Behind the pharmacy counter, the unseen drug theft problem
by Naomi Schalit and John Christie, ©Maine Center for Public Interest Reporting
Sep 09, 2013 | 7442 views | 0 0 comments | 63 63 recommendations | email to a friend | print

AUGUSTA, Maine - Most of the people who fill your prescriptions are honest and do their job well. But some of those people in white smocks are thieves, drug addicts or both. The typical image of drug thieves is armed robbers with masks holding up pharmacies for pills to feed their habit. But stealing happens on the other side of the pharmacy counter as well.

PART ONE

An investigation by the Maine Center for Public Interest Reporting of state disciplinary records has revealed that from 2003 to 2013, 16 pharmacists and 41 pharmacy technicians lost their licenses for pilfering drugs from pharmacy shelves or even from the patients whose prescriptions they filled.

More than one-third of the prescription drugs stolen from Maine pharmacies are taken by employees. And according to industry experts, the pharmacy professionals who are caught for theft represent only a fraction of those who actually steal.

One pharmacy technician stole 737 tablets of Suboxone, a methadone-like medication used to treat drug addiction; 8,724 tablets of Hydrocodone, a narcotic pain reliever; 600 tablets of Phentermine, a diet drug that’s also a stimulant; and 410 tablets of Alprazolam, used to treat anxiety and panic disorders.

In another case, a pharmacist forged a prescription for Vicodin — hydrocodone combined with acetaminophen — to his bulldog, Stella Rose, then dispensed the pills to himself and “ingested two pills for the half hour car ride to his home in Rumford,” according to the state records.

Almost every Maine pharmacist and pharmacy technician caught and disciplined for stealing medications said they did it to feed their drug habit. And they did it because it was there.

“In a recent survey of recovering pharmacists, participants noted that easy access to the drugs encouraged them to take them and likely led to their addiction,” wrote the American Pharmacists Association in 2013.

It’s dangerous when someone high on drugs dispenses medication.

“If I’m John or Jane Q. Public, I certainly don’t want an impaired pharmacist or pharmacy technician filling my prescriptions,” said John Burke, commander of the Warren County, Ohio Drug Task Force and a nationally known expert on drug theft. “I don’t want to have a drug in my pill bottle that I shouldn’t have gotten.”

Greg Cameron, a pharmacist and Husson University professor who worked for 15 years as an investigator for the Maine Board of Pharmacy, said, “If you’ve got a pharmacist that's working impaired, the public’s going to be at more of a risk for the pharmacist making mistakes because he’s not of sound mind and judgment.”

The majority of pharmacy thefts over the past decade involve two of the most abused drugs in the nation: Hydrocodone and Oxycodone, another narcotic pain reliever.

Kenneth McCall, head of the Maine Pharmacy Association and a professor at the University of New England School of Pharmacy, said that while pharmacy employees may well have addiction problems and steal, so do other members of the health professions.

“In the broad picture, to really address this issue of substance abuse and misuse of prescription drugs, we can’t focus on one access point in our communities,” said McCall. “We have to think systematically, holistically and broaden the scope.”

There are 1,866 pharmacists and 2,461 pharmacy technicians in Maine, so the percentage of pharmacy employees caught stealing drugs is small.

But much of pharmacy drug theft likely goes undiscovered and unreported. Assistant Attorney General Michael Miller, who advises the Pharmacy Board and formerly ran the Maine attorney general’s health crimes unit, said, “I believe there’s a lot of criminal conduct that does not get caught at all.”

Pharmacist let mother dispense drugs

A pharmacy technician does much of the routine work involved in filling prescriptions, from taking refill orders to actually filling prescription bottles. Each filled prescription is supposed to be checked by a licensed pharmacist before it is given to a customer. Pharmacy technicians do not need more than a high school diploma to be licensed and are trained on the job.

A pharmacist has at least four years of college education in pharmacy or may have a pharmacy doctorate. In Maine, only pharmacists can counsel customers, and each pharmacy is required by law to have a “pharmacist in charge” to oversee its daily workings.

When pharmacy technicians and pharmacists get into trouble, the state Board of Pharmacy considers their case and metes out punishment. The records of those cases are posted online, and provide a detailed picture of the bad behavior in the pharmacy profession. Some examples:

• The pharmacist disciplined for 15 prescription misfills either made by her or by pharmacy staff under her supervision. They including giving a stool softener to someone instead of an antibiotic and tripling the dosage of a six-year-old’s medication, causing the girl’s teacher to call the mother to say the child was “disoriented, walking into walls, and ‘hyper.’”

•The pharmacists and pharmacy technicians who were investigated and disciplined because they failed to disclose their criminal history when applying to practice in Maine.

