text book style
• Extremely messy or neat
• Keep in mind anyone can make a prescription pad!
• Unnecessary information on Rx, eg. Xanax ®
How to detect?
• Different ink colors
• Writing style
• Match sig and duration of therapy with quantity of
• Call prescriber and confirm
• Verify order with physician (use outside source to
obtain physician contact)
How to detect photocopied prescriptions
• “Dust marks” or shadows
• Prescriber’s handwriting may smear or bleed on
How to detect fradulent phoned-in prescriptions
• Pose as prescriber or nurse
• Call in prescriptions either for themselves or fake patients
• Usually called in when prescriber not available (weekends or evenings)
• How to detect?
• Call back the prescriber utilizing a number from Directory Assistance
• Ask for prescriber license certificate number and validate on ACP
• Engage the “prescriber” in brief medical conversation i.e. patients’ diagnosis
• Repeat back
what is CADMUS?
CADMUS is a fed agency that tracks diversion of drugs
what methods to prevent robbery?
• Deter robbery attempts
• Make a robbery attempt as difficult as possible
• Minimize danger to staff and customers: Play it safe –
don’t be a hero during a robbery!
• Minimize loss of product and finances
• Increase chances for police to apprehend the suspect
how to protect your premise?
• Ask the experts to survey your premise:Independent
contractor toevaluate site; local police services
• Install surveillance equipment and alarm system
• Make access to the dispensary restricted (i.e. lock,
• Display deterrent signage: Alarm company, narcotic stock
• Physical measures: Security vaults, secondary location for narcotics, restricted access, security lights
how to protect pts and staff?
• Background checks: Credit checks, criminal checks
• Do not discuss pharmacy operations with outsiders:
Pharmacy procedures, Inventory controls, Delivery
• Keep minimal amounts of cash on hand
• Train staff to be alert and observant
What to do when something happened?
• Call the police!
• Preserve the crime scene: Lock the doors, don’t
• Assist the police: Turn the matter to them, refer
• If any damage: Call the contractor for repairs ASAP
• Call a third party to assess alarm system effectiveness
• Call alarm company to reset/repair alarm system
• Determine quantity/dollar value oflosses
• Call insurance company to open a claim file
• Notify ACP and Health Canada accordingly
what to do during robbery?
• Do not obstruct theintruder
• Give the robber what they want
• Pay attention to physical features
• If you can – identify mode of getaway, vehicle description
• Record description of theweapon
• Close the pharmacy and obtain contact info of witnesses
• Call police!
• Document observations about the incident and robber ASAP. Do this independently as not to influence