•The pharmacist who owned a pharmacy in Waterville, took a job elsewhere and put his mother in charge of the Waterville pharmacy, where she dispensed medications — even though she wasn’t a pharmacist.

Among the largest number of cases are the ones where pharmacy employees steal drugs. It’s not a problem unique to Maine: The US Drug Enforcement Administration says that for the last three years, “employee pilferage” has constituted the largest single percentage of pharmacy thefts nationwide – 46 percent vs. 26 percent for armed robbery thefts and 28 percent for night break-in thefts. In terms of dosage units – the amount of drugs stolen – employee theft is 44 percent, night break-in is 45 percent and armed robbery is 11 percent.

Steve Sylven, the spokesman for Shaw’s, which employs 35 pharmacists and 45 pharmacy techs at its 15 pharmacies in Maine, said the company is constantly reviewing and revising its methods to prevent theft of drugs.

“Certainly theft is a pervasive issue in the retail industry and we invest significantly in our loss prevention department,” said Sylven.

“While I can’t get into the methods we use to deter theft for obvious reasons, we have multiple measures in place to prevent theft which includes everything from cameras to inventory protocols.”

The disciplinary file on pharmacy technician Maria Kiyanitsa, who lost her license in 2007 after admitting to stealing “in excess of one thousand hydrocodone tablets from Rite Aid,” is representative of the many cases concerning pharmacy technicians and pharmacists.

“Ms. Kiyanitsa subsequently admitted to the Board investigator that she was addicted to hydrocodone and had been diverting hydrocodone for her own use for approximately six months by taking five to ten pills at a time from the Rite Aid stock. … Rite Aid Pharmacy #4660 reported approximately 2,900 pills missing from its stock during this period of time,” reads the record.

“Addiction is a major problem among a minority of pharmacists,” writes the American Pharmacists Association in the study materials. As far back as 1998, the association reported that 19 percent of practicing pharmacists “are occasional or regular users of controlled substances without a prescription.”

In Maine, Lani Graham, the physician who runs the Medical Professionals Health Program, said that among current pharmacists, “you would expect between 5 and 8 percent affected by substance use disorders.” There are no estimates for pharmacy technicians.

That would mean between 93 and 149 Maine pharmacists are substance abusers or recovering substance abusers. And many of them have not been identified, sanctioned or helped.

“Currently,” said Graham, “we have 13 in our program. The ones that are out there, some of them are under other forms of care and doing well.

“Some of them may not yet be in care” at all, Graham said.

They may not be in care because they’re not being detected. While 58 thefts came before the board between Jan. 1, 2003 and Dec. 31, 2012, only one new theft was brought to the board between Jan. 1 and Aug. 30, 2013.

Punishments getting harsher

Pharmacy board chair Joseph Bruno said that he believes that all, or at least most, of the addicted pharmacy staff that steal are being reported. But he also said that it’s hard to find out who’s taking drugs and stealing because identifying the abusers is difficult, despite the fact that pharmacy security has been beefed up in the last few years.

“If you have an incompetent pharmacist, it’s almost easier than someone with a drug problem. Many of these people with drug problems, they have become used to living their lives under the influence. They can function,” he said.

And currently, the pharmacy board’s investigative work is being hampered by a staffing problem.

“We’re trying to hire someone, it’s very difficult because of the state wage scale,” said Bruno. “We want a pharmacist. Seven years ago, we had two pharmacist inspectors who understood what it was like to be a pharmacist. They were replaced by two ex-police officers.”

One of those investigators left, said Bruno. “So now we have one ex-police officer who’s the pharmacy investigator. While he does a good job from an investigative standpoint, he doesn’t get a lot of the subtleties of how a pharmacy works, so he misses a lot of computer-related ‘this is where you should have looked for these things.’”

Given the current lack of investigative muscle, is the board living up to its mandate “to protect the public health and welfare?”

“Any licensing board is there for the public safety,” said Bruno. “We try to do the best we can and protect the public. One way of doing that is harsh punishment and making sure that these people are taken out of circulation.

“I think we’re doing much better than we have in the past,” said Bruno, who said fines doled out by the board are higher under his chairmanship.

Besides harsh punishment, the pharmacy board has proposed another measure to ensure that pharmacy staff works at a higher professional level than in the past.

“One of the efforts in the next three to five years is everyone’s going to have to be a certified pharmacy technician,” said Bruno, which requires additional training and certification by a national board.

But, said Bruno, that won’t necessarily weed out potential drug addicts and thieves. “Just because you have a license doesn’t mean you’re not going to steal,” he said.

PART TWO

The sole purpose of the board that regulates pharmacists in Maine is to “protect the public health and welfare,” according to state law.  But in 13 cases over the last decade the board has jeopardized the public’s health by allowing people with a history of substance abuse and theft to hold a license to dispense drugs at pharmacies across the state.

In one case, the state Board of Pharmacy gave a license to an Auburn man despite  “his habitual substance abuse” that they said “is foreseeably likely to result in … performing duties in a manner that endangers the health or safety of the public.”

The pharmacist got a job working at two Bangor Walgreens pharmacies, where he proceeded to steal narcotics and ultimately admitted that he consumed the pills while he was working. He was fired, then arrested and lost his pharmacist license.

A Maine Center for Public Interest Reporting examination of state pharmacy board records showed that during the last ten years, 16 Maine pharmacists had their licenses revoked by the state for stealing drugs. Thirteen pharmacists were allowed to practice pharmacy despite their history of drug abuse and theft. Five went on to steal or abuse drugs again and lose their licenses once more.

Almost all of these pharmacists had been drug abusers. In those cases, Maine pharmacy board required counseling, drug testing and limitations on hours worked in exchange for getting approval to work again. 

But even with those strict conditions, one drug crime expert questioned whether Maine regulators were gambling with the public’s safety.

“You have to be very careful about putting them back in a workplace that’s a smorgasbord of the things they’re addicted to,” said John Burke, Commander of the Warren County, Ohio Drug Task Force and a nationally known expert on drug theft. “It’s like making an alcoholic a bartender.”

Normand Turgeon, a pharmacist who was given his license back twice after stealing and abusing drugs but went on to steal and abuse again, said he doubted that he would have ever been able to safely return to dispensing drugs to the public.

The only safe pharmacy job for him would have been an administrative one, he said, “where you don’t deal with drugs, where you never actually see drugs.”

Among those who had their licenses revoked and then given back are a pharmacist who wrote prescriptions to his dog so he could get the painkillers; a pharmacist who stole Hydrocodone, Alprazolam, Ambien, Zolpiden and Tylenol with Codeine because of what he claimed was “stress” on the job; and an addicted pharmacist who got his morphine “by stealing leftover doses at a home care IV pharmacy” where he worked.

The case of Eric A. Johnson of Presque Isle demonstrates the pharmacy board’s willingness to allow someone with a history of theft and drug abuse to dispense drugs to the public. 

Johnson graduated from the Massachusetts College of Pharmacy in 1999 and worked at Wal-Mart Pharmacy until his arrest on July 2, 2003.

“The arrest was brought about by the applicant’s theft of Hydrocodone from his employer’s pharmacies in Houlton and Skowhegan,” Pharmacy Board disciplinary records state. Hydrocodone is a narcotic pain reliever.

The board suspended Johnson’s license on July 8 and on Sept. 9, 2003, Johnson agreed to the revocation of his license.

Johnson began substance abuse counseling “which he successfully completed after 28 days at a facility located in Ft. Fairfield,” according to state records. He then faced legal proceedings related to his theft and was convicted on June 9, 2004. He spent 21 days in jail, paid $2,000 in restitution and was placed on probation for one year.

The records describe how Johnson entered a halfway house for substance abusers in Bangor in 2005, went to Alcoholics Anonymous meetings and got counseling. He drove a delivery truck driver in Aroostook County and then “suffered a relapse and began using Oxycodone and Methadone, and joined a ring of users who stole property to support their opiate habits.” Oxycodone is a narcotic pain reliever even stronger than Hydrocodone.

Johnson was arrested again on Oct. 29, 2005, sentenced to jail for 21 days, fined and put on probation.

Three years later, Johnson petitioned the board for reinstatement of his license, saying he had signed a five-year contract with the Medical Professionals Health Program, the Maine Medical Association’s support program for substance-abusing medical professionals; was receiving counseling at least monthly; going to AA sessions; undergoing drug testing; and not using alcohol or drugs. He said had “terminated his relationships with drug users.”

The pharmacy board voted unanimously to reinstate Johnson’s license, concluding “that Eric Johnson has been rehabilitated to the extent that he has earned the public’s trust, and reinstating his license to practice pharmacy would not pose a threat of harm to the public if the following conditions are complied with.”

The board’s conditions echoed the ones from the support program’s contract and also limited the amount of time each week Johnson could work as a pharmacist.

Johnson did not respond to numerous attempts to reach him for comment.

Lori McKeown, a pharmacist who was president of the board when Johnson got his license back, did not respond to requests for comment. But Joseph Bruno, the current head of the board, said that the board is inclined to give a second chance to pharmacists who are addicted, who steal — and who then turn their lives around.

“A lot of people screw up one time, not only in medical professions. As a society, are you willing to hold that one mistake against that person for the rest of their life?” said Bruno. “They’ve gone to school for a minimum of five, six years. You don’t want them to waste a career.”

A contract with the Maine Medical Professionals Health Program, or MPHP, weighs heavily in the pharmacist’s favor, said Bruno. The pharmacy board gives $20,000 a year to the substance abuse program.

Dr. Lani Graham, who runs the MPHP, says the relapse rate in her program is “fantastically low,” only 10-11 percent over the last three years.

“I wouldn’t hesitate for a minute as a patient to seek the help of any of the professionals that are in our program,” she said, adding that the participants in the program are her “heroes and heroines.”

But others say that there’s a risk to putting formerly addicted pharmacists back to work in a place where drugs are the focus of their work and where just one slip-up can be dangerous, even fatal to a patient.

“These are the health-care professionals who are filling our prescriptions,” says Charlie Cichon, president of the National Association of Drug Diversion Investigators. Mistakes, said Cichon, “lead to patient harm.”

Rodney Larson, founding dean of Husson University’s School of Pharmacy, said that not every pharmacist will make it through addiction and back to health.

“I’ve seen pharmacists come back and become productive members of the profession and society after treatment, and I have seen pharmacists who have left the profession,” he said. “I’ve known pharmacists who have died after overdoses — they can handle recovery or not and some people can’t. Unfortunately, those people tend to get deeper in trouble.”

Johnson’s case illustrates Bruno’s point – a second chance can work out. Johnson’s license was recently renewed, a sign the board has seen no problems.

Normand Turgeon is one of the cases that went the other way. Twice.

In October, 2005, CVS Pharmacy in Lewiston alleged to the pharmacy board that Turgeon had illegally diverted 5,000 tablets of Hydrocodone APAP over a period of two years.

In early November, the board suspended Turgeon’s license and in December, Turgeon admitted to diverting Hydrocodone APAP from CVS and failing to disclose a criminal conviction as required in his 2002 renewal application. His license was revoked and he was fined $100.

The next month, Turgeon asked the board to give him back his license. In February, 2006 the board agreed to give it back, but imposed conditions, including urine screenings and counseling. He was ordered not to take prescription medications without a prescription.

In July, Turgeon asked the board to relax those conditions and allow him to see his “treating specialist” less frequently. The board agreed.

But several months later, the board learned that Turgeon had tested positive for barbiturates in June, August, September and November. In February 2007, they revoked Turgeon’s license again and fined him $1,500.

Seven months later, Turgeon requested reinstatement of his license yet again. In December 2007, the board voted to give him his license back, with conditions. Several months later, Turgeon convinced the board to lighten the conditions.

On April 9, 2010, Turgeon was working as a pharmacist at Kennebec Pharmacy and Home Care in Augusta when he got into trouble again.

“In the medication storage room, where Mr. Turgeon had been working, an employee found a cut straw and a powdery substance,” pharmacy board records state. “The powder later tested positive for hydromorphone, hydrocodone and cocaine. … Mr. Turgeon ultimately admitted to Investigator Tom Avery that he had ingested the powder by snorting it through the straw, and that he had been doing so for months. Mr. Turgeon also admitted to drinking liquid morphine overfill.”

Once again, Turgeon’s license was revoked. He has not reapplied for his license.

Turgeon now works in customer service and participates in Alcoholics Anonymous. He said he should not have been granted his license back just three months after it was first suspended.

“I look back now, I was very happy to get it back, but it was too soon,” he said. “Of course, you know the person who’s out of work wants to get back to work even if they’re not ready. As I look back now, the period needs to be longer,” in order to demonstrate a pharmacist’s commitment to sobriety.

After the final revocation of his license, he “thought about going back for the longest time, but then realized, ‘I couldn’t dispense drugs anymore, I couldn’t trust myself.’”

Pharmacy board chair Bruno could not comment on particular cases, but said about Turgeon’s case, “That was before my time. The makeup of the board means something, and the current board you have now is an older and wiser board.”

If a pharmacist had gotten his or her license reinstated and then failed to pass a drug test, Bruno said “that would not sit well with me.

“I would have said ‘You’re done. It’s pretty clear, this is what you must do, if you think you are above it all.’”

Bruno said the board under his leadership since March 2011 has increased the punishment for many pharmacist and pharmacy technicians’ violations. And it has only granted one of the two requests for reinstatement by pharmacists who lost their licenses for stealing.

“We are much harsher than past boards, because we do not want to see impaired pharmacists out there and frankly, it’s a stain on the profession,” said Bruno.

 The Maine Center for Public Interest Reporting is a nonpartisan, non-profit news service based in Hallowell. Email: mainecenter@gmail.com. Web: pinetreewatchdog.org. Freelance reporter Claire Cameron contributed to this report